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Flashcards in Eczema Deck (16):

Pattern of eczema:
- clinical course
- pattern of involvement

- Relapsing, remitting
- Infants usually develop facial eczema first, flexural surfaces affected later


Briefly describe the pathophys of eczema.

- Primary disturbance of epidermal barrier function
- Dry skin - decreased filaggrin and ceramides
- Staph aureus for secondary bacterial infection


What are the diagnostic criteria for eczema?

Itch + 3 of:
- Flexural dermatitis (or cheeks if 18/12 old)
- PHx flexural dermatitis
- PHx dry skin > 12/12
- PHx asthma/hayfever
- Onset < 2 years


Clinical features of eczema (acute and chronic)

- Erythema
- Oedema
- Papules and vesicles
- Ooze/crust
- Excoriations

Chronic (often from body's response to protect itself):
- Lichenification: silvery/purple thickening
- Dryness
- Scaling
- Cracking/fissuring
- Post-inflammatory hypo/hyperpigmentation


What are some aggravating factors of eczema?

Heat, prickle (wool, nylon, seams, labels), and dryness


What are the main points for everyday mx of eczema?

1. Avoid aggravators
2. Moisturiser
3. Daily, cool salt and oil bath


How might you avoid aggravators of eczema?

1. Heat
- Avoid: too many clothes/blankets, hot baths > 29deg, heaters etc.
- Do: light loose clothing to bed; lukewarm baths

2. Dryness
- Avoid: soap - use bath oils/washes, excessive soaking, air blowing heaters
• Air blowing heaters
• Swimming pools
• excessive soaking

3. Prickles
- Avoid: animal hair/dander, woollens, sharp tags/rough fabric, sand pits
- Do: cotton/polyester, care with labels etc

4. Beware allergens


How might you moisturise daily for eczema? What would you use? How often?

• Emollients use often every day, top to toe min twice daily, optimum 4-6x
○ Be careful about transfer of germs into creams

• Dermeze (50% paraffin+soft) when young, qv less visible when going to school
○ sorbolene may irritate


How to avoid scratching?

- Keep nails short
- Mittens
- Splints at night if severe


What kinds of measures should parents follow when it comes to everyday baths for eczema?

- Very important 1-2/day
- 5min max
- add 1 capful of bath oil + salt
- lukewarm
- apply moisturisers after baths


List Mx options for an eczema flare.

1. Steroids
2. Anti-histamines - itch
3. Tar creams - lichenification
4. Wet dressings
5. Bleach Baths
6. Oral abx


What kinds of steroids can be used in a flare? What is important about how to use it?

• Face (weaker): hydrocortisone 1% BD (mild facial eczema), pimecrolimus (moderate facial eczema)

• Body (stronger):
• Advantan, or mometasone furoate 0.1% (Elocon) daily

• Use aggressively and not thinly when flaring!
• Ointments are preferred because they have emolient effects and are less irritating


What do wet dressings help with in a flare? How?

• Essential in controlling a flare and promoting sleep
• Use if other treatments have not cleared the eczema within 48 h
• Tubifast/chux - reduce itch, treat infection, moisturise skin, protect skin, promote sleep


What Ix can be done for eczema?

Tests rarely needed:
- Allergy skin prick testing (SPT)
- IgE test:
○ If post prandial eczema flares(<30-60min)


Which organisms often cause secondary infections in eczema? How might each present?

- Staph aureus: crusts, weeping, erythema and increased itch

-HSV1 - eczema herpeticum
- Fluid filled blisters - vesicle
- Multiple crusted erosions
- Grouped, punched out
- Painful, increased itch
- May be unwell - fever, malaise


How might you manage a secondary infection in eczema?

- Remove crusts ASAP via cold compress/soak in bath
• Apply steroids/moisturisers once removed - but NO STEROIDS for HSV1
- Bleach bath (4%) to cool bath water (12mls per 10L of water)

- Bacterial infection: Oral cephalexin/flucloxacillin
- HSV1: oral aciclovir (best within 48h)

- ophthalmology review ASAP for HSV1
- Nasal carriage: mupirocin ointment (Bactroban)