Saturday 13 October 2012

Eczema (Dermatitis)

Acute - inflamed, weeping skin with vesicles
Subacute - erythema, dry/flaky skin, crusted
Chronic - lichenified skin


Epidemiology

  • 40% of population have an episode associated with atopy
  • Atopic individuals have a tendency to
    • Asthma
    • Eczema
    • Hay fever
    • Allergic rhinitis

Aetiology
  • Genetic-polygenic
  • Environmental triggers
    • Detergents/chemicals
    • Infection
    • Stress/anxiety
    • Animal fur
    • Foods (dairy products in the very young)

Clinical features
  • Itchy erythematous scaly patches
  • Often flexural
  • May be associated with nail pitting

Investigations
  • May have raised IgE or eosinophils
  • Skin-patch testing

Management
  • Education and explanation
  • Avoid irritants
  • Emollients, bath oil or soap substitutes
  • Topical steroids or immunomodulators (tacrolimus)
  • Antibiotics for secondary infection
  • Antihistamines
  • Second-line agents
    • Ultraviolet (UV) light
    • Oral steroids
    • Ciclosporin/azathioprine

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