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Eczema- Atopic (Adult) :a chronic, itchy, inflammatory skin condition that…
Eczema- Atopic (Adult) :a chronic, itchy, inflammatory skin condition that affects people of all ages, although it presents most frequently in childhood
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Differentials
Psoriasis — less itchy, well-circumscribed, reddish, flat-topped plaques with silvery scales; typically symmetrical.
Allergic contact dermatitis — eczematous rash, at any site related to a topical allergen, in a person of any age. Allergic contact dermatitis can be both an alternative diagnosis and a trigger factor of atopic eczema.
Seborrhoeic dermatitis — red, sharply marginated lesions with greasy scales; usually confined to areas with sebaceous gland activity (for example ears, beard area, eyebrows, scalp, and nasolabial folds).
Fungal infection — annular patch or plaque with slightly raised, sometimes scaly, border, and central clearing.
Scabies or other infestations — should be suspected when there is recent onset of an itchy rash in a family.
Referral
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food allergy trigger is suspected and the expertise to diagnose and manage food allergy is not available in primary care.
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Complications
Infection e.g. bacterial, fungal, herpes complex
Psychosocial problems e.g. insomnia, depression, poor self confidence
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Specific management
Moderate disease- potent topical steroid until signs improvement. Then consider a reduction in the frequency of application or potency step down. Consider topical tacrolimus ointments for facial eczema not responding to steroids.
Eczema Herpecticum- stop topical steroids/tacrolimus and refer urgently to dermatology. Obtain urgent viral PCR swabs if available.
Mild disease- topical steroid e.g clobetasone butyrate to trunk and limbs. Hydrocortisone 1% to face
Causes
environmental factors (such as exposure to pets, house-dust mites, and pollen)
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urgent referrral
eczema herpeticum (characterized by rapidly worsening, painful eczema; clustered blisters; and punched out erosions) is suspected.
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Categories
Moderate-areas of dry skin, frequent itching, and redness (with or without excoriation and localized skin thickening).
Severe-widespread areas of dry skin, incessant itching, and redness (with or without excoriation, extensive skin thickening, bleeding, oozing, cracking and alteration of pigmentation).
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Infected- weeping, crusted,pustules with fever/malaise
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