Background
- 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
Clinical
Clinical Diagnosis
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.
Differential Dx
| Condition | Ages | Characteristics | |
|---|---|---|---|
| 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 |
Complications
- 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
Management
- 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