Eczema (Atopic Dermatitis)
Last updated 20.09.12
Definition
- Chronic dry, itchy, inflammatory skin disease
Features
- Typically begins in early childhood
- Onset typically prior to 12 months old
- Most children grow out of eczema by 5yrs old
- Incidence 30% children
UK Diagnostic Criteria
- Itch with 3+ of
- History of involvement of skin creases
- Personal history of asthma or allergic rhinitis or
history oof atopy in 1st
degree relative
- History of dry skin in last 12 months
- Onset <2yrs old
- Visible flexural eczema
Associated S/S
- Erythematous rash
- Pruritis
- May be intractable
- Sleep disturbance
Complications
- Infection
- Herpes simplex 1 or 2: eczema herpeticum
Ix
- Swabs for bacterial or viral infection
- +/- Skin patch testing or RAST indicated if
- History of flushing, itch, urticarial or general flare
after food ingestion
- Itchy child <12 months old with moderate to severe
eczema not improving with treatment
- Child compliant with adequate treatment for 6 weeks
with no improvement
- Eczema lesions in peri-orbital
and exposed areas (arms, legs) may need to consider environmental allergen
Mx
- Avoid environmental irritants
- Soaps, bubble baths, shampoos
- Wool, sheepskin, nylon, carpets
- Grass, sand
- Maintain moist skin
- Daily bathing with dispersible oil in water
- If showering spray oil onto wet skin immediately
afterwards
- Apply emollient after bathing or showering
- Pat dry rather than rubbing
- Avoid scratching: pressure, cooling, emollients (up to
BD if very dry)
- Minimise overheating: baths <29o
- Avoid allergic factors
- Skin patch results if available
- Cats, dogs & other pets
- No evidence of diet exclusion in adults
- Paeds Mx
- Routine Mx for Paeds
- QV bath lotion
- Dermeeze
- Mx of Flare Ups
- Aggressive use of steroids until clears
- Apply after bathing then Dermeeze
to other places
- +/- wet dressings
- Consider admission for young children especially if
requiring wet dressings
- Family respite
- No Improvement
- Confirm steroid compliance (steroid phobia)
- Consider infection
- Consider allergy as precipitant
- Topical Corticosteroids
- Creams for acute weeping dermatosies
- Ointment if dry area & lichenified
- Lotion for hairy areas
- Used until dermatitis settles then switch to emollient
- Face & flexures
- Hydrocortisone 1% topical dialy
to BD
- OR Desonide 0.05% lotion
topical daily
- Other areas
- Moderate or potent corticosteroid
topical daily to BD
- Should settle by 7-14days
- Strong steroid Mometasone (Elecon) 0.1%
- Lichen simplex
- Potent to very potent corticosteroid
topical daily
- If no initial response consider more potent corticosteroid, more frequent application, occlusive dressings
& R/V of Dx
- No response to potent steroids needs derm opinion
- Wet Dressings &/or Cool Compress
- Wettex in water & oil mix
- Secure with crepe bandage
- Applied BD
- +/- Topical Primecrolimus
- Maintenance therapy for frequently recurring facial
dermatitis if continued topical corticosteroids not
appropriate
- LPC 3% to 6% + Dalicylic
acid 2% to 6% in aqueous cream or simple ointment daily at night
- Superimposed Infection
- Triclosan 2% bath oil diluted reduces infection
- Recurrent infections
- Double dipping with Dermeeze
-
Bleech baths to reduce staph load: 1/4 cup of white king in half an adult bath
twice per week
- Localised infection: Mupirocin
2% ointment or cream topical BD 7/7
- Widespread infection
- Di/Flucloxacillin 500mg (child 12.5mg/kg, max 500mg) PO 6/24 10/7
-
If
penicillin hypersensitivity Cephalexin 1g (Child 25mg/kg, max 1g) PO 12/24
10/7
-
Penicillin immediate hypersensitivity Roxithromycin 300mg (Child 4mg/kg, max 150mg) PO daily 10/7
-
Mainly of
benefit due to sedative effect, rarely suppress itch
References
eTG: Dermatitis, accessed
13/03/2013