Eczema

Question 1

What is eczema?

Answer 1

Inflammatory skin condition

Question 2

What are the types of eczema?

Answer 2

Endogenous:
>Atopic
>Discoid
>Pompholyx
>Gravitational 
>Seborrhoeic

Exogenous:
>Irritant
>Allergic
>Photodermatitis

Question 3

What is required for a diagnosis of atopic eczema?

Answer 3

Major criteria:
>Itchy skin (reports rubbing/scratching)

Minor criteria (2 of)
>Onset <2 years
>Hx of skin crease involvement
>Personal or first degree relative hx of atopic disease
>Visible flexural dermatitis

Question 4

What is the presentation of atopic eczema? Consider:
>Infantile
>Early childhood
>Adulthood

Answer 4

Infantile:

• Typically present before 6months
• Usually starts on face
• Once crawling affects knees

Early Childhood:

• flexure surfaces involves
• neck often involved

Adults:
>Increased lichenification
>flexures and hands

Question 5

What investigations can be done if considering atopic eczema?

Answer 5

*IgE RAST test
*Patch test if:
>suggestive Hx
>Recent onset in older child or adult
>odd distribution

Question 6

What are the first line managements of atopic eczema?

Answer 6

1. Emollients:
   >Topical ointments and creams 250g/week
   >Soap substitute
   >Bath additives
2. Topical steroids (applied 30mins after emmolient)
3. Topical immunomodulators

Question 7

What is the least potent steroid cream?

Answer 7

Hydrocortisone 1%

Question 8

What is the most potent steroid cream?

Answer 8

Dermovate

Question 9

What are second line managements of atopic eczema?

Answer 9

• Antibiotics for secondary infection
• Oral steroids
• Phototherapy
• Immunosuppresants: methotrexate, azathiaprine, ciclosporin