Paediatrics OTC - Atopic Eczema

Question 1

What is atopic eczema? (3)

Answer 1

2-6 months
Px shows family Hx of asthma, eczema or hayfever.
Predisposed to irritant contact dermatitis.

Question 2

State the diagnostic process of Atopic eczema. (7)

Answer 2

Itchy skin (reports of scratching) in last 12 months + 3 or more features:
- Involving skin creases
- Personal Hx of atopic disease or Hx of atopic disease in first degree relative if child < 4 years.
- General dry skin in previous year.
- Onset < 2 yrs.

*Asian, Black-Carribean and black African = atopic eczema can appear on the external surfaces and discoid/follicular patterns = common.

Question 3

What are the common features of atopic eczema? (7)

Answer 3

Moist/weeping lesions
Thickened/lichenified skin
Darker skin appears papular.
Scratch marks evident.
Staphylococcal secondary infections common with staphylococcal foliculitis occurring resulting from emollients/occlusive dressings.
Atopic children prone to infection with Herpes Simplex.

Question 4

What are the main features of seborrhoeic dermatitis? (1)

Answer 4

Cradle cap

Question 5

What are the main features of psoriasis? (1)

Answer 5

Black skin (purple patches with grey scale appearance)
Can also appear dark brown

Question 6

Briefly outline OTC tx for atopic eczema. (3)

Answer 6

Emollients/soap substitutions
Antihistamines
CS - Not OTC for < 10 years.

Question 7

What counselling is given to px with atopic eczema? (4)

Answer 7

Avoid irritants:
- House dust mites
- Perfumed bath oils/foams
- Possibly some materials e.g. wool.
- Pet dander

Question 8

Explain the use of emollients as atopic eczema. (7)

Answer 8

Relives the effect of dry skin.
Added to bath water and used as a soap substitute.
If stinging occurs when emollient is used on application = DISCONTINUE!
Some contains antiseptics but can over dry/irritate the skin.
Liberally applied - no upper dosage limit.
Beware slippery baths.
Liquid paraffin

Question 9

Give an e.g. of emollient. (1)

Answer 9

Oilatum

Question 10

Explain the use of antihistamines as atopic eczema tx. (2)

Answer 10

For itching
Sedating version can be used at night to help children sleep and prevent excessive nocturnal itching.

Question 11

Give e.g. antihistamines used for atopic eczema. (2)

Answer 11

Chlorphenamine (P), Promethazine, Hydrozyxine (POM)
Only licensed for < 1 yr = hydroxyzine (from 6 months)