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ECZEMA. Introduction Case Scenarios Conclusions. Introduction. Eczema = Dermatitis. 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

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Presentation Transcript
slide2
Introduction
  • Case Scenarios
  • Conclusions
effect on quality of life burden of disability
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
case 1
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”
slide8
Sleeping poorly
  • Allergy tests?
basic management of atopic dermatitis
Basic Management of Atopic Dermatitis
  • Explanation – expectations of treatment
  • Emollients
  • Topical Corticosteroids
explanation
Explanation
  • Incredibly common
  • Cause unknown – NOT allergy
  • Self-limiting in most cases (eventually)
  • Waxing and waning natural history
emollients
Emollients
  • Bath
  • General
  • No limit to their use
topical corticosteroids
Topical Corticosteroids
  • Mainstay of treatment
  • Not dangerous if properly used
  • Most “steroid phobias” allayed by explanation
  • Awareness of different strengths
package of care
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
role of nursing colleagues
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
what about infection
What about Infection?
  • Staphylococcus aureus on 100% of skin lesions
  • But antibiotics don’t cure atopic dermatitis
  • But some cases improve when either topical or systemic antibiotics added
eczema herpeticum
Eczema Herpeticum
  • Unwell patient
  • Severe pain
  • Typical umbilicated, coalescing papules
  • Herpes simplex virus (usually type 1)
  • Urgent hospital admission
what to try if adequate control not achieved
What to Try if Adequate control NOT Achieved
  • Concordance (social issues)
  • Infection
  • “Pulse” of stronger topical corticosteroid
  • Bandaging
  • Referral
case 2
Case 2
  • 75 year old man
  • Retirement apartment
  • Likes to keep clean
  • Diuretics
  • Itching started on legs and spread to arms and trunk
pathogenesis
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
management
Management
  • Is the patient clinically or sub-clinically dehydrated?
  • Is the environment too dry?
  • Is the skin being degreased too frequently or too harshly?
slide25
Emollient
  • Topical corticosteroid – dip in and out after initial pulse
case 3
Case 3
  • 40 year old man
  • “Fed-up” with years of dandruff
  • Recent onset of itchy, red scaling of eyebrows, naso-labial folds
pathogenesis1
Pathogenesis
  • Tentative
  • Increased numbers of Pityrosporum ovale coupled with ? Genetic tendency
treatment
Treatment
  • Targeted against both P.ovale and inflammation
  • Chronic condition therefore need for repeated periods of treatment
slide31
Anti-Pityrosporum shampoo eg Selsun, Head & Shoulders, Nizoral (contact time)
  • Combination anti-Pityrosporum and anti-inflammatory cream eg Cannesten HC, Daktacort, Nizoral
case 4
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
hand dermatitis
Hand dermatitis
  • Multifactorial
  • Endogenous
  • Irritant
  • Allergic
  • Infection – Bacterial and Fungal
management1
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
conclusions
Conclusions
  • Diagnosis
  • Precipitating causes
  • Time for explanation – natural history
  • Empower the patient to treat their disease
  • Package of treatment
  • Point of follow-up
what to try if adequate control not achieved1
What to Try if Adequate control NOT Achieved
  • Concordance (social issues)
  • Infection
  • “Pulse” of stronger topical corticosteroid
  • Bandaging
  • Referral