Makindo Medical Notes

Related Subjects: |Nikolsky's sign |Koebner phenomenon |Erythema Multiforme |Pyoderma gangrenosum |Erythema Nodosum |Dermatitis Herpetiformis |Lichen Planus |Acanthosis Nigricans |Acne Rosacea |Acne Vulgaris |Alopecia |Vitiligo |Urticaria |Basal Cell Carcinoma |Malignant Melanoma |Squamous Cell Carcinoma |Mycosis Fungoides (Sezary Syndrome) |Xeroderma pigmentosum |Bullous Pemphigoid |Pemphigus Vulgaris |Seborrheic Dermatitis |Pityriasis/Tinea versicolor infections |Pityriasis rosea |Scabies |Dermatomyositis |Toxic Epidermal Necrolysis |Stevens-Johnson Syndrome |Atopic Eczema/Atopic Dermatitis |Psoriasis

Widespread herpes simplex (eczema herpeticum) should be considered in any patient with rapidly deteriorating atopic eczema, with immediate referral to a dermatologist or paediatrician.

About

• A chronic inflammatory skin disease characterized by intense itching and eczematous lesions in typical sites:
• Infants: face, scalp, and extensors.
• Children/adults: flexural surfaces, such as elbows and knees.

Aetiology

• Both genetic and environmental factors contribute.
• Involves defects in skin barrier function, often due to abnormalities in proteins like filaggrin, leading to increased skin permeability and sensitivity to irritants/allergens.

Epidemiology

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

Clinical Presentation

• Dry, itchy, red skin with papules and vesicles on an erythematous base.
• Often seen on flexor surfaces (elbows, knees); severe cases may show blistering, cracking, oozing, and bleeding.

Severity Classification

• Clear: Normal skin, no active eczema.
• Mild: Areas of dry skin, infrequent itching, some redness.
• Moderate: Frequent itching, redness, and possible excoriation.
• Severe: Widespread dryness, incessant itching, thickened skin, bleeding, oozing, and cracking.

Clinical Forms

• Atopic dermatitis: Classic eczema seen in children/adults, affecting flexural areas.
• Contact dermatitis: Localized reaction to specific allergens or irritants.
• Seborrhoeic dermatitis: Involves sebaceous areas (e.g., face, scalp); also known as cradle cap in infants.
• Xerotic eczema: Often in older adults, related to dry skin and excessive washing.

Management

• Emollients:
  • Essential for ongoing care; choose creams, lotions, or ointments based on patient preference.
  • Emollient soap substitutes reduce irritation during washing.
  • Apply liberally, especially after bathing.
• Topical corticosteroids:
  • Used alongside emollients; apply once daily, consider twice-weekly maintenance for moderate to severe eczema.
  • Side effects include skin thinning, bruising, perioral dermatitis, and potential fungal infection spread.
• Topical calcineurin inhibitors:
  • Considered in moderate to severe cases unresponsive to corticosteroids.
• Anti-infectives: Oral antibiotics are not recommended for routine treatment but may be needed for infections.
• Antihistamines: Short-term use of sedating antihistamines may help if sleep disturbance is severe.
• Phototherapy & Immunosuppressants: Considered for severe, unresponsive cases.
• Diet & Environmental Factors:
  • Exclusive breastfeeding for three months may reduce infant eczema risk in families with a history of atopy.
  • Routine dietary exclusions are not recommended without confirmed allergies.

References

• SIGN Guidelines on Eczema