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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

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Eczema

ECZEMA

DR SIVANIE VIVEHANANTHA

DERMATOLOGY STR


AIMS

  • Brief overview of eczema

  • Enable early recognition & effective management



Classification of eczema
CLASSIFICATION OF ECZEMA

ENDOGENOUS

  • Atopic

  • Seborrheic

  • Discoid

  • Pompholyx / dyshidrotic

  • Varicose / venous / stasis / gravitational

EXOGENOUS

  • Allergic contact

  • Irritant contact

  • Photosensitive / photoaggravated



Management of exogenous ezcema
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
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
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
ERYTHRODERMA adapt management plan to increase compliance!

  • > 90% involvement of inflammatory skin disease

  • Causes:

    - Eczema - Psoriasis

    - CTCL (Sezary syndrome) - Drugs

    - Lymphoma / leukaemia - GvHD

    - HIV - Idiopathic


  • Consequences: adapt management plan to increase compliance!

    - 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
SUMMARY adapt management plan to increase compliance!

  • 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


Thank you
THANK YOU adapt management plan to increase compliance!