Eczema (Dermatitis)

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CLINICAL DESCRIPTION

A chronic inflammatory skin condition characterised by episodes of intense itch.

Classification: 

Depends on causes whether intrinsic (endogenous) to the individual or from external environment (exogenous)

  • Endogenous
    • Atopic eczema
    • Seborrheic eczema
    • Nummular eczema
    • Stasis eczema
    • Asteatosis eczema
  • Exogenous
    • Contact eczema
      • Due to scratching, the skin in eczema may become secondarily infected by bacteria, fungi or viruses.
      • Therapy must therefore include of the superinfection as well as of the eczema if indicated.
  • Underlying medical conditions may influence clinical appearance of various eczemas e.g., seborrhoeic eczema may be severe in the immunosuppressed and people with history of atopic diseases are more likely to develop atopic eczema.

CLINICAL FEATURES

SIGNS AND SYMPTOMS
  • Manifests with an erythematous skin rash, excoriations, oozing, vesicles, bullae, crusts, lichenification depending on duration and cause.
INVESTIGATIONS
  • Usually a clinical diagnosis after history and examination.

TREATMENT 

  • Counsel the patient on the condition
  • atopic eczema is chronic and may come and go. It is not curable but requires good skin care to prevent flares.
  • Remove any obvious precipitating factors e.g., contact and atopic eczema) like soaps, detergents, cosmetics, clothing etc.
  • Food allergies are generally rare as a cause of eczema. Avoid unnecessary exclusion of foods in the diet with an aim of controlling eczema
  • Moisturisers must be used liberally
  • All treatments for eczema must be used together with and not instead of emollients.
  • Treatment aims to control symptoms and to prevent disease activity

Topical Steroids:

  • Give Betamethasone 0.05 % 12 hourly until symptoms improve.
  • Whether to use the medicine in a cream or ointment form will depend on if it is acute, subacute or chronic (see below).
  • For children and on other parts of the body like the face, genitalia and skin folds, weaker strength steroids like Hydrocortisone 1 % 12 hourly may be tried first and upgrade if there is unsatisfactory progress.
  • If superinfected e.g., with bacteria or viruses, treat the infection as well as stated under the relevant sections

Antihistamines

  • Must only be used to help sedate a patent who is failing to sleep due to severe itch.
  • They therefore complement the role of steroids and emollients and must not be used as a sole treatment modality. Their use should be reviewed after a week.
  • Promethazine 25 mg orally at night for a maximum of 7 days (for children prescribe according to body weight)

Alternatively

  • Give Chlorpheniramine 4 mg at night for a maximum of seven days (for children prescribe according to body weight)

 

ACUTE ECZEMA

Manifested by an eruption comprising one or more of the following features: erythema, vesicles, bullae, erosions and crusts.

General Management 

  • Wet or oozing lesions - use the above stated medicines in creams form to keep them dry

SUBACUTE ECZEMA

Manifests with more scaling and fissures mixed with some erythema.

General Management

  • Use ointment form.

CHRONIC ECZEMA

Manifests with more dryness and scaling with lichenification (skin thickening).

Severe itch a constant feature

General Management

  • Advise to stop scratching.
  • Liberal use of moisturisers
  • Use ointment form

Alternative

  • Give topical steroid e.g., Betamethasone 0.1%