Eczema

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WhatCauses ?

Clinical Presentations Of

Complication Of

Treatment Options For

Prevention Of

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What Is Eczema?

Eczema (Atopic dermatitis) is a chronic inflammatory skin condition which mostly starts in infantile stage. It is more common in children with family members who have asthma, hay fever or atopic dermatitis.

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What Causes Eczema?

It is due to combination of multiple factors, including increase in Th2 inflammatory cells which would reduce production of filaggrin proteins. They have a key role in assisting with water binding capacity of stratum corneum (top layer of skin) cells. Ceremide also plays a major role in hydrating our skin. However in eczema, we have considerable reduction in amount of our skin ceramide.

Clinical Presentations Of Eczema

Pruritus (itch) is the main symptom associated with eczema. Atopic dermatitis (eczema) presents generally as ill-defined red scaly, flaky patches which can affect different part of body at different stage of life:

  • Infantile (<2 years):
    • It affects scalp, neck, cheeks and spare central face area
    • It can presents as oozing red patches
    • It also involves extensor aspect of extremities & trunk
    • It does spare diaper area at this stage of life
  • Childhood (2-12 years):
    • It presents as thickening and hardening of skin at antecubital (elbow crease) & popliteal fossa (behind knee)
    • It can involve head (especially around the mouth), neck, wrists, hands, ankles & feet area
  • Adult
    • It mostly is limited to chronic hand dermatitis
    • It can also presents as facial dermatitis with severe eyelid involvements
Complication Of Eczema
  • Secondary bacterial infection with staph. Aureus or streptococcus infections, which presents as honey crusted dry blood
  • Eczema Herpeticum: herpes infection affecting eczema patches, presents as multiple grouped 1mm vesicles (small fluid filled blisters) affecting eczema patches. This is an urgent condition which needs to be treated right away
Treatment Options for Eczema
  • Home remedies
    • Moisturizers (CeraVe or Cetaphil, Aveno,…) should be used twice a day and especially after each daily bath or shower with lukewarm water
    • Avoiding scented products (scented shampoo, body wash, conditioner, detergent)
  • Over the counter medications
    • Hydrocortisone 1% can be applied once or twice a day to affected area
    • Anti-histamine
      • Claritin (Loratadine)
      • Cetirizine (Zyrtec)
      • Fexofenadine (Allegra)
      • Bilastine
  • Prescription
    • Topical medications
      • Topical steroid creams and ointments as well as scalp lotions or solutions
      • Protopic ointment & Elidel cream especially over facial and body folds
      • Crisaborole topical therapy
    • Phototherapy
      • Narrow band UVB phototherapy
    • Systemic therapy
      • Orel steroid (prednisone) 0.5mg/kg – 1mg/kg staring dose
      • Methotrexate on weekly basis as well as daily folic acid
      • Cyclosporine
      • Imuran
      • Dupilumab (an injectable biologics)
      • Jack inhibitors (new class of medications)
Prevention Of Eczema
  • Avoiding scented products
  • Daily bath or shower with lukewarm water
  • Avoiding using soap, instead benefiting from CeraVe or Cetaphil cleansers
  • Avoiding drying the skin post bath, just dabbing the skin
  • Applying a thick layer of moisturizer within 3 minutes after bath
  • Using cotton cloth, less irritating to skin
  • Avoiding scented detergent or fabric softener
  • Applying a thick layer of moisturizer to affected area prior going to bed
  • Minimizing sweating which can irritate skin
  • Minimizing drooling in infants and using barrier cream (zinc paste products) to protect the skin

Essential Reads

Itchy Skin

Pruritus is a a sensation that elicits a desire to scratch. Pruritus is the most common skin symptom, with underlying systemic etiology in 10-25% of patients

Rash

Pruritus is a a sensation that elicits a desire to scratch. Pruritus is the most common skin symptom, with underlying systemic etiology in 10-25% of patients.

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What Causes Eczema?
It is due to combination of multiple factors, including increase in Th2 inflammatory cells which would reduce production of filaggrin proteins. They have a key role in assisting with water binding capacity of stratum corneum (top layer of skin) cells. Ceremide also plays a major role in hydrating our skin. However in eczema, we have considerable reduction in amount of our skin ceramide.

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