Eczema (atopic dermatitis) Flashcards
Risk factors for eczema
- Family history of atopy (eczema, asthma, allergic rhinitis)
- Loss of function in FLG gene involved in skin barrier function
- Children living in urban areas
- Relatively lesser exposure to endotoxins in early life
Usual clinical presentation of eczema
- Dry skin
- Severe itch
Briefly describe the classifications of eczema
- Mild: With or without redness, infrequent itching
- Moderate: Redness with frequent itching and localised skin thickening
- Severe: Widespread dryness and redness of skin with incessant itching and skin bleeding/cracking/oozing
Standard treatment options for eczema
- Emollient PRN
- Topical steroids
Suggest a topical steroid that can be used in a 20yo F patient with mild eczema. State the dosing regimen and duration of usage
Choices of topical steroid: Groups 5-6 such as..
- Betamethasone valerate cream (group 5)
- Trimcinolone acetonide 0.1% cream group 5.
- Desonide cream 0.05% (group 6)
Dosing regimen and duration: 1-2 application BD for 2-4 weeks
Suggest a topical steroid to be used on eczema in facial areas and skin folds
Group 6 and 7 steroids such as:
- Hydrocortisone acetate 0.1% cream/ointment (group 7)
- Betamethasone 0.025% cream/ointment (group 7)
- Desonide 0.05% cream
Besides topical steroids, what is the other drug class that can be used especially for the face and skin folds?
Topical calcineurin inhibitors BD
- Tacrolimus 0.03% or 0.1% ointment
- Pimecrolimus 1% cream
Common adverse effects of Pimecrolimus 1% cream?
- Transient burning
- Erythema
- Pruritus
(applies to tacrolimus cream as well)
Describe the topical steroids that should be use in a patient with moderate eczema in the following situations:
- Acute flares
- Usual topical corticosteroids
- Acute flares: high potency steroids (Group 1-3) for up to three weeks, then continue with lower potency steroid until it resolves
- E.g. Clobetasol propionate ointment (group 1), Mometasone furoate 0.1% ointment (group 2), Betamethasone dipropionate 0.05% cream (group 3) - Usual topical steroids: medium to high potency (group 3-4)
- E.g. Betamethasone dipropionate 0.05% cream (group 3), Mometasone furoate 0.1% cream (group 4)
Main issue in the usage of topical corticosteroid on the face and skin folds?
Skin atrophy
Describe an oral treatment regimen for an acute exacerbation of chronic eczema in teenagers and adults
Prednisolone 40-60 mg/day for 3-4 days, then 20-30mg for 3-4 days
List possible adjunctive therapies in eczema and state if they are recommended to be used. If not, why?
- Topical anti-infectives: not recommended due to risk of developing eczema itself
- Oral anti-infectives: not recommended unless there are signs of bacterial infections
- Oral antihistamines: limited use as itch is not histamine mediated. Could be used in concurrent urticaria or rhinoconjunctivitis
- Tar preparations: Anti-itch and anti-inflammatory, helps correct keratinisation by decreasing epidermal proliferation. Used as second-line for sub-acute, chronic and lichenified eczema
Counselling points for moisturisers
- Use liberally and at least twice a day
- Use immediately after bathing to prevent skin from drying due to water evaporation
Non-pharmacological management for eczema?
- Baths: avoid long hot baths and strong detergents/soaps. Choose cleansers with physiological pH (6). Pat dry affected areas after showering.
- Moisturisers: use at least twice daily and liberally. Choose moisturisers free of additives, fragrances and perfumes
- Avoid triggering factors (e.g. excessive sweating, dry environments)
- Wet dressings are useful for flares
Maximum duration of ultra-high potency topical steroids?
3 weeks
