- Chronic, relapsing
- Pruritic (itchy)
- Non-contagious
- Inflammatory skin condition
- Known hereditary component, more common in affected families.
- Affects 10-20% of children and 1-3% of adults in industrialized countries
- Occurs most commonly in infants and children, onset decreases substantially with age.
- Unlikely to develop in patients older than 30 yrs.
- There is no cure. It can be controlled with preventive measures and medicines.
- It is estimated that 75% will improve by the time children reach adolescence, whereas 25% continue to face the symptoms through adulthood.
Symptom - Vary with the age of patients.
- Infants- Face, scalp, legs and arms. Red, scaly, oozing, crusting rash.
- Older children- Elbow and knee flexures, sides of neck, wrist and ankle. Dry, thick, scaly skin with persistent itching.
- Adolescents- Flexural. Thick, lichenified leathery and dull-looking lesions .
Associated disorders - Allergic contact dermatitis
- Drug sensitivity
- Food allergy
- Alopecia areata
- Urticaria
Diagnosis - No Diagnostic test
- Physical examination
- History- allergies and asthma in family
What makes Atopic eczema worse? - Exposure to pollen, mold, dust
- Cold and dry air in the winters
- Colds or flu
- Contact with irritants and chemicals
- Contact with wool
- Dry skin
- Emotions and stress
- Exposure to too much water- taking long/frequent showers, swimming too often
- Sudden temperature change
- Fragrances or dyes in skin lotions or soaps
Skin care at home- Eczema remedies - Keep the skin moist using creams or lotions 2-3 times daily. moisturizers should be free of alcohol, scents, dyes, fragrances, or other chemicals.
- Keep your child's fingernails cut short. consider night gloves if nighttime scratching is a problem.
- Use gentle body washes and cleansers instead of regular soaps.
- Short, cooler baths are better than long, hot baths
- Apply lubricating creams and lotions while the skin is damp.
How to cure Eczema? Moisturizers
STEROIDS Ointments for eczema
- Provide lubrication and occlusion
- Dry, thick, hyperkeratotic lesions
- Occlusive nature improves steroid absorption
- Should not be used in hairy or intertriginous areas-groin,axilla
- Greasy- poor patient compliance
Creams for eczema
- Less potent than ointments of the same medication
- Acute exudative lesions respond because of their drying effect
- Can be used in intertriginous areas
Lotions for eczema
- Contain alcohol- drying effect on oozing lesions
- Hairy areas
Potency of topical corticosteroids
Grade 5,6 used in children
Amount of cream to apply - FTU may be helpful to know how much cream to apply
- FTU (Finger tip unit)- amount of ointment/cream expressed from a tube with 5mm diameter nozzle, applied from the distal crease to tip of index finger of an adult.
- 1 FTU is enough to treat area of skin twice the size of flat of an adult's hand with fingers together.
- 2 FTU = 1 gm of topical
Absorption of topical steroids Absorbed at different rates from different parts of body
- Forearm 1%
- Armpit 4%
- Face 7%
- Eyelids and genitals 30%
- Palm 0.1%
- Sole 0.05%
Side Effects of topical corticosteroids - Skin thinning
- Stretch marks
- Easy bruising
- Telangiectasias
- Susceptibility to skin infection
Immunosuppressants
- Calcineurin inhibitors- Tacrolimus and Pimecrolimus
- Not approved for children younger than 2 yrs
Oral
- Antihistamines- diphenhydramine and hydroxyzine
- Steroids
- Antibiotics- to treat infected rash
Phototherapy- NBUVB
