Understanding eczema

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Understanding eczema
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Skin changes in eczema

• Eczema is an inflammatory condition arising from
  a breakdown of the epidermalbarrier
• In normal, healthy skin, the epidermis acts as a
  protective barrier
• In eczema, the lipid layer is defective causing
• Water loss
• Cracks in the outer layer of skin (stratum
  corneum)

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Signs and symptoms of eczema

• Presents as an itchy red rash which may be
• Dry with scaling and cracking
• Wet and weepy
• Often located on flexor surfaces
• Insides of elbows, behind knees, faceand neck
• Extensor surfaces may be affected in children
  under 18 months and Asian/Black children
• May also present with oedema, papules and
  vesicles, or thickened skin (lichenified) in
  chronic eczema

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History

• Atopic eczema nearly always appears in childhood1
• In 80-90 of cases before the age of 5 years1,2
• Considered to be part of the atopic march
  with hayfever, asthma or perennial allergic
  rhinitis3
• Commonly there is a family history of eczema or
  allergy1,2

1. Holden CA, Parish WE (1998) In Ebling
Textbook of Dermatology. Vol 1, 6th edition
Rook, Wilkinson. p. 681-7082. Beltrani VS,
Boguneiwicz M (2003). Dermatology Online Journal,
9(2), 1 3. NICE (2007) Clinical Guideline 57,
London, December 2007
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Causal factors

• Usually as the result of exposure to a trigger
  factor or environmental allergen
• Common triggers include house dust mites, pollen,
  pet dander and food
• Eczema triggers are often the same as asthma or
  hayfever triggers
• Stress does not cause, but may aggravate eczema1

1. Beltrani VS, Boguneiwicz M (2003). Dermatology
Online Journal, 9(2), 1
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Course of the disease

• Atopic eczema is a chronic condition
  characterised by intermittent flare-ups and
  periods of remission
• In children, the severity of symptoms can
  fluctuate throughout the day
• Eczema usually clears up during childhood, but
  may persist into adulthood1
• Adults who had childhood eczema are more likely
  to develop irritant contact dermatitis2

1. NICE (2007) Clinical Guideline 57, London,
December 20072. Holden CA, Parish WE (1998) In
Ebling Textbook of Dermatology. Vol 1, 6th
edition Rook, Wilkinson. p. 681-708
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Infected eczema

• Damage from inflammation and scratching can make
  patients with eczema more susceptibleto
  bacterial and viral infections1
• Bacterial infections are normally due to
  Staphylococcus aureus
• The skin of people with eczema tends to be more
  heavily colonised with staphylococci than normal1

1. NICE (2007) Clinical Guideline 57, London,
December 2007
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Eczema herpeticum

• Children with eczema are more vulnerable to
  Herpes simplex infections
• Herpes infection may rapidly become widespread
  a condition called eczema herpeticum
• Eczema herpeticum can become systemicand life
  threatening and needs urgent hospital referral
• Patients should be educated to recognise the
  signs and symptoms of eczema herpeticum1, which
  include
• A widespread dense rash with vesicles and
  punched-out erosions

1. NICE (2007) Clinical Guideline 57, London,
December 2007
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When to seek specialist dermatological advice

• When there is a question around diagnosis
• In the case of infection, when your patient
• Has not responded to treatment for bacterial
  infection
• Is experiencing severe and recurrent infections
• Or you suspect eczema herpeticum
• With regards to treatment, when your patient
• Has not responded satisfactorily to optimum
  topical therapy
• May benefit from specialist advice on treatment
  application such as wet wraps
• Is experiencing significant social or
  psychological problems

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Other types of specialist advice

• When eczema is having a significant impact on a
  patients quality of life and psychosocial
  wellbeing, they should be referred for
  psychological advice
• Patients with moderate or severe eczema and
  suspected food allergy should be referred for
  specialist investigation and allergy management
• Children with eczema who fail to grow at the
  expected rate should be referred for specialist
  paediatric advice relating to growth

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Date of preparation March 2008 Code DIP/08-434