- Itchy, cracked, dry, sore skin areas
- Hands, flexor surfaces of elbows & knees (face, scalp in children)
- Multifactorial aetiology
- Adults : children = 80:20
- FHx, also seen with asthma / rhinitis
- Flare ups may be triggered by detergent, cold weather food allergens
- Cell mediated IgE hypersensitivity rxn
Itchy skin and at least 3 of:
- Visible flexural dermatitis involving the skin creases (or visible dermatitis on the cheeks and/or extensor areas in children ≤ 18 months).
- Personal history of flexural dermatitis.
- Personal history of dry skin in the last 12 months.
- Personal history of asthma or allergic rhinitis (or history of atopic disease in a first-degree relative if the patient is <4 years old).
- Onset of signs and symptoms <2 years.
Very rarely a punch Bx may be required.
|Seborrhoeic eczema||Infants||Characteristic non-pruritic greasy scales (esp. scalp/nappy). Appears in first 6 weeks of life and spond. resolves in weeks|
|Seborrhoeic eczema||Adults||Erythematous patches with yellow, white or greyish scales in seborrhoeic area esp. face, scalp chest|
|Nummular (discoid) eczema||Children and adults||Coin-shaped scaly patches on legs or buttocks ± itch|
|Irritant contact dermatitis||Children and adults||Acute ot chronic eczematous lesions at sites of exposure, typically less itchy than atopic eczema|
|Allergic contcat dermatitis||Children and adults||Well-circumscribed erythematous rash with max. expression at exposure sites|
|Asteatotic eczema||Adults||Scaly, fissured patches of dermatitis on dry skin, esp. legs|
|Psoriasis||Adults and children||Well efined red scaly plaques (extensor surfaces, nails, scalp)|
|Dermatophyte infesction||Children and adults||One or more demarcated scaly plaques with central clearing ±itch|
|Impetigo||Children||Demarcated erythematous patches with blisters or honey-yellow crusting|
|Scabies||Children||Itchy superficial burrows and pustules on palms and soles, between fingers and genitalia|
- Skin barrier dysregulation - prone to infection.
- Staph. aureus - weeping, crusting, pustules, constitutional Δ.
- Eczema herpericum - HSV - severe infection.
- Molloscum contagiosum.
- Fungal infectuions (M.furfur) - local scales.
- Emollients to stop the skin drying (not aqueous cream as it may irritate skin)
- Topical steroid cream / ointments (lowest effective potency dose first) to reduce inflammation during flare up
- Topical calcineurin inhibitors (tacrolimus). Second line. Block T-cell activation without causing skin atrophy
- Treatments for any superadded infections (bact/viral/fungal)
- Antihistamines if itch causing insomnia
- Wet wrap therapy and phototherapy from dermatologist only