Atopic Eczema


  • stubborn itchy rash

Typical Patient

  • family history of atopy

  • rare in babies before 4 months

  • 15% infants and small children

  • may reappear in adulthood

Symptoms / Signs

  • babies

    • face first then hands / feet

  • children

    • skin folds - elbows, knees

  • adults

    • face

    • hands

Variants

Pathology

  • ? genetic defect in skin

Investigations

  • none

  • consider patch test if possibility of contact dermatitis

Treatments

  • reduce contact

    • irritants

    • allergens

  • emollients

  • topical steroids

  • antibiotics

  • antihistamines

  • evening primrose / star flower oil (3-6g)

  • coal tar

  • PUVA / UVB

  • tacrolimus

Prognosis

  • no treatment can be considered a cure

  • most improve over time

Complications

  • secondary infection

    • Staphylococcus aureus

      • suddenly gets worse

      • yellow/golden crusting

    • Herpes simplex

 

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