π‘ Red flag: Widespread herpes simplex infection (eczema herpeticum) should be suspected in any patient with rapidly worsening atopic eczema β‘.
This is a dermatological emergency β immediate referral to dermatology/paediatrics.
π About
- Chronic inflammatory skin disease with intense pruritus and eczematous lesions in characteristic sites:
- πΆ Infants: face, scalp, extensor surfaces
- π§ Children/adults: flexural surfaces (elbows, knees, neck)
𧬠Aetiology
- Combination of genetic and environmental factors.
- Defects in skin barrier proteins (e.g., filaggrin) β β permeability, sensitivity to allergens, irritants, microbes.
- Often associated with the atopic triad: eczema, asthma, allergic rhinitis π€§.
π Epidemiology
- 15β20% of school-aged children π¦
- 2β10% of adults π©
- Frequently improves with age, but some persist into adulthood.
π©Ί Clinical Presentation
- Dry, itchy π₯, erythematous skin with papules, vesicles, excoriations.
- Flexural distribution common; severe disease β lichenification, cracking, oozing.
- Complications: bacterial infection (impetiginisation), eczema herpeticum (HSV), widespread fungal infections.
π Severity Classification
- β
Clear: Normal skin
- π Mild: Small patches, occasional itching
- π£ Moderate: Frequent itching, redness, excoriations
- π¨ Severe: Widespread, thickened skin, bleeding/oozing, sleep disturbance
π Clinical Forms
- Atopic dermatitis: Flexural eczema, chronic relapsing course
- Contact dermatitis: Allergic or irritant trigger (nickel, detergents)
- Seborrhoeic dermatitis: Scalp/face involvement; βcradle capβ in infants
- Xerotic eczema: Dry skinβrelated, common in elderly
π οΈ Management
- π§ Emollients: Foundation of care; applied liberally & often, including soap substitutes
- π Topical corticosteroids: Step-up by potency depending on site/severity; βfingertip unitβ rule for dosing
- π§΄ Topical calcineurin inhibitors: (tacrolimus, pimecrolimus) for steroid-sparing use
- π¦ Infection control: Treat secondary bacterial infection (flucloxacillin); oral antibiotics NOT for routine use
- π€ Antihistamines: Sedating antihistamines for severe nocturnal itch
- βοΈ Phototherapy / Immunosuppressants: Consider if severe refractory disease (dermatology-led)
- π₯ Diet/environment: Avoid known triggers; routine exclusion diets not recommended unless proven allergy
π Exam Tips
- Always mention emollients + steroid ladder as first-line πͺ
- Know red flags: eczema herpeticum, recurrent infections
- Remember psychosocial impact β poor sleep, bullying, school issues
π References