1. Definition
Eczema is a common inflammatory pruritic skin condition that often commences in early childhood and varies in severity and duration.
2. Causes
Genetic mutations in the filaggrin gene which codes for a protein profillargin responsible for epidermal structure, has been identified as an important risk factor for Atopic Dermatitis as this mutation causes deteriorating skin barrier function.
Exposure to microbial flora early in life allows for a change in the T helper cytokine balance favouring a Th1-cell response. (ie less risk of developiong allergic phenomena). Therefore , there is a strong likelihood that exposure to high doses of antibiotics in neonates may alter the composition of their intestinal flora and have an effect on their normal immune responses.
Infections and endotoxin exposure- children that are exposed to animals , viruses and bacteria and various endotoxins are less likely to develop atopic diseases.
3. Types
Typically there are three different types of lesions: acute, subacute and chronic.
3.1 Acute
Acute lesions are extremely itchy with vesicles over a red base
3.2. Subacute
The subacute lesion is the next step in disease progression.
3.3. Chronic
Chronic lesions have undergone extensive tissue remodelling resulting in lichenified skin – thickened skin due to chronic inflammation
4. Treatment
Allergen avoidance is recommended when an aggravating factor is identified.
Parent education about the nature of the disease is vital.
Emollient therapy is the cornerstone of eczema management and increases skin hydration and reduces itch . Emollients also increase the efficacy of topical corticosteroids
4.1 Topical corticosteroids
Topical corticosteroids are divided into mild, moderately potent, potent and very potent. The vehicle in which the steroid is packaged is important. Ointments are preferable, followed by creams and lastly lotions.
4.2 Topical calcineurin inhibitors
TCI’s belong to the immune modulant drug class and have established efficacy in treating eczema. They are useful for the facial areas and in milder cases of eczema flares.
4.3 Antihistamines
Antihistamines are useful to help manage pruritic effects.
