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Thursday, 23 June 2011

ECZEMA


The terms eczema and dermatitis are often used to describe the same
condition. Eczema is a non-infectious inflammation of the skin. It may be
acute, subacute or chronic and is influenced by many factors, i.e.
constitutional, irritant (vaseline, mineral oils, soaps and detergents –
vegetable oils usually are no problem), allergens, heat, stress, infection
etc. An acute eczema characteristically shows redness, swelling,
papules, blisters, oozing and crusts. Progressing to the subacute stage,
the skin is still red but becomes drier and scalier and may show pigment
changes. In the chronic stage lichenification, excoriations, scaling and
cracks are seen. There are many different types of eczema, the most
common ones will be presented on the following pages. They may have
predominantly acute, subacute or chronic phases. Itching is often the
major complaint.
ATOPIC ECZEMA
Atopic eczema is a multifactorial skin disease seen in patients with an
atopic constitution. This means that they have a genetic pre-disposition
for hypersensitivity reactions such as asthma, hay fever and atopic
eczema. The eczema comes and goes and may be triggered or worsened
by dryness of the skin, infections, heat, sweating, contact with allergens
or irritants and emotional stress. Atopic eczema in children and
adults appears in elbow- and knee-folds, on the wrists and ankles and
on the face and neck, in some cases it may become generalised. Itch is
an important feature. In long-standing disease lichenification is common.
Management of atopic eczema in children and adults
- Explain to the patient the recurrent nature of the disease! Take the time to explain
daily skin care as described below, and how to use the drugs prescribed.
- Stop the use of irritants such as vaseline, mineral oils and soap. Avoid temperature
extremes and contact with wool. Use a non-greasy moisturiser such as aqueous
cream, if the skin is very dry urea 5% or 10% ointment. Soap is an irritant, especially
if not rinsed off properly after use. In active phases of eczema use aqueous cream
or emulsifying ointment as a soap.
- In severe eczema, the patient should take rest.
- Lesions: - A mild topical steroid such as hydrocortisone 1% (cream for acute or
wet, ointment for chronic or dry lesions) once to twice daily until lesions
clear, usually in about 2 weeks.
- In severe or refractive cases a stronger steroid e.g. betamethasone
11
0.1% once daily for 1-2 weeks. Do not use strong steroids in the face.
- Always use topical steroids intermittently when they are used over
longer periods of time.
- Chronic lichenified cases: coal tar 2-10% paste/ointment at night.
- For severe itchiness use antihistamines e.g. promethazine 25 mg at night.
- For bacterial superinfection use betadine shampoo as a soap or when weepy bathe
in potassium permanganate 1:4000 solution. In severe or widespread infection give
antibiotics (cloxacillin, erythromycin) as in impetigo.

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