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Flashcards in Eczema Deck (16):
1

Pattern of eczema:
- clinical course
- pattern of involvement

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

2

Briefly describe the pathophys of eczema.

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

3

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

4

Clinical features of eczema (acute and chronic)

Acute:
- 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

5

What are some aggravating factors of eczema?

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

6

What are the main points for everyday mx of eczema?

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

7

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

8

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

9

How to avoid scratching?

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

10

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

11

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

12

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

13

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

14

What Ix can be done for eczema?

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

15

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

16

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)