Eczema

This is also known as atopic dermatitis, which is a chronic atopic condition causing defects in the natural continuity of the skin barrier, therefore leading to inflammation. The pathophysiology of it includes:

• Defects in the skin barrier to form tiny gaps, allowing for irritants, allergens, and microbes to enter the skin

• Immune response to these leads to the inflammation and associated symptoms

Presentation

Dry skin and flares of itchy, erythematous, poorly demarcated patches

• Usually forms on the cheeks of infants

• Usually forms on the flexural surfaces in older children and adults

Complications

• Eczema herpeticum - Dermatological emergency where the impaired skin protection leads to a disseminated HSV infection. Presents as a monomorphic vesicular rash, which can ulcerate and crust. Treated with IV Aciclovir.

• Superficial bacterial infection - usually caused by staph or strep

• Erythroderma - dermatological emergency where there is widespread erythema affecting >90% of the skin surface, which can result in heat and fluid loss, causing hypothermia and systemic symptoms

• Side-effects of long-term topical corticosteroid use - skin thinning, striae, telangiectasia

Management

Advise patients to avoid:

• Activities that break down the skin barrier e.g. hot baths, itching, scrubbing skin, and using soaps that remove natural oils of the skin

• Known triggers e.g. humidity, diet etc.

Things to give:

• Emollients - thick, greasy creams e.g. E45, Cetraben to help create an artificial skin barrier

• Topical corticsteroids e.g. Hydrocortisone, Betamethasone (Betnovate)