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Atopic Eczema (atopic dermatitis) - Coggle Diagram
Atopic Eczema (atopic dermatitis)
Intro
prevalence = 20%
genetic deficiency of skin barrier function
enhanced antigen penetration through deficient epidermal barrier
onset usually in 1st yr of life, but uncommon in 1st 2mo (unlike infant seborrhoeic dermatitis)
often family hx of atopy
eczema
asthma
allergic rhinitis (hayfever)
1/3 will develop asthma
Exclusive breastfeeding may delay onset in predisposed children, but does not appear to have impact on prevalence later in childhood
mainly a disease of childhood
most severe in 1st yr of life
resolves in 50% by 12, 75% by 16
Dx
made clinically
elevated total IgE
skin/RAST may reveal allergens
Immune deficiency should be excluded if eczema severe, atypical or a/w FTT or unusual infections
Clinical features
main sx = pruritus
no itch, not eczema
scratching exacerbates rash - erythema, weeping, crusting
itch-scratch cycle
distribution changes with age
infant: scalp, face, trunk
older child: flexor surfaces (cubital + popliteal fossae) + friction surfaces (neck, wrists, ankles)
skin dry, lichenification from prolonged scratching (accentuation of normal marks)
Comps
exacerbations
common
often for no reason
regional lymphadenopathy common in flares - resolves once skin improves
causes
infection (bacterial or viral)
ingestion of allergen
contact with irritant/allergen
heat/humid environment
change/reduction in meds
stress
infection
strep
staph
A aureus thrives on atopic skin, releases superantigens that worsen eczema
HSV: eczema herpeticum
Tx
avoid irritants/precipitants
soap
biological detergents
pure cotton clothes best - avoid nylon + wool
allergens
prevent scratching damage
short nails
mittens @ night
emollients
mainstay tx
moisturise + soften skin
apply liberally 2+ times a day/after bath
ointments>creams
soft + liquid paraffins
can use emollient oil as soap substitute
topical corticosteroids
use with care
mild (1% hydrocortisone) BD
moderate steroids must be used minimally, applied thinly, not on face
excess use can cause thinning of skin + systemic SEs
immunomodulators
short term topical tacrolimus or pimecrolimus
must be >2y/o
for eczema not controlled by steroids, risk of adverse effects from further steroids
occlusive bandages
helpful when scratching is a problem
can be impregnated with zinc/tar paste
worn until skin improved (overnight or 2/3d)
wet stockinette wraps
for young children with widespread scratching
diluted topical steroids in damp wraps, covered with dry wraps
antibiotics/antivirals
topical if mildly infected
systemic if widespread/severe infection
systemic acyclovir for eczema herpeticum
oral antihistamines
suppresses itch
2nd gen not sedative
dietary elimination
trial for 4-6wks to see response
may need hydrolysed protein/AA formula instead of cows milk formula
carried out with advice of dietician
children can usually tolerate offending food by 3-4y/o (except peanuts)
esp eggs (consider screening)
psychosocial support
check if it interferes with sleep/other aspects of life
Eczema can be non-atopic