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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
AtopicMost common and described here
SeborrhoeicGreasy/scaly erythematous rash around nose, ears and scalp
AsteatoticCracked skin, often on lower limbs
DiscoidCoin-like lesions
Pityriasis albaPink scaly patches that later leave hypopigmentated areas of skin
PompholyxItchy blisters on hands and feet
VaricoseAssociated 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

Questions

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