Eczema

Question 1

What is eczema?

Answer 1

• chronic, relapsing, inflammatory skin condition characterised by an itchy red rash

Question 2

Which part of the body is prone to have eczema?

Answer 2

• skin creases such as the folds of the elbows or behind the knees

Question 3

Which age group is commonly affected by eczema?

Answer 3

• <5 (80%)

Question 4

What are the trigger factors for eczema?

Answer 4

• Irritants - eg, soaps and detergents
• Skin infections: Staphylococcus aureus
• Contact allergens
• Extremes of temperature and humidity
• Abrasive fabrics - eg, wool
• Dietary factors
• Inhaled allergens - eg, house dust mites, pollens, pet dander and moulds

Question 5

What are the endogenous triggers for eczema?

Answer 5

• genetic mutations affect the production of filaggrin
• Stress
• Hormonal changes in women (if adults are considered)

Question 6

What is the diagnostic criteria for eczema?

Answer 6

• itchy skin condition + 3 of
  
  • History of itchiness in skin creases or cheeks if below 18months
  • History of asthma or hay fever
  • General dry skin
  • Visible flexural eczema
  • Onset in the first two years of life

Question 7

What are the presentations of eczema?

Answer 7

• During infancy, atopic eczema primarily involves the face, the scalp and the extensor surfaces of the limbs
• In children and in adults with long-standing disease, eczema is often localised to the flexure of the limbs
• Crusting, weeping, pustulation - if bacterial infection present

Question 8

What tools can you use to assess severity and well-being in a child with atopic eczema?

Answer 8

• Visual analogue scales (0-10)
• Children’s Dermatology Life Quality Index (CDLQI)
• Infants’ Dermatitis Quality of Life Index (IDQOL)

Question 9

What are the differential diagnosis for eczema?

Answer 9

• Psoriasis.
• Contact dermatitis.
• Seborrhoeic dermatitis.
• Fungal infections.
• Lichen simplex chronicus.
• Scabies

Question 10

What Ix would you order for eczema?

Answer 10

• clinically diagnosed

Question 11

What disease are associated with eczema?

Answer 11

• asthma
• hay fever
• allergic rhinitis

Question 12

How would you mx eczema?

Answer 12

Conservative

• avoid trigger factors
• keep skin hydrated
• apply emollients

Pharmacology

• topical steroids
• Topical pimecrolimus if uncontrolled
• emollient antimicrobial
• oral flucloxacillin 14 days - if s.aureus infection (erythromycin if penicillin allergy)
• oral penicillin 14 days - if strep. pyogenes infection

Question 13

What are the cx of eczema?

Answer 13

• S. aureus infection - impetigo
• Herpes simplex infection
• Superficial fungal infections
• Reduced self-esteem
• Disturbed sleep patterns