Skin OTC - Eczema

Question 1

Define Eczema.

Answer 1

A.K.A. Dermatitis
A polymorphic pattern of inflammation which is acute phase is characterised by erythema, vesicular ion and in chronic phase by dryness, lichenification and fissuring.

Question 2

What are the common features of eczema? (3)

Answer 2

Red, sore, itchy skin.

Question 3

What is the difference between acute vs chronic eczema?

Answer 3

Acute: Red, hot, swollen and itchy skin. Papules and tiny blisters, coalescing to form large blisters. Exudating and crusting scaling.

Chronic: Drier skin, scaly, licenification and painful fissures.

Question 4

What are the clinical variations of eczema? (8)

Answer 4

Atopic ‘ a state of hypersensitivity to common environmental allergens may be inherited.’
Allergic/irritant contact (triggered by allergens/irritants)
Seborrhoeic: Scalp, eyebrows and ears. Characterised by greasy yellow scales.
Gravitational (varicose): Oedematous legs, fragile skin, ulceration if scratched.
Asteatotic: legs of elderly, very dry skin and appears red superficial blisters.
Pompholyx: Presents with vesicles or large blisters on palms, fingers or soles of feet.
Discoid: Multiple coin shape, itchy lesions, found in middle aged men, stress related.
Chronic hand: erythema, vesicles, papules, scaling, fissures, itching and pain affecting hands can be incapacitating.

Question 5

What are the symptoms of atopic eczema?

Answer 5

Itch
Onset < 2 yrs.
- Visible flexural dermatitis
- Hx of other atopic disease e.g. asthma, hay fever.

Question 6

What are the complications of atopic eczema?

Answer 6

Scratching and skin excoriation causing secondary infection usually with staph aureus.
Signs including skin weeping and crusting, failure to respond to tx, rapidly worsening eczema and in severe cases, fever and malaise.
Bacterial infection (folliculitis, crusting) - tx with K permanganate or other antiseptic bath products e.g. Dermol.
Severe = ABx oral.

Some px are prone to viral infections e.g. warts or Molluscum Contagiosum. Rarely can be life-threatening - eczema herpeticum.
- Widespread lesions (Herpes simples)
- GP referral if suspected e.g. clusters of blisters on lesions, sudden obvious worsening of eczema, fever.
- Parents warned of contact with anyone who has H simplex or cold sores.

Question 7

What are the treatment options for atopic eczema?

Answer 7

Clear: Emollients

Mild: Emollients + Mild potency topical steroids or emollients alone.

Moderate: Emollients + topical CS (Body moderate potency 7-14 days, Face/neck mild potency 3-5 days.) Topical calcineurin inhibitors (Body: Tacrolimus, Face/Neck: Tacrolimus/Pinecrolimus) Bandages.

Severe: Emollients + topical CS (Body moderate potency 7-14 days, Face/neck mild potency 3-5 days.) Topical calcineurin inhibitors (Body: Tacrolimus, Face/Neck: Tacrolimus/Pinecrolimus) Bandages, Phototherapy, Systemic therapy e.g. Ciclosporin.