Eczema Flashcards
Eczema history
onset, pattern and severity
response to previous and current treatments
possible trigger factors
impact of condition on child and parent
dietary history
growth and development
personal and FH of atopic disease
effect on sleep and psychosocial wellbeing
itch
Diagnosis of eczema
when child has itchy skin and 3 or more of the following:
- visible flexural dermatitis involving skin creases e.g. bend of elbows or behind knees (cheeks and or extensor areas if 18 months or under)
- PH of flexural dermatitis (or dermaitis on the cheeks and/or extensor areas if 18 months or under)
- PH of asthma or allergic rhinits (first degree relative if <4)
- onset of signs andsymptoms under the age of 2 (dont use this criteria in children under 4)
assessment tools used in eczema
visual analgoue scales (0-10) capturing child an or parents assessment of severity, itch and sleep loss over previous 3 days and nights
or
POEM
CDLQI
IDQoL
DFI
Explaining Eczema to a parent
- often improves with time
- no all children grow out of it, may get worse in teenage or adult lif
- often develop astham and or hayfever
- sometimes food allergy can be associated with atopic eczema, particularly in young children
- not clear what role factors such as stress, humidity or extremes of temperature have in causing flares - avoid where possible
- may make skin darker or lighter temporarily
- saftey net for infection - weeping, pustules, crusts, fever, malaise
Description of eczema
characterised by papules and vesicles on an erythematous base
presentation of eczema
itchy, erythematous dry scaly patches
common in flexor aspects - but extensor and face in infants
chronic scartching/ rubbing can lead to excoriations and lichenification
Types of eczema
Endogenous:
- discoid
- varicose
- atopic
- seborrheic
exogenous:
- photodermatitis
- contact allergic dermatitis
- contact irritant dermatitis
features of eczema
xerotic (Dry) skin
golden crusting - suspcious of secondary infection
lihenification
Managment for infected eczema
- swabs from infected lesions
- if localised clinical infection - topical AB with topical corticosteroids
- wide spread - systemic AB
- fluclozacillin (Erythromycin if allergy) first line for S.aureus or streptococcal
Eczema Heprecticum - when to suspect and complications
dermatological emergency
usually close contact with someone with a cold sore
suspect if:
- rapidly worsening painful eczema
- fever
- grouped vesicles
- eroded, punched out lesions
complications:
- encephalitis
- pneuominits
- hepaitis
Managment of eczema
emolliants - bath additives, creams, ointments
topical corticosteroids
- mild potency for mild eczema
- moderate potency for moderate eczema
- potent for severe
- dont use potent preperations in children without specalist dermatological advice
- facial eczema in a child: 1% hydrocortisone
phototherapy
systemic steroids, azathioprine, ciclosporin
causes of erythrodermic eczema
withdrawal of systemic steroids
secondary infection with bacteria or virus
psychological stress
development of contact dermatitis
