💡 Red flag: Widespread herpes simplex infection (eczema herpeticum) should be suspected in any patient with rapidly worsening atopic eczema ⚡. This is a dermatological emergency → immediate referral to dermatology/paediatrics.

📖 About

Chronic inflammatory skin disease with intense pruritus and eczematous lesions in characteristic sites:

👶 Infants: face, scalp, extensor surfaces
🧒 Children/adults: flexural surfaces (elbows, knees, neck)

🧬 Aetiology

Combination of genetic and environmental factors.
Defects in skin barrier proteins (e.g., filaggrin) → ↑ permeability, sensitivity to allergens, irritants, microbes.
Often associated with the atopic triad: eczema, asthma, allergic rhinitis 🤧.

📊 Epidemiology

15–20% of school-aged children 👦
2–10% of adults 👩
Frequently improves with age, but some persist into adulthood.

🩺 Clinical Presentation

Dry, itchy 🔥, erythematous skin with papules, vesicles, excoriations.
Flexural distribution common; severe disease → lichenification, cracking, oozing.
Complications: bacterial infection (impetiginisation), eczema herpeticum (HSV), widespread fungal infections.

Eczema Image

📏 Severity Classification

✅ Clear: Normal skin
🙂 Mild: Small patches, occasional itching
😣 Moderate: Frequent itching, redness, excoriations
🚨 Severe: Widespread, thickened skin, bleeding/oozing, sleep disturbance

🔎 Clinical Forms

Atopic dermatitis: Flexural eczema, chronic relapsing course
Contact dermatitis: Allergic or irritant trigger (nickel, detergents)
Seborrhoeic dermatitis: Scalp/face involvement; “cradle cap” in infants
Xerotic eczema: Dry skin–related, common in elderly

🛠️ Management

💧 Emollients: Foundation of care; applied liberally & often, including soap substitutes
💊 Topical corticosteroids: Step-up by potency depending on site/severity; “fingertip unit” rule for dosing
🧴 Topical calcineurin inhibitors: (tacrolimus, pimecrolimus) for steroid-sparing use
🦠 Infection control: Treat secondary bacterial infection (flucloxacillin); oral antibiotics NOT for routine use
💤 Antihistamines: Sedating antihistamines for severe nocturnal itch
☀️ Phototherapy / Immunosuppressants: Consider if severe refractory disease (dermatology-led)
🥛 Diet/environment: Avoid known triggers; routine exclusion diets not recommended unless proven allergy

📌 Exam Tips

Always mention emollients + steroid ladder as first-line 🪜
Know red flags: eczema herpeticum, recurrent infections
Remember psychosocial impact → poor sleep, bullying, school issues

📚 References

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Eczema/Dermatitis