Eczema (Atopic dermatitis)

Question 1

Criteria for diagnosis

Answer 1

Itch

Typical morphology and distribution

Dry skin

History of atopy

Chronic relapsing dermatitis

Question 2

Distribution

Answer 2

The typical distribution of atopic dermatitis changes as the patient grows older.

In infants the rash appears typically on:

• the cheeks of the face
• the folds of the neck
• and scalp.

It may then spread to the limbs and groin.

Question 3

Relative distribution of atopic dermatitis in infants

Answer 3

Question 4

Atopic dermatitis in children

Answer 4

Question 5

Management

Avoid irritants:

Answer 5

Avoid soap.

Use a bland bath oil in the bath and a cleansing bar, e.g. Cetaphil, DermaVeen as a soap substitute.

Older children should have short, tepid showers

Avoid rubbing and scratching—

• keep fingernails short
• consider mittens or splints at night if severe

Avoid sudden changes of temperature

Wear light, soft, loose clothes, preferably made of cotton.

Cotton clothing should be worn next to the skin.

Avoid wool next to the skin.

Avoid dusty conditions and sand, esp. sandpits.

Avoid contact with people with ‘sores’, esp. herpes.

Consider dust mite reduction strategies:

• premium grade dust mite covers for bedding,
• wash linen in hot water >55°C and
• consider replacing carpets and fabrics on furniture.

Question 6

Management

Improve skin condition:

Answer 6

Emollients: apply twice daily to dry skin, choose from:

–Ego skin cream

–sorbolene alone or with 10% glycerol

–QV cream (esp. winter) or lotion (summer only)

–paraffin creams (e.g. Dermeze), esp. infants

–bath oils (e.g. Alpha Keri, QV)

Question 7

Medication

Answer 7

Choose a potency of corticosteroid appropriate for the site

• and apply liberally until the skin is perfectly clear.

Most dermatitis should clear within 7–14 days.

Question 8

Topical corticosteroid therapy

Answer 8

For face, axillae and groin:

1% hydrocortisone ointment, daily

if inadequate response, methylprednisolone aceponate 0.1% ointment or fatty ointment, daily

For trunk and limbs:

triamcinolone acetonide 0.02% ointment, daily

if more severe or in the flexures, use:

–methylprednisolone aceponate 0.1% ointment or fatty ointment, daily, or

–mometasone furoate 0.1% ointment, daily

For hands, feet, lichenified wrists and ankles:

betamethasone dipropionate 0.05% ointment, daily, or

– mometasone furoate 0.1% ointment, daily

Question 9

Secondary infection:

Answer 9

Consider in the event of:

• failure of topical treatment, or
• if crusting or
• pustules are present.

Take swabs from skin or nares.

Treat with mupirocin 2% ointment if localised,

• or oral antibiotics if widespread

For recurrent infection, consider:

• bleach baths (sodium hypochlorite 6% solution 60 mL per bath, twice weekly)