The terms eczema and dermatitis (inflammation of the skin) are often used interchangeably. Atopic eczema is common as part of the atopic syndrome of eczema, hay fever and asthma. It affects about 1 in 6 children and 1 in 20 adults and usually develops around 3–12 months of age. The distribution changes with age and moves from the face, neck, scalp and extensor surfaces in infants to flexures, particularly the popliteal and antecubital fossae, in older children and adults. Ninety per cent of children ‘grow out’ of their eczema by puberty. Contact dermatitis may be caused by allergy (e.g. latex gloves or nickel in jewellery, watches and buttons) or irritant from chronic contact with substances that remove natural skin oils such as washing up liquid. Eczema, like many skin diseases, can have a significant effect on quality of life, can lead to low self-esteem and limit day-to-day activities – exploring the patient’s ideas and concerns is essential.
History and Examination
Ask about site – is it the typical atopic distribution or a local distribution such as around the neck from nickel sensitivity or perfume (bergamot oils)? Ask about the treatments they have tried, frequency of application, occupation, exacerbating triggers (including stress) and family history. On examination look for vesicles (these are often not seen but the patient may tell you about them), dry skin and poorly defined areas of a pink scaly rash. There may also be evidence of weeping or oozing and crusting. Look for areas of excoriation from itching which can lead to lichenification (thickened leathery skin) and check for any infected areas.
Management
There are three important aspects to the management of eczema:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
