Eczema Flashcards
Pattern of eczema:
- clinical course
- pattern of involvement
- Relapsing, remitting
- Infants usually develop facial eczema first, flexural surfaces affected later
Briefly describe the pathophys of eczema.
- Primary disturbance of epidermal barrier function
- Dry skin - decreased filaggrin and ceramides
- Staph aureus for secondary bacterial infection
What are the diagnostic criteria for eczema?
Itch + 3 of:
- Flexural dermatitis (or cheeks if 18/12 old) - PHx flexural dermatitis - PHx dry skin > 12/12 - PHx asthma/hayfever - Onset < 2 years
Clinical features of eczema (acute and chronic)
Acute:
- Erythema - Oedema - Papules and vesicles - Ooze/crust - Excoriations
Chronic (often from body’s response to protect itself):
- Lichenification: silvery/purple thickening - Dryness - Scaling - Cracking/fissuring - Post-inflammatory hypo/hyperpigmentation
What are some aggravating factors of eczema?
Heat, prickle (wool, nylon, seams, labels), and dryness
What are the main points for everyday mx of eczema?
- Avoid aggravators
- Moisturiser
- Daily, cool salt and oil bath
How might you avoid aggravators of eczema?
- Heat
- Avoid: too many clothes/blankets, hot baths > 29deg, heaters etc.
- Do: light loose clothing to bed; lukewarm baths - Dryness
- Avoid: soap - use bath oils/washes, excessive soaking, air blowing heaters
• Air blowing heaters
• Swimming pools
• excessive soaking - Prickles
- Avoid: animal hair/dander, woollens, sharp tags/rough fabric, sand pits
- Do: cotton/polyester, care with labels etc - Beware allergens
How might you moisturise daily for eczema? What would you use? How often?
• Emollients use often every day, top to toe min twice daily, optimum 4-6x
○ Be careful about transfer of germs into creams
• Dermeze (50% paraffin+soft) when young, qv less visible when going to school
○ sorbolene may irritate
How to avoid scratching?
- Keep nails short
- Mittens
- Splints at night if severe
What kinds of measures should parents follow when it comes to everyday baths for eczema?
- Very important 1-2/day
- 5min max
- add 1 capful of bath oil + salt
- lukewarm
- apply moisturisers after baths
List Mx options for an eczema flare.
- Steroids
- Anti-histamines - itch
- Tar creams - lichenification
- Wet dressings
- Bleach Baths
- Oral abx
What kinds of steroids can be used in a flare? What is important about how to use it?
• Face (weaker): hydrocortisone 1% BD (mild facial eczema), pimecrolimus (moderate facial eczema)
- Body (stronger):
- Advantan, or mometasone furoate 0.1% (Elocon) daily
- Use aggressively and not thinly when flaring!
- Ointments are preferred because they have emolient effects and are less irritating
What do wet dressings help with in a flare? How?
- Essential in controlling a flare and promoting sleep
- Use if other treatments have not cleared the eczema within 48 h
- Tubifast/chux - reduce itch, treat infection, moisturise skin, protect skin, promote sleep
What Ix can be done for eczema?
Tests rarely needed:
- Allergy skin prick testing (SPT)
- IgE test:
○ If post prandial eczema flares(<30-60min)
Which organisms often cause secondary infections in eczema? How might each present?
- Staph aureus: crusts, weeping, erythema and increased itch
- HSV1 - eczema herpeticum
- Fluid filled blisters - vesicle
- Multiple crusted erosions
- Grouped, punched out
- Painful, increased itch
- May be unwell - fever, malaise
