Eczema (Dermatitis)

Question 1

What is eczema?

Answer 1

A chronic, relapsing skin condition characterised by an itchy rash that favours skin creases such as the folds of the elbows or behind the knees. Eczeme = dermatitis

Question 2

How common is eczema?

Answer 2

Affects 15-20% of school children and 2-10% of adults

80% present before 5 yaers

Question 3

What are the presentations of acute and chronic eczema?

Answer 3

Acute= rapidly evolving red rash, which may be blistered and swollen
Chronic = longstanding irritable area. Often darker than surrounding skin, thickened (lichenified) and excoriated.

Question 4

What are the differential diagnosis of eczema?

Answer 4

Atopic eczema - predominantly in children, inherited factors are important, almost always family history of dermatitis/asthma

Irritant contact dermatitis - provoked by handling water, detergents, solvents (things that may damage skin cells if in sufficient time and concentration), location strictly according to site of contact

Allergic contact dermatitis - provoked by things that other people don’t usually react to (nickel, rubber, hair dye etc. patch testing)

Asteatotic dermatitis - dry skin, less sebum secretion

Stasis/gravitational - often in elderly, on swollen, varicose veins poorly function veins

Seborrhoeic - M. furfur yeast infection on areas with a lot of sebaceous glands (face, scalp, axilla, behind ears)-usually well-defined, yellowish oily plaque with fine scaling. Treat with antifungal + steroid and coal tar shampoo

Discoid/nummular dermatitis - disc/coin-shaped. Thought to be started off initially by injury to skin. Mainly on limbs, tend to be chronic.

Infective dermatitis - due to bacterial infection (impetigo) or fungal infection

Otitis externa - dermatitis of the external ear canal

Dermatitis Herpetiformis - Associate with coeliac disease, usually affect the bottom, scalp, elbow and knee. Extremely itchy papules and blisters (vesicles) on normal or reddened skin

Question 5

What are the principles of management for eczema?

Answer 5

Identify and tackle any contributing factors:
-reduce shower, use of soaps or detergents, wear soft cool clothing avoiding wool, prevent skin from dusts, water, solvents, injury

1- Apply emollient (moisturiser) liberately and generously particularly after bathing and itching e.g. dyprobase

2. Topical steroids: steroid ladder- hydrocortisone, eumovate, betnovate, dermovate
3. Pimecrolimus - anti inflammatory, new and very effective on atopic dermatitis with fewer side effects compared to topical steroids
4. Anti histamine
5. Antibiotics (fluclox/eryth)
6. Systemic steroids (azathioprine)