ECZEMA

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ECZEMA

• DR SIVANIE VIVEHANANTHA
• DERMATOLOGY STR

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AIMS

• Brief overview of eczema
• Enable early recognition effective management

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ECZEMA
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CLASSIFICATION OF ECZEMA

• ENDOGENOUS
• Atopic
• Seborrheic
• Discoid
• Pompholyx / dyshidrotic
• Varicose / venous / stasis / gravitational

• EXOGENOUS
• Allergic contact
• Irritant contact
• Photosensitive / photoaggravated

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PATCH TEST
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MANAGEMENT OF EXOGENOUS EZCEMA

• Avoidance of offending agent
• Topical steroids /- prednisolone
• Patch testing for allergic contact dermatitis or
  photo-patch testing for photo-allergic dermatitis
• Soap substitutes and emollients

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HISTORY

• Age of onset?
• H/O childhood eczema?
• Any evidence of worsening eczema with diet? If
  so, which type of food?
• Areas affected?
• Worsening / improving / static disease?
• Eczema free days?
• Pruritus? If so, does it keep the patient up at
  night?
• Antibiotics? Hospitalisation for infective flare
  ups?
• H/O eczema herpeticum?
• H/O erythroderma?

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• PMH Atopy?
• FH
• - Atopy?
• - Ask specifically if any siblings. If has
  siblings, atopy?
• DH
• - What meds?
• - Previous treatments? Helpful / unhelpful?
• - Current treatment? Helpful / unhelpful?
• - Always ask about
• Frequency of application and quantities
  used!
• SS , shampoo, emollient, topical steroid,
  steroid
• sparing agent, scalp applications, suits,
  
• antihistamines
• Days off school / work?

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MANAGEMENT

• Bath additives (antibacterial?)
• Soap substitute (antibacterial?) and shampoo
• Emollient
• Topical steroid (combination with topical
  antibiotic?)
• Steroid sparing agents eg. topical tacrolimus
• Scalp application
• Potassium permanganate soaks

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• Suits
• Bandaging eg. viscopaste, tubigrip
• Antihistamines (driving advice!)
• Allergen avoidance
• Dietitician involvement?
• Occupational health involvement
• IgE levels? (inteprete with caution!)
• Systemic treatment eg. prednisolone, ciclosporin
  etc

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• Tailor treatment to each INDIVIDUAL patients
  needs and adapt management plan to increase
  compliance!
• Remember Afrocaribbean / Black people only wash
  their hair once a week and may be reluctant to
  use certain topical treatment if hair relaxed.
• Ask patient if they are willing to change
  hairstyle.
• Nurse involvement in skin care regimen
• REMEMBER
• 1 FTU 0.5 grams
• Covers surface area equivalent
  to 2 palms
• Ensure patient is aware of this and
• prescribe adequate amounts of topical
  treatment!

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ERYTHRODERMA

• gt 90 involvement of inflammatory skin disease
• Causes
• - Eczema -
  Psoriasis
• - CTCL (Sezary syndrome) - Drugs
• - Lymphoma / leukaemia - GvHD
• - HIV
  - Idiopathic

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• Consequences
• - Heat loss
• - Fluid loss (Hypovolaemia and renal failure)
• - Electrolyte imbalance
• - High output cardiac failure
• - Hypoalbunaemia
• - Hyperuricaemia
• - Death!
• Mx (Symptomatic)
• - Rx underlying condition / remove offending
  drug
• - Temperature control
• - IV fluids
• - Dietician input
• /- ITU admission

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SUMMARY

• Brief overview of eczema
• Early recognition and effective management
• Early involvement of Dermatologist when eczema is
  poorly controlled /- erythrodermic or if patch
  test is required

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THANK YOU