Known hereditary component, more common in affected families.
Affects 10-20% of children and 1-3% of adults in industrialized countries
Occurs most commonly in infants and children, onset decreases substantially with age.
Unlikely to develop in patients older than 30 yrs.
There is no cure. It can be controlled with preventive measures and medicines.
It is estimated that 75% will improve by the time children reach adolescence, whereas 25% continue to face the symptoms through adulthood.
Symptom
Vary with the age of patients.
Infants- Face, scalp, legs and arms. Red, scaly, oozing, crusting rash.
Older children- Elbow and knee flexures, sides of neck, wrist and ankle. Dry, thick, scaly skin with persistent itching.
Adolescents- Flexural. Thick, lichenified leathery and dull-looking lesions .
Associated disorders
Allergic contact dermatitis
Drug sensitivity
Food allergy
Alopecia areata
Urticaria
Diagnosis
No Diagnostic test
Physical examination
History- allergies and asthma in family
What makes Atopic eczema worse?
Exposure to pollen, mold, dust
Cold and dry air in the winters
Colds or flu
Contact with irritants and chemicals
Contact with wool
Dry skin
Emotions and stress
Exposure to too much water- taking long/frequent showers, swimming too often
Sudden temperature change
Fragrances or dyes in skin lotions or soaps
Skin care at home- Eczema remedies
Keep the skin moist using creams or lotions 2-3 times daily. moisturizers should be free of alcohol, scents, dyes, fragrances, or other chemicals.
Keep your child's fingernails cut short. consider night gloves if nighttime scratching is a problem.
Use gentle body washes and cleansers instead of regular soaps.
Short, cooler baths are better than long, hot baths
Apply lubricating creams and lotions while the skin is damp.
How to cure Eczema?
Moisturizers
STEROIDS
Ointments for eczema
Provide lubrication and occlusion
Dry, thick, hyperkeratotic lesions
Occlusive nature improves steroid absorption
Should not be used in hairy or intertriginous areas-groin,axilla
Greasy- poor patient compliance
Creams for eczema
Less potent than ointments of the same medication
Acute exudative lesions respond because of their drying effect
Can be used in intertriginous areas
Lotions for eczema
Contain alcohol- drying effect on oozing lesions
Hairy areas
Potency of topical corticosteroids
Grade 5,6 used in children
Amount of cream to apply
FTU may be helpful to know how much cream to apply
FTU (Finger tip unit)- amount of ointment/cream expressed from a tube with 5mm diameter nozzle, applied from the distal crease to tip of index finger of an adult.
1 FTU is enough to treat area of skin twice the size of flat of an adult's hand with fingers together.
2 FTU = 1 gm of topical
Absorption of topical steroids
Absorbed at different rates from different parts of body
Forearm 1%
Armpit 4%
Face 7%
Eyelids and genitals 30%
Palm 0.1%
Sole 0.05%
Side Effects of topical corticosteroids
Skin thinning
Stretch marks
Easy bruising
Telangiectasias
Susceptibility to skin infection
Immunosuppressants
Calcineurin inhibitors- Tacrolimus and Pimecrolimus
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