flashcards_eczema

Question 1

What is the treatment for clear skin with no evidence of active atopic eczema?

Answer 1

None.

Question 2

What is the treatment for mild atopic eczema?

Answer 2

Emollient with frequent and liberal use + mild topical corticosteroid (e.g. hydrocortisone 1%) with continued treatment until >48hrs after flare has been controlled.

Question 3

When is routine follow-up not normally needed for atopic eczema?

Answer 3

For mild atopic eczema.

Question 4

What is the treatment for moderate atopic eczema?

Answer 4

Emollient with frequent and liberal use + moderate topical corticosteroid (betamethasone valerate 0.025% or clobetasone butyrate 0.05%) with continued treatment until >48hrs after flare has been controlled.

Question 5

When should a patient with moderate atopic eczema be admitted?

Answer 5

If eczema herpeticum is suspected.

Question 6

What should be considered if there is severe itching or urticaria in moderate atopic eczema?

Answer 6

Consider a 1-month trial of a non-sedating antihistamine (e.g. cetirizine, loratadine, fexofenadine).

Question 7

What are the 2nd line treatments for moderate atopic eczema?

Answer 7

Topical calcineurin inhibitors (e.g. tacrolimus) and bandages.

Question 8

What is the treatment for severe atopic eczema?

Answer 8

Emollient with frequent and liberal use + potent topical corticosteroid (e.g. betamethasone valerate 0.1%) with continued treatment until >48hrs after flare has been controlled. Prescribe a maintenance regimen of topical corticosteroids.

Question 9

When should a 1-month trial of a non-sedating antihistamine be considered for severe atopic eczema?

Answer 9

If there is severe itching.

Question 10

When should a sedating antihistamine be considered for severe atopic eczema?

Answer 10

If the itching is affecting sleep, consider a 7–14-day trial of a sedating antihistamine (e.g. chlorphenamine).

Question 11

What additional treatment options are available for severe, extensive eczema causing psychological distress?

Answer 11

Consider a course of oral corticosteroids, 2nd line: topical calcineurin inhibitor, phototherapy if other options have failed, systemic therapy if all above ineffective.

Question 12

What conservative measures should be taken for atopic eczema?

Answer 12

Identify and educate about triggers (e.g. food allergens, contact allergens, inhalational allergens, irritants like soaps), cut nails short to avoid scratching especially in children.

Question 13

What is the role of emollients in managing atopic eczema?

Answer 13

Use emollients in large amounts and often, apply on the whole body, frequently and liberally, even when skin is clear, use as a soap substitute.

Question 14

How should topical corticosteroids be used for atopic eczema?

Answer 14

Use once or twice daily, apply to areas of active eczema, avoid potent corticosteroids in children < 12 months without specialist advice, consider using topical corticosteroids for 2 consecutive days per week to prevent flares.

Question 15

What should be done if a topical corticosteroid is deemed ineffective?

Answer 15

Consider using a different type of steroid of a similar potency before increasing the potency.

Question 16

What are the different potencies of topical corticosteroids for atopic eczema?

Answer 16

Mild Potency: hydrocortisone 1%, Moderate Potency: betamethasone valerate 0.025% or clobetasone butyrate 0.05%, Potent: betamethasone valerate 0.1%, mometasone.

Question 17

When should oral steroids be considered for atopic eczema?

Answer 17

If very severe and extensive.

Question 18

What are topical calcineurin inhibitors and when should they be used?

Answer 18

Topical tacrolimus for moderate to severe eczema in children > 2 years that has not been controlled with steroids. Do not use under occlusive bandages.

Question 19

What is the role of bandages in managing atopic eczema?

Answer 19

Used with emollients for areas of chronic lichenified skin, help emollient absorption and stop children from scratching, used for short-term flares (7-14 days).

Question 20

What is the treatment for infected eczema?

Answer 20

Swab the affected area, advise about maintaining good hygiene when using emollients and other creams, 1st line: Flucloxacillin (oral if extensive, topical if local), penicillin allergy: erythromycin, antibiotics for no longer than 2 weeks, recurrent infections: antiseptics (e.g. chlorhexidine).

Question 21

What advice should be given to parents and children regarding eczema herpeticum?

Answer 21

Provide advice on how to identify eczema herpeticum (rapidly worsening painful eczema, clustered blisters, punched-out erosions).

Question 22

What are the indications for referral in atopic eczema?

Answer 22

Immediate referral for eczema herpeticum, urgent referral (2 weeks) if severe atopic eczema has not responded to optimum therapy within 1 week or treatment to bacterially infected eczema has failed, refer if diagnosis is uncertain, atopic eczema on the face is not responding, contact allergic dermatitis is suspected, causing significant social and psychological problems or severe recurrent infections.