Eczema - Children Flashcards
Classification of eczema (endogenous vs exogenous)
Atopic, seborrhoea, discoid, pompholyx, varicose
Vs
Allergic, irritant, photosensitive
Always … sparing in infant eczema
Always perioral sparing in infant eczema due to drooling/moist area, also nappy area
Atopic eczema/dermatitis
Starts in infancy
80% + mild
Commonest in children (1 in 5 in UK)
‘Atopic march’ - The progression from eczema to later developing food allergies, allergic rhinitis and asthma is called the allergic march. The allergic march is also called the atopic march.
Diagnostic criteria for eczema
Itching + 3 or more of:
visible flexural dermatitis involving the skin creases, such as the bends of the elbows or behind the knees (or visible dermatitis on the cheeks and/or extensor areas in children aged 18 months or under)
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1.1
Atopic eczema in under 12s: diagnosis and management (CG57)
• personal history of flexural dermatitis (or dermatitis on the cheeks and/or extensor areas in children aged 18 months or under)
• personal history of dry skin in the last 12 months
• personal history of asthma or allergic rhinitis (or history of atopic disease in a first-degree relative of children aged under 4 years)
• onset of signs and symptoms under the age of 2 years (this criterion should not be used in children aged under 4 years).
Clinical features of eczema in children
Dry skin - Reflects impaired skin barrier function
Episodic pattern with periodic flares + remissions
Sleep disturbance caused by itching - marked impairment of QOL for child and family
Pathogenesis of atopic eczema
Deficiency of filaggrin - chromosome 1q21
Overproduction of serum IgE
Genes regulating inflammation and production of inflammatory cytokines, alteration in T-cell TH1:TH2 - hygiene hypothesis
Chromosomal loci implicated in atopic eczema - 1q21, 3q21, 13q14, 11q13,5q
What is filaggrin?
Formed in keratohyalin granules is necessary for maturation of corneal layer and production of natural moisterising factors
Thenar eminence - look for hyperlinea - can link to eczema
History + exam for eczema
Time of onset, pattern, severity
Response to previous and current treatment
Possible trigger factors
The impact of the atopic eczema on children and their parents or carers
Dietary history including any dietary manipulation
Growth and development
Personal and family history of atopic disease
Filaggrin details
Filaggrin, when broken down on the skin surface, also goes on to produce so-called ‘natural moisturizing factor’ which also helps to keep the skin hydrated and act as a barrier. Filaggrin breakdown products also inhibit the growth of micro-organisms such as Staphylococcus aureus, a common organism found on the skin of eczema patients.
What is the ‘atopic march’?
This is where atopic eczema is found to precede the development of food allergies, hayfever and asthma in chronological order.
Investigations in eczema
Usually none
Skin swab for bacteriology/virology if infection suspected
Allergy testing
Food allergy - 30% of children with moderate to severe eczema
Suspect if reaction/GI problems, FTT
Ix - RAST, SPT, food challenge
Mx - 6 week trial of hydrolysed milk
Airborne allergy
Pollens, house dust mite, pet dander, moulds
Usually >2yr
Exposed sites
Cow milk allergy
Usually improves by 1 year of age
Extensively hydrolysed formula is recommended as first choice for infants under 6 months of age for treating immediate cows milk allergy (non-anaphylactic), food protein-induced enterocolitis syndrome, atopic eczema, gastrointestinal symptoms and food protein-induced proctocolitis.
Starting any baby on hydrolysed formula, why do dieticians need to get involved?
To stop later life milk allergy developing - if avoided for too long can lead to anaphylaxis when introduced later in life
Management of eczema in children
Establish diagnosis, severity, and extent of disease
Check growth parameters
Determine any possible trigger factors + treat accordingly
Spent time with parents to explain eczema and management - it is aimed at controlling and although no cure symptoms usually improve with age
Good education is vital - veraal and written and clear written treatment plan
Community nurses
Websites - national eczema society
Psychological support and school support
General measures for treating atopic eczema
Keep cool - fan in bedroom
Avoid soap and detergents - wash with emollients
Reduce allergens as far as possible
Use emollients
Keep nails short
Use cotton clothes and bed sheets
Synthetic duvet and pillows
Protective glove and bandages
Keep animals out of the bedroom
Use non-biological washing powder and avoid fabric conditioner
Avoid dusty environmental like attacks or house renovation
Avoid playing in long grass or walking amongst trees during pollen season
Discoid eczema
Infantile seborrheic dermatitis
ISD is an eryhtematosquamous skin disease of early infancy
Begins in first month of life and clears by 4-6months
Thick adherent yellow or whitish, greasy skin
May use vegetable oil to treat
Frequent nappy changes
Ketoconazole shampoo on scalp
Pompholyx
Aetiology unknown - warm weather, atrophy, expression of allergy to nickel
Mostly pubertal age
Few days to weeks, subside spontaneously
Treatment - avoid contact with nickel, topical steroids - medium or high potency, zinc oxide, oral antihistamines
