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

 

 Face

 

Complications

-  Infection

-  Bacterial: Strep, Staph

-  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

- Antihistamines

-  Mainly of benefit due to sedative effect, rarely suppress itch

-  Used at night

 

 

 

References

eTG: Dermatitis, accessed 13/03/2013

RCH CPG: Eczema

RCH Eczema Management Plan