Eczema / Atopic Dermatitis

Question 1

Who does eczema affect?

Answer 1

-The most common inflammatory skin disease worldwide
-More common in HICs
-Typically affects those with a history of atopy / atopic triad
-Usually starts in infancy, can settle in late childhood but can progress to adulthood

Question 2

How does eczema present?

Answer 2

-Characterised by remission and relapse with acute flares on a background of chronic dermatitis
-Erythematous, weeping / crusted, may have blisters
-Over time may become lichenified and scaly

Question 3

How do infantile, childhood and adult presentations differ?

Answer 3

INFANTILE
-Occurs at or shortly after birth
-Involves scalp, armpit and groin creases, cheeks
CHILDHOOD
-Extensor distribution transitions to flexural
-Dribble / food –> mouth and chin involvement
-Lichenification is common due to chronic itching
ADULT
-Varies a lot
-May continue in flexural pattern or become diffuse
-May recur from childhood on the hands due to occupational / domestic factors
VARIATION AMONG ETHNICITIES
-Perifollicular and extensor distribution more common in those of African descent
-NB scoring systems may underestimate severity in non-Caucasian patients due to erythema appearing more purple / dark

Question 4

What are the differential diagnoses for eczema?

Answer 4

-Seborrhoeic dermatitis
-Psoriasis
-Contact dermatitis

Question 5

How would you manage a patient with eczema?

Answer 5

-Patient education, avoid irritants, psychological support
-Topical treatments eg emollients, moisturises, wet wraps
-Potassium permanganate antiseptic cream
-Topical steroids
-Topical Calcineurin inhibitors (immunomodulators) eg tacrolimus
-Phototherapy (severe)
-Systemic antihistamines, steroids, immunosuppressives