ECZEMA

Introduction
Case Scenarios
Conclusions
Introduction
Eczema = Dermatitis
Effect on Quality of Life
(Burden of Disability)
10-15% children suffer from atopic
dermatitis
Asteototic dermatitis is becoming more
and more common in the elderly
Hand dermatitis is a major cause of
absence from work
Basic assessment and treatment
Case 1
6 months old child
Onset of problems at
age 2 months
Formula fed child-
several changes in
milk tried
None of the
ointments work
Sleeping poorly
Allergy tests?
Basic Management of Atopic
Dermatitis
Explanation expectations of treatment
Emollients
Topical Corticosteroids
Explanation
Incredibly common
Cause unknown NOT allergy
Self-limiting in most cases (eventually)
Waxing and waning natural history
Emollients
Bath
General
No limit to their use
Topical Corticosteroids
Mainstay of treatment
Not dangerous if properly used
Most steroid phobias allayed by
explanation
Awareness of different strengths

Package of Care
Time
Explain
Prescribe a package of emollient(s) and
topical steroid(s)
Empower the parents to alter strengths of
corticosteroids depending on clinical
severity
Role of Nursing Colleagues
Ideal disease for follow-up by practice
nurses and health visitors
Offer support through chronic disease
Easy access for flares of disease
Support from specialist dermatology
nurses in secondary care
What about Infection?
Staphylococcus aureus on 100% of skin
lesions
But antibiotics dont cure atopic dermatitis
But some cases improve when either
topical or systemic antibiotics added
Eczema Herpeticum
Unwell patient
Severe pain
Typical umbilicated,
coalescing papules
Herpes simplex virus
(usually type 1)
Urgent hospital
admission
What to Try if Adequate control
NOT Achieved
Concordance (social issues)
Infection
Pulse of stronger topical corticosteroid
Bandaging
Referral

Case 2
75 year old man
Retirement apartment
Likes to keep clean
Diuretics
Itching started on legs and spread to arms
and trunk

Pathogenesis
Dryness and suppleness = state of
hydration of Stratum corneum
State of hydration of stratum corneum
dependant on rate of migration of water
through stratum corneum and rate of
evaporation from its surface
Natural level of skin lipids decreases as
age increases
Management
Is the patient clinically or sub-clinically
dehydrated?
Is the environment too dry?
Is the skin being degreased too frequently
or too harshly?
Emollient
Topical corticosteroid dip in and out after
initial pulse


Case 3
40 year old man
Fed-up with years of dandruff
Recent onset of itchy, red scaling of
eyebrows, naso-labial folds
Seborrheic Eczema
Pathogenesis
Tentative
Increased numbers of Pityrosporum ovale
coupled with ? Genetic tendency
Treatment
Targeted against both P.ovale and
inflammation
Chronic condition therefore need for
repeated periods of treatment

Anti-Pityrosporum shampoo eg Selsun,
Head & Shoulders, Nizoral (contact time)
Combination anti-Pityrosporum and anti-
inflammatory cream eg Cannesten HC,
Daktacort, Nizoral

Case 4
35 year old car mechanic
Eczema as a toddler but clear for years
Recent onset dry, itchy, red rash both
hands
Some improvement when goes on holiday

Hand dermatitis
Multifactorial
Endogenous
Irritant
Allergic
Infection Bacterial and Fungal
Management
Package of treatment
Address any precipitating cause
Scrapings for mycology and swab for
bacterial contamination/infection if
indicated
General hand care
Emollients
Topical Corticosteroid
Conclusions
Diagnosis
Precipitating causes
Time for explanation natural history
Empower the patient to treat their disease
Package of treatment
Point of follow-up
What to Try if Adequate control
NOT Achieved
Concordance (social issues)
Infection
Pulse of stronger topical corticosteroid
Bandaging
Referral

Any eczema questions?