Eczema/atopic dermatitis Flashcards
What are the typical distribution patterns of eczema in a patient
Infant <1
Child >1
Adult
All have dermatitis over the flexors
<1 = + cheeks and face
>1 = Generalized
Adult = neck and face
What are the typical characteristics of eczema in terms of describing the rash.
Redness
Swelling
crusts/oozing
itchiness => scratch marks
Thickened skin (steroids thin it)
What cytokines are most involved in eczema?
IL4,5,13,31
What is your typical management plan for a patient with mild eczema?
Long term management?
Emollients all over body AM
+ Topical steroids (hydrocortisone) PM given at 1 fingertip dose per 2 palms worth of eczema
OR Calcineurin inhibitors (tacrolimus) PM
Long term: Topical steroids (hydrocortisone) 2x/week
How would you dose the topical steroid?
Based on the fingertip where 1 fingertip = 0.5g of steroids = 2 palms worth of eczema
What are the side effects of using topical steroids?
What are the general side effects of oral steroid use?
Skin atrophy/thinning
Cataracts/glaucoma
Telangiectasia (spider veins)
Acne
Striae (stretch marks)
Steroids + Cushing sx: weight gain, high blood pressure, diabetes, thinning of the skin, muscle weakness, mood changes
Other steroid sx: osteoporosis, immunosuppression.
Other than steroids and emollients and calcineurin inhibitors, what are alternative treatments that may be used?
Phototherapy: reduces inflammation but requires a big commitment with appointments and consider missing school
Systemic Therapy: Methotrexate
What population groups benefit most from phototherapy?
Darker skinned
What bacterial and viral is most associated with eczema?
How would you prevent the bacterial?
How would you treat both?
Staph aureus
Prevention via Milton bath or topical antibiotics e.g. fucidin
tx: Oral flucloxacillin
HSV/ eczema herpeticum which is very painful
Oral acyclovir and opthalmology referral
What is your typical management plan for a patient with mild eczema that is oozing pus?
Emollients all over body AM
+ Topical steroids (hydrocortisone) PM given at 1 fingertip dose per 2 palms worth of eczema
OR Calcineurin inhibitors (tacrolimus) PM
take cultures and determine but if Staph aureus then give fluclox and then prevent future infections via Milton bath or Fucidin (topical antibiotic)
What must always be administered with methotrexate? How would you dose methotrexate?
Folate
Dosage = 0.4mg/kg/week
Discuss the use of systemic therapy in eczema patients
Oral steroids is the most widely used however this must only be used in the short term and emergencies
Cyclosporin is quick and good for emergencies but there are many side effects => <1yr use only
Methotrexate is the current best option as it is well tolerated however it is a folate antagonist => must give folate with it
