1. Eczema School. Department of Dermatology, Aarhus Sygehus,
Anne Braae Olesen, MD, Ph.D. or
Mette Deleuran, Chairman, MD, DMSc.

2. Purpose/goal for the Eczema School.
To educate the parents about the disease
To treat the disease correctly.
To accept the disease.

3. Different names for the disease
Child eczema
Asthma eczema
Atopic dermatitis
Atopic eczema
Prurigo Besnier

4. Atopic eczema – how to describe the disease?
Chronic skin disease that varies in intensity
Dominated by severe itch and an increased tendency to itch
Acute eczema: weeping? and often with infection.
Chronic eczema: dry, infiltrated skin.

5. How common is the disease and courses for the disease?
Affects per cent of all Danish children
Increased prevalens
Genetic factors are involved
Increased risk for the disease if the parents and siblings have the disease
Environment and everyday life also have an impact on the disease.

6. Changes in the skin. The mechanical barrier is defect
Decreased amount of fats in the skin
Increased water loss from the skin
Increased amount of inflammatory cells in the skin

7. Skin barrier function
Altered composition of fatty acids in the strateum corneum
Increased water loss LB

8. Skin dryness
Krakeleret eksem
Huden knastør og skællende

9. Atopic Eczema – itch The skin is leaking
Evaporation – the skin gets dry
The skin is itching and the child itches back
”Definition” af kløe (1600-tallet): en ubehagelig fornemmelse som medfører et ønske om at kradse sig
Det er ikke nogen rationel refleks. Kløe og krads medfører yderligere hudirritation og likenisering samt eksem
(Smerte er en anti-kløe tilstand)
Tomgangsbevægelse
Polerede negle
Undgå bebrejdelser (operant betingning)

10. Do you think I sleep well at night?

11. Development of eczema disease
90 per cent develop the disease in the first three years of life
Early debut can be predictive for severe disease
75-80 per cent are clear of symptoms in childhood
In per cent of the patients the disease comes back
25-50 per cent develop hand eczema later

12. Distribution of eczema
Infants: especially the face, the scalp and the extensor sides of the extremities

13. Distribution of eczema
Infants, especially the face, the scalp and the extensor sides of the extremities.

14. “Lick eczema”
Cheilitis
tørt fissureret eksem omkring mund og læber

15. Distribution of eczema.
Children: flexural areas, head and neck, ankles and wrists.

16. Distribution of eczema.
Adults: often face, neck and hands.

17. Complications
Wound infections with staph. aureus: impetigo.

18. Complications
Impetigo, oozing eczema.

19. Complications
Herpes infections

20. Complications
Molluscum.

21. Complications
Warts and condyloma

22. Increased risks for other diseases
Asthma (approximately 33 per cent)
Hay fever (approximately 33 per cent)
Food allergies (5-7 per cent)
Food intolerance

23. Diet in children with eczema
Nursing can postpone eczema debut
Uncertain whether the eczema can be prevented
Eczema patients on a diet are not free of symptoms
Some children do get better on a diet
A diagnosis of food allergy is based on history, prick/RAST-test and maybe provocation.

24. Dietary treatment in patients with eczema
Many positive prick/RAST-tests concerning foods are not clinically relevant
Some food allergies can disappear when the child grows older
Dietary treatment do not always need to be life long
It is important to consider the diet from time to time.

25. Dietary treatment in patients with eczema
Avoid strict diets in children where you do not have specific suspicion on allergies.
Malnutrition has been observed
How severe the diet should be depends on the disease history.

26. Principles for treatment
Avoid factors that irritate the skin

27. Principles for treatment
Emmollient is basic treatment Control of dryness and itch

28. Steroid creams

29. Steroid creams Containing cortico-steroids Are divided into 4 groups
Effect and side effect go hand in hand
Diminish the inflammation in the skin
Contract the block vessels and diminish erythema
Diminish itch

30. Steroid creams
Absorption of cream is greatest in areas with thin skin and intertriginous areas
Face and genitals are especially sensitive
Use milder steroid creams in these areas
When you use the cream in the right way there are only few side effects

31. Steroid side effects Atrophy Skin bleedings Telangiectasiae Infections
Acne
Worsening of the disease when you stop the treatment

32. Treatment principles – steroid cream
Only apply cream/ointment on active areas
Apply in a thin layer: fingertip units
Wash your hands after applying the cream or use gloves
Use an effective cream to start with and reduce the strength when the skin gets better
It is important to reduce gradually to prevent a flair of the disease

33. Treatment principles – steroid cream
Used in the right way there are only few side effects
Chronic untreated eczema harms the skin
We see more under treated than over treated children
It is important that the children get a normal life

34. Tar treatment of eczema
Tar is a good treatment for eczema
It is greasy and it smells
Tar can sting on the skin if you have open wounds
Can be used undiluted or diluted in creams
Increases photo sensitivity

35. UV-treatment for eczema
Sun light and UVB-treatment help most patients
UV-treatment is best for bigger children
PUVA-treatment for adults

36. Gamma-linolenic acid Unsaturated fatty acids It helps a few patients
It is expensive
You have to eat a lot of capsules every day
It can be tried when you have severe eczema for a period
Stop the treatment if it does not have any effect because the effect is not documented in larger groups

37. Alternative treatment
Miralex cream

38. Treatment of eczema complicated with impetigo
Wash with water and mild soap
Sodium permanganate (red baths)
Steroid creams with antibiotics
Antibiotic creams and ointments
Antibiotics as tablets or mixture

39. Newer treatments: Elidel and Protopic
Elidel cream: 1 per cent
Protopic ointment 0,03 per cent and 0,1 per cent
Effective for treatment of atopic dermatitis
Long term control of atopic dermatitis for around 80 per cent of the patients

40. Elidel and Protopic Advantages: Do not contain steroids
Can be used in all skin areas
Can be used for long term treatment
Does not induce atrophy

41. Elidel treatment of atopic dermatitis
Elidel må bruges efter 2 år
Behnadlingsfri interval på 14 dage før vaccination (28 dage ved levende vaccination)
Protopic 0,03 % må bruges hos børn over 2 år
Protopic 0,1% hos børn over 16 år
De samme regler for vaccination

42. Elidel and Protopic Side effects:
Feeling hot on the skin after application
Bacterial infections in the skin
Herpes infections

43. Elidel and Protopic
Do not use solarium or get UV-treatment when treated with Elidel and Protopic