1. ECZEMA

2. Introduction Case Scenarios Conclusions

3. Introduction

4. Eczema = Dermatitis

5. Effect on Quality of Life (Burden of Disability) 10-15% children suffer from atopic dermatitis Asteototic dermatitis is becoming more and more common in the elderly Hand dermatitis is a major cause of absence from work

6. Basic assessment and treatment

7. Case 1 6 months old child Onset of problems at age 2 months Formula fed child- several changes in milk tried None of the ointments work

8. Sleeping poorly Allergy tests?

9. Basic Management of Atopic Dermatitis Explanation – expectations of treatment Emollients Topical Corticosteroids

10. Explanation Incredibly common Cause unknown – NOT allergy Self-limiting in most cases (eventually) Waxing and waning natural history

11. Emollients Bath General No limit to their use

13. Topical Corticosteroids Mainstay of treatment Not dangerous if properly used Most steroid phobias allayed by explanation Awareness of different strengths

14. Package of Care Time Explain Prescribe a package of emollient(s) and topical steroid(s) Empower the parents to alter strengths of corticosteroids depending on clinical severity

15. Role of Nursing Colleagues Ideal disease for follow-up by practice nurses and health visitors Offer support through chronic disease Easy access for flares of disease Support from specialist dermatology nurses in secondary care

16. What about Infection? Staphylococcus aureus on 100% of skin lesions But antibiotics dont cure atopic dermatitis But some cases improve when either topical or systemic antibiotics added

18. Eczema Herpeticum Unwell patient Severe pain Typical umbilicated, coalescing papules Herpes simplex virus (usually type 1) Urgent hospital admission

20. What to Try if Adequate control NOT Achieved Concordance (social issues) Infection Pulse of stronger topical corticosteroid Bandaging Referral

21. Case 2 75 year old man Retirement apartment Likes to keep clean Diuretics Itching started on legs and spread to arms and trunk

23. Pathogenesis Dryness and suppleness = state of hydration of Stratum corneum State of hydration of stratum corneum dependant on rate of migration of water through stratum corneum and rate of evaporation from its surface Natural level of skin lipids decreases as age increases

24. Management Is the patient clinically or sub-clinically dehydrated? Is the environment too dry? Is the skin being degreased too frequently or too harshly?

25. Emollient Topical corticosteroid – dip in and out after initial pulse

27. Case 3 40 year old man Fed-up with years of dandruff Recent onset of itchy, red scaling of eyebrows, naso-labial folds

28. Seborrheic Eczema

29. Pathogenesis Tentative Increased numbers of Pityrosporum ovale coupled with ? Genetic tendency

30. Treatment Targeted against both P.ovale and inflammation Chronic condition therefore need for repeated periods of treatment

31. Anti-Pityrosporum shampoo eg Selsun, Head & Shoulders, Nizoral (contact time) Combination anti-Pityrosporum and anti- inflammatory cream eg Cannesten HC, Daktacort, Nizoral

32. Case 4 35 year old car mechanic Eczema as a toddler but clear for years Recent onset dry, itchy, red rash both hands Some improvement when goes on holiday

34. Hand dermatitis Multifactorial Endogenous Irritant Allergic Infection – Bacterial and Fungal

35. Management Package of treatment Address any precipitating cause Scrapings for mycology and swab for bacterial contamination/infection if indicated General hand care Emollients Topical Corticosteroid

36. Conclusions Diagnosis Precipitating causes Time for explanation – natural history Empower the patient to treat their disease Package of treatment Point of follow-up

37. What to Try if Adequate control NOT Achieved Concordance (social issues) Infection Pulse of stronger topical corticosteroid Bandaging Referral

38. Any eczema questions?