Eczema

Atopic eczema is the most common type of eczema (dermatitis) that results in a pruritic erythematous rash and usually affects flexor surfaces.

Suggested approach to atopic eczema osce station

Examine

• Dermatological skin exam

Describing lesions

• Lesions
  • ‘There are multiple papules and vesicles with an erythematous base distributed over the flexor surfaces.’
  • ‘These range in size from 1-6mm.’
  • ‘There is some evidence of lichenification and scaling but no evidence of secondary infection or eczema herpeticum.’
  • ‘These lesions are consistent with atopic eczema.’

Differential diagnosis

• Other types of eczema

If allowed to ask patient questions

• Personal/family history of asthma, hay fever, eczema

Atopic eczema

Types of eczema

• Exogenous: irritant contact, allergic contact, photocontact/photosensitive, photo-allergic
• Endogenous

Associations

• Atopic individuals/families
  • Asthma
  • Hay fever
  • Eczema

Management

• Topical treatments
  • Emollients and bath/shower substitutes
  • Corticosteroids (e.g. hydrocortisone, mometasone)
  • Calcineurin inhibitors (e.g. pimecrolimus, tacrolimus)
• Others
  • Identify and avoid allergens
  • Antihistamines for persistent pruritus/sleep disturbance
  • Phototherapy if other treatments fail
  • Antibiotics if secondary infection

Questions

What is a fingertip unit?

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Please list two complications of eczema

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What may exacerbations in eczema be associated with?

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Now try a station

1. Dermatological skin exam
2. Eczema exam
3. Eczema history
4. Find more here