Table of Contents
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
Types of eczema
- Exogenous: irritant contact, allergic contact, photocontact/photosensitive, photo-allergic
- Endogenous
Atopic | Most common and described here |
Seborrhoeic | Greasy/scaly erythematous rash around nose, ears and scalp |
Asteatotic | Cracked skin, often on lower limbs |
Discoid | Coin-like lesions |
Pityriasis alba | Pink scaly patches that later leave hypopigmentated areas of skin |
Pompholyx | Itchy blisters on hands and feet |
Varicose | Associated with chronic venous insufficiency; affects lower limbs |
Associations
- Atopic individuals/families (i.e. asthma, hay fever, eczema)
- Exacerbations may be associated with:
- Allergens (e.g. chemicals, food, dust, pet fur)
- Infection
- Heat/sweating
- Stress
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
Complications
- Secondary infection
- Eczema herpeticum