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

Questions