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

• Nummular / Discoid eczema

• Pompholyx

• Plantar dermatosis

• Asteatosis

• stasis eczema

Pathology

• ? genetic defect in skin

Investigations

• none

• consider patch test if possibility of contact dermatitis

Treatments

• reduce contact

  • irritants

  • allergens

• emollients

• topical steroids

• antibiotics

  • antiseptics

    • potassium permanganate

  • topical

    • sodium fusidate

  • systemic

    • flucloxacilin

    • erythromycin

• 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

    • Eczema herpeticum

    • severe blistering rash

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