Definition
An inflammatory skin condition characterised by dry pruritic skin
What is eczema (or atopic dermatitis)?
Usually starts in infancy and is episodic in nature
What is the natural history of eczema?
Mild potency topical corticosteroids e.g., 0.1% hydrocortisone
What is the pharmacological treatment for mild eczema?
Itchy skin plus 3 from: flexural eczema (and/or extensor in <18mYOs), personal history of eczema, dry skin, asthma or allergic rhinitis (or 1st degree relative), onset before 2 years.
What is needed to diagnose eczema?
Note - investigations are needed.
Folliculitis
What is a potential adverse effect of ointments used to treat eczema?
Epidermis (and dermis in severe cases)
Plain emollients
What is the primary non-pharmacological treatment for eczema (recommended by NICE)?
Note - this is the first step for mild, moderate and severe eczema. Emollients containing active ingredients are generally not recommended as they increase the risk of skin reactions.
Apply sparingly to all affected areas about 15-30 mins after emollient application
What is the advice on how to apply topical corticosteroids?
Note - finger-tip units provided in the medication leaflet
Topical calcineurin inhibitors
What is the second-line pharmacological treatment for moderate-severe eczema?
Note - prescribed by a specialist
IgE
What is the antibody which is high in eczema?
Should be applied liberally every 2-3 hours (~4 times a day), during or after washing following gentle drying
What is the guidance on emollient application for eczema?
Note - skin should still be moist when applied after washing, they should be smoothed not rubbed into skin
Bandages
What is the third-line treatment for moderate and severe eczema?
2-10%
What is the percentage of adults with eczema in the population?
Lichenification
What is the process by which the skin becomes thickened and leathery in response to persistent scratching of patches of chronic eczema?
Note - eczema can split into acute eczema (flares) or chronic eczema. Flares vary in appears from poorly demarcated redness to fluid in the skin (vesicles), scaling, or crusting of the skin. Whereas chronic eczema is characterised by lichenified skin and bumps from keratin build-up (keratosis pilaris).
Primarily involves the face, the scalp, and the extensor surfaces of the limbs. The nappy area is usually spared.
What is the presentation of eczema in infants?
Potent topical corticosteroids
What is the pharmacological treatment for severe eczema?
Phototherapy and oral corticosteroids
What is the 4th and 5th line treatments for severe eczema?
Note - Phototherapy is available in secondary care for the treatment of very severe eczema that has proved resistant to standard treatment. Systemic immunosuppressants (for example ciclosporin and azathioprine) are also available in secondary care for the same indication. Oral corticosteroids can be prescribed short-term in primary care for severe flares.
Spongiosis
What is the name of fluid build-up in the epidermis? (seen on a microscopic level in eczema)
Dryness and itching, especially when exposed to irritants. Hands may primarily be affected.
What is the presentation of eczema in adults?
Note - In adults and children with long-standing disease eczema is often localised to the flexure of the limbs.
Betamethasone valerate 0.025%
70-90% of cases
What percentage of cases occur before the age of 5 years?