ECZEMA DR SIVANIE VIVEHANANTHA DERMATOLOGY STR

AIMS  Brief overview of eczema  Enable early recognition & effective management

ECZEMA

CLASSIFICATION OF ECZEMA ENDOGENOUS  Atopic  Seborrheic  Discoid  Pompholyx / dyshidrotic  Varicose / venous / stasis / gravitational EXOGENOUS  Allergic contact  Irritant contact  Photosensitive / photoaggravated

PATCH TEST

MANAGEMENT OF EXOGENOUS EZCEMA  Avoidance of offending agent  Topical steroids +/- prednisolone  Patch testing for allergic contact dermatitis or photo- patch testing for photo-allergic dermatitis  Soap substitutes and emollients

HISTORY  Age of onset?  H/O childhood eczema?  Any evidence of worsening eczema with diet? If so, which type of food?  Areas affected?  Worsening / improving / static disease?  Eczema free days?  Pruritus? If so, does it keep the patient up at night?  Antibiotics? Hospitalisation for infective flare ups?  H/O eczema herpeticum?  H/O erythroderma?

 PMH: Atopy?  FH: - Atopy? - Ask specifically if any siblings. If has siblings, atopy?  DH: - What meds? - Previous treatments? Helpful / unhelpful? - Current treatment? Helpful / unhelpful? - Always ask about: Frequency of application and quantities used! SS, shampoo, emollient, topical steroid, steroid sparing agent, scalp applications, suits, antihistamines  Days off school / work?

MANAGEMENT  Bath additives (antibacterial?)  Soap substitute (antibacterial?) and shampoo  Emollient  Topical steroid (combination with topical antibiotic?)  Steroid sparing agents eg. topical tacrolimus  Scalp application  Potassium permanganate soaks

 Suits  Bandaging eg. viscopaste, tubigrip  Antihistamines (driving advice!)  Allergen avoidance  Dietitician involvement?  Occupational health involvement  IgE levels? (inteprete with caution!)  Systemic treatment eg. prednisolone, ciclosporin etc

 Tailor treatment to each INDIVIDUAL patient’s needs and adapt management plan to increase compliance!  Remember Afrocaribbean / Black people only wash their hair once a week and may be reluctant to use certain topical treatment if hair relaxed. Ask patient if they are willing to change hairstyle.  Nurse involvement in skin care regimen  REMEMBER: 1 FTU = 0.5 grams = Covers surface area equivalent to 2 palms Ensure patient is aware of this and prescribe adequate amounts of topical treatment!

ERYTHRODERMA  > 90% involvement of inflammatory skin disease  Causes: - Eczema - Psoriasis - CTCL (Sezary syndrome) - Drugs - Lymphoma / leukaemia - GvHD - HIV - Idiopathic

 Consequences: - Heat loss - Fluid loss (Hypovolaemia and renal failure) - Electrolyte imbalance - High output cardiac failure - Hypoalbunaemia - Hyperuricaemia - Death!  Mx (Symptomatic): - Rx underlying condition / remove offending drug - Temperature control - IV fluids - Dietician input +/- ITU admission

SUMMARY  Brief overview of eczema  Early recognition and effective management  Early involvement of Dermatologist when eczema is poorly controlled +/- erythrodermic or if patch test is required

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