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Dr. F.Shariati. DERMATITIS AND ECZEMA. Topics discussed. Diagnosis of eczema Incidence Aggravators History and assessment Treatments Clinical Cases. TERMINOLOGY. Eczema = Greek term “To boil over” - PowerPoint PPT Presentation
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DrFShariati
DERMATITIS AND ECZEMADERMATITIS AND ECZEMA
1048708 Diagnosis of eczema1048708 Incidence1048708 Aggravators1048708 History and assessment1048708 Treatments1048708 Clinical Cases
Topics discussed
TERMINOLOGY
Eczema =
Greek term ldquoTo boil overrdquo
Usually refers to severely inflamed dermatitis and the signs and symptoms associated with such an acute process (itching sting burning of the skin with
drainage from lesions)
Types of common eczemasbull Atopic eczema (infantile e flexural e atopic dermatitis) bull Seborrhoeic dermatitis (cradle capldquoin infants)bull Contact dermatitis is of two types(Allergic contact dermatitis
` Irritant contact dermatitis)bull Xerotic eczema (asteatotic e e craquele or craquelatum
winter itch pruritus hiemalis)
Less common eczemas bull Dyshidrosis (dyshidrotic e pompholyx vesicular)
(palmoplantar dermatitis)bull Discoid eczema (nummular e exudative e microbial e)bull Venous eczema (gravitational e stasis dermatitis varicose e)bull Neurodermatitis (lichen simplex chronicus localized scratch
dermatitis)bull Autoeczematization (id reaction autosensitization)bull Dermatitis herpetiformis (Duhringrsquos Disease)
Types of common eczemas
Clinical classification
bull Acute eczema
bull Subacute eczema
bull Chronic eczema
CARDINAL FEATURES OF INFLAMMATIONampeczema
bull Calor (warmth) - increased blood flow
bull Rubor (redness) -dilated blood vessels
bull Dolor (pain)- irritation of nerves in inflamed tissues
bull Serum IgE levels
bull Skin prick tests(Allergy test)
bull Skin patch tests
bull RAST(checks to see if the body is producing
antibodies against common things like house
dustmitepollenscat and dog hair and food
substances)
bull Skin biopsy
INVESTIGATIONS
Patch Test
Skin biopsy
Xerotic eczema
(Charlesworth Am J Med 2002)
CHILDHOOD ECZEMA
Atopic Eczema
Infantile stage ( 0-2 years ) tends to start around 3-6 monthsUsually affects the face
wristsnappy area and when severe every part of the bodyOften gets infected
Childhood stage( 2-12 years )the skin starts to become dry cracked and thickenedUsually
affects the elbowsback of kneesankles and back of earsSevere thickening of the skin is
very common in Afro-Caribbeans and Asians
Adolescent and adult phase (puberty onwards) lichenification of the skin is very
prominent nowAffects the elbowsknees neck and bottom of the eyes
STAGES of Atopic EczemaPHASES
Distribution
Infantile stage
adult phase
Atopic Derm Adults
Hand Eczema
Foot Eczema
lichenification of the skin
lichenification of the skin
Must haveMajor Features
itchy skin
family history of atopy
typical picture( facial flexures lichenification)
Plus three or more of the followingMinor Features
Xerosisichthyosishyper linear palms keratosis pilaris
periaricular fissuresdennie-morgan lines
chronic scalp scalingpityriasis albacataract
UK Diagnostic criteria Sampson et al
Associated Findings
bull Pityriasis alba
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
DERMATITIS AND ECZEMADERMATITIS AND ECZEMA
1048708 Diagnosis of eczema1048708 Incidence1048708 Aggravators1048708 History and assessment1048708 Treatments1048708 Clinical Cases
Topics discussed
TERMINOLOGY
Eczema =
Greek term ldquoTo boil overrdquo
Usually refers to severely inflamed dermatitis and the signs and symptoms associated with such an acute process (itching sting burning of the skin with
drainage from lesions)
Types of common eczemasbull Atopic eczema (infantile e flexural e atopic dermatitis) bull Seborrhoeic dermatitis (cradle capldquoin infants)bull Contact dermatitis is of two types(Allergic contact dermatitis
` Irritant contact dermatitis)bull Xerotic eczema (asteatotic e e craquele or craquelatum
winter itch pruritus hiemalis)
Less common eczemas bull Dyshidrosis (dyshidrotic e pompholyx vesicular)
(palmoplantar dermatitis)bull Discoid eczema (nummular e exudative e microbial e)bull Venous eczema (gravitational e stasis dermatitis varicose e)bull Neurodermatitis (lichen simplex chronicus localized scratch
dermatitis)bull Autoeczematization (id reaction autosensitization)bull Dermatitis herpetiformis (Duhringrsquos Disease)
Types of common eczemas
Clinical classification
bull Acute eczema
bull Subacute eczema
bull Chronic eczema
CARDINAL FEATURES OF INFLAMMATIONampeczema
bull Calor (warmth) - increased blood flow
bull Rubor (redness) -dilated blood vessels
bull Dolor (pain)- irritation of nerves in inflamed tissues
bull Serum IgE levels
bull Skin prick tests(Allergy test)
bull Skin patch tests
bull RAST(checks to see if the body is producing
antibodies against common things like house
dustmitepollenscat and dog hair and food
substances)
bull Skin biopsy
INVESTIGATIONS
Patch Test
Skin biopsy
Xerotic eczema
(Charlesworth Am J Med 2002)
CHILDHOOD ECZEMA
Atopic Eczema
Infantile stage ( 0-2 years ) tends to start around 3-6 monthsUsually affects the face
wristsnappy area and when severe every part of the bodyOften gets infected
Childhood stage( 2-12 years )the skin starts to become dry cracked and thickenedUsually
affects the elbowsback of kneesankles and back of earsSevere thickening of the skin is
very common in Afro-Caribbeans and Asians
Adolescent and adult phase (puberty onwards) lichenification of the skin is very
prominent nowAffects the elbowsknees neck and bottom of the eyes
STAGES of Atopic EczemaPHASES
Distribution
Infantile stage
adult phase
Atopic Derm Adults
Hand Eczema
Foot Eczema
lichenification of the skin
lichenification of the skin
Must haveMajor Features
itchy skin
family history of atopy
typical picture( facial flexures lichenification)
Plus three or more of the followingMinor Features
Xerosisichthyosishyper linear palms keratosis pilaris
periaricular fissuresdennie-morgan lines
chronic scalp scalingpityriasis albacataract
UK Diagnostic criteria Sampson et al
Associated Findings
bull Pityriasis alba
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
1048708 Diagnosis of eczema1048708 Incidence1048708 Aggravators1048708 History and assessment1048708 Treatments1048708 Clinical Cases
Topics discussed
TERMINOLOGY
Eczema =
Greek term ldquoTo boil overrdquo
Usually refers to severely inflamed dermatitis and the signs and symptoms associated with such an acute process (itching sting burning of the skin with
drainage from lesions)
Types of common eczemasbull Atopic eczema (infantile e flexural e atopic dermatitis) bull Seborrhoeic dermatitis (cradle capldquoin infants)bull Contact dermatitis is of two types(Allergic contact dermatitis
` Irritant contact dermatitis)bull Xerotic eczema (asteatotic e e craquele or craquelatum
winter itch pruritus hiemalis)
Less common eczemas bull Dyshidrosis (dyshidrotic e pompholyx vesicular)
(palmoplantar dermatitis)bull Discoid eczema (nummular e exudative e microbial e)bull Venous eczema (gravitational e stasis dermatitis varicose e)bull Neurodermatitis (lichen simplex chronicus localized scratch
dermatitis)bull Autoeczematization (id reaction autosensitization)bull Dermatitis herpetiformis (Duhringrsquos Disease)
Types of common eczemas
Clinical classification
bull Acute eczema
bull Subacute eczema
bull Chronic eczema
CARDINAL FEATURES OF INFLAMMATIONampeczema
bull Calor (warmth) - increased blood flow
bull Rubor (redness) -dilated blood vessels
bull Dolor (pain)- irritation of nerves in inflamed tissues
bull Serum IgE levels
bull Skin prick tests(Allergy test)
bull Skin patch tests
bull RAST(checks to see if the body is producing
antibodies against common things like house
dustmitepollenscat and dog hair and food
substances)
bull Skin biopsy
INVESTIGATIONS
Patch Test
Skin biopsy
Xerotic eczema
(Charlesworth Am J Med 2002)
CHILDHOOD ECZEMA
Atopic Eczema
Infantile stage ( 0-2 years ) tends to start around 3-6 monthsUsually affects the face
wristsnappy area and when severe every part of the bodyOften gets infected
Childhood stage( 2-12 years )the skin starts to become dry cracked and thickenedUsually
affects the elbowsback of kneesankles and back of earsSevere thickening of the skin is
very common in Afro-Caribbeans and Asians
Adolescent and adult phase (puberty onwards) lichenification of the skin is very
prominent nowAffects the elbowsknees neck and bottom of the eyes
STAGES of Atopic EczemaPHASES
Distribution
Infantile stage
adult phase
Atopic Derm Adults
Hand Eczema
Foot Eczema
lichenification of the skin
lichenification of the skin
Must haveMajor Features
itchy skin
family history of atopy
typical picture( facial flexures lichenification)
Plus three or more of the followingMinor Features
Xerosisichthyosishyper linear palms keratosis pilaris
periaricular fissuresdennie-morgan lines
chronic scalp scalingpityriasis albacataract
UK Diagnostic criteria Sampson et al
Associated Findings
bull Pityriasis alba
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
TERMINOLOGY
Eczema =
Greek term ldquoTo boil overrdquo
Usually refers to severely inflamed dermatitis and the signs and symptoms associated with such an acute process (itching sting burning of the skin with
drainage from lesions)
Types of common eczemasbull Atopic eczema (infantile e flexural e atopic dermatitis) bull Seborrhoeic dermatitis (cradle capldquoin infants)bull Contact dermatitis is of two types(Allergic contact dermatitis
` Irritant contact dermatitis)bull Xerotic eczema (asteatotic e e craquele or craquelatum
winter itch pruritus hiemalis)
Less common eczemas bull Dyshidrosis (dyshidrotic e pompholyx vesicular)
(palmoplantar dermatitis)bull Discoid eczema (nummular e exudative e microbial e)bull Venous eczema (gravitational e stasis dermatitis varicose e)bull Neurodermatitis (lichen simplex chronicus localized scratch
dermatitis)bull Autoeczematization (id reaction autosensitization)bull Dermatitis herpetiformis (Duhringrsquos Disease)
Types of common eczemas
Clinical classification
bull Acute eczema
bull Subacute eczema
bull Chronic eczema
CARDINAL FEATURES OF INFLAMMATIONampeczema
bull Calor (warmth) - increased blood flow
bull Rubor (redness) -dilated blood vessels
bull Dolor (pain)- irritation of nerves in inflamed tissues
bull Serum IgE levels
bull Skin prick tests(Allergy test)
bull Skin patch tests
bull RAST(checks to see if the body is producing
antibodies against common things like house
dustmitepollenscat and dog hair and food
substances)
bull Skin biopsy
INVESTIGATIONS
Patch Test
Skin biopsy
Xerotic eczema
(Charlesworth Am J Med 2002)
CHILDHOOD ECZEMA
Atopic Eczema
Infantile stage ( 0-2 years ) tends to start around 3-6 monthsUsually affects the face
wristsnappy area and when severe every part of the bodyOften gets infected
Childhood stage( 2-12 years )the skin starts to become dry cracked and thickenedUsually
affects the elbowsback of kneesankles and back of earsSevere thickening of the skin is
very common in Afro-Caribbeans and Asians
Adolescent and adult phase (puberty onwards) lichenification of the skin is very
prominent nowAffects the elbowsknees neck and bottom of the eyes
STAGES of Atopic EczemaPHASES
Distribution
Infantile stage
adult phase
Atopic Derm Adults
Hand Eczema
Foot Eczema
lichenification of the skin
lichenification of the skin
Must haveMajor Features
itchy skin
family history of atopy
typical picture( facial flexures lichenification)
Plus three or more of the followingMinor Features
Xerosisichthyosishyper linear palms keratosis pilaris
periaricular fissuresdennie-morgan lines
chronic scalp scalingpityriasis albacataract
UK Diagnostic criteria Sampson et al
Associated Findings
bull Pityriasis alba
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Types of common eczemasbull Atopic eczema (infantile e flexural e atopic dermatitis) bull Seborrhoeic dermatitis (cradle capldquoin infants)bull Contact dermatitis is of two types(Allergic contact dermatitis
` Irritant contact dermatitis)bull Xerotic eczema (asteatotic e e craquele or craquelatum
winter itch pruritus hiemalis)
Less common eczemas bull Dyshidrosis (dyshidrotic e pompholyx vesicular)
(palmoplantar dermatitis)bull Discoid eczema (nummular e exudative e microbial e)bull Venous eczema (gravitational e stasis dermatitis varicose e)bull Neurodermatitis (lichen simplex chronicus localized scratch
dermatitis)bull Autoeczematization (id reaction autosensitization)bull Dermatitis herpetiformis (Duhringrsquos Disease)
Types of common eczemas
Clinical classification
bull Acute eczema
bull Subacute eczema
bull Chronic eczema
CARDINAL FEATURES OF INFLAMMATIONampeczema
bull Calor (warmth) - increased blood flow
bull Rubor (redness) -dilated blood vessels
bull Dolor (pain)- irritation of nerves in inflamed tissues
bull Serum IgE levels
bull Skin prick tests(Allergy test)
bull Skin patch tests
bull RAST(checks to see if the body is producing
antibodies against common things like house
dustmitepollenscat and dog hair and food
substances)
bull Skin biopsy
INVESTIGATIONS
Patch Test
Skin biopsy
Xerotic eczema
(Charlesworth Am J Med 2002)
CHILDHOOD ECZEMA
Atopic Eczema
Infantile stage ( 0-2 years ) tends to start around 3-6 monthsUsually affects the face
wristsnappy area and when severe every part of the bodyOften gets infected
Childhood stage( 2-12 years )the skin starts to become dry cracked and thickenedUsually
affects the elbowsback of kneesankles and back of earsSevere thickening of the skin is
very common in Afro-Caribbeans and Asians
Adolescent and adult phase (puberty onwards) lichenification of the skin is very
prominent nowAffects the elbowsknees neck and bottom of the eyes
STAGES of Atopic EczemaPHASES
Distribution
Infantile stage
adult phase
Atopic Derm Adults
Hand Eczema
Foot Eczema
lichenification of the skin
lichenification of the skin
Must haveMajor Features
itchy skin
family history of atopy
typical picture( facial flexures lichenification)
Plus three or more of the followingMinor Features
Xerosisichthyosishyper linear palms keratosis pilaris
periaricular fissuresdennie-morgan lines
chronic scalp scalingpityriasis albacataract
UK Diagnostic criteria Sampson et al
Associated Findings
bull Pityriasis alba
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Clinical classification
bull Acute eczema
bull Subacute eczema
bull Chronic eczema
CARDINAL FEATURES OF INFLAMMATIONampeczema
bull Calor (warmth) - increased blood flow
bull Rubor (redness) -dilated blood vessels
bull Dolor (pain)- irritation of nerves in inflamed tissues
bull Serum IgE levels
bull Skin prick tests(Allergy test)
bull Skin patch tests
bull RAST(checks to see if the body is producing
antibodies against common things like house
dustmitepollenscat and dog hair and food
substances)
bull Skin biopsy
INVESTIGATIONS
Patch Test
Skin biopsy
Xerotic eczema
(Charlesworth Am J Med 2002)
CHILDHOOD ECZEMA
Atopic Eczema
Infantile stage ( 0-2 years ) tends to start around 3-6 monthsUsually affects the face
wristsnappy area and when severe every part of the bodyOften gets infected
Childhood stage( 2-12 years )the skin starts to become dry cracked and thickenedUsually
affects the elbowsback of kneesankles and back of earsSevere thickening of the skin is
very common in Afro-Caribbeans and Asians
Adolescent and adult phase (puberty onwards) lichenification of the skin is very
prominent nowAffects the elbowsknees neck and bottom of the eyes
STAGES of Atopic EczemaPHASES
Distribution
Infantile stage
adult phase
Atopic Derm Adults
Hand Eczema
Foot Eczema
lichenification of the skin
lichenification of the skin
Must haveMajor Features
itchy skin
family history of atopy
typical picture( facial flexures lichenification)
Plus three or more of the followingMinor Features
Xerosisichthyosishyper linear palms keratosis pilaris
periaricular fissuresdennie-morgan lines
chronic scalp scalingpityriasis albacataract
UK Diagnostic criteria Sampson et al
Associated Findings
bull Pityriasis alba
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
CARDINAL FEATURES OF INFLAMMATIONampeczema
bull Calor (warmth) - increased blood flow
bull Rubor (redness) -dilated blood vessels
bull Dolor (pain)- irritation of nerves in inflamed tissues
bull Serum IgE levels
bull Skin prick tests(Allergy test)
bull Skin patch tests
bull RAST(checks to see if the body is producing
antibodies against common things like house
dustmitepollenscat and dog hair and food
substances)
bull Skin biopsy
INVESTIGATIONS
Patch Test
Skin biopsy
Xerotic eczema
(Charlesworth Am J Med 2002)
CHILDHOOD ECZEMA
Atopic Eczema
Infantile stage ( 0-2 years ) tends to start around 3-6 monthsUsually affects the face
wristsnappy area and when severe every part of the bodyOften gets infected
Childhood stage( 2-12 years )the skin starts to become dry cracked and thickenedUsually
affects the elbowsback of kneesankles and back of earsSevere thickening of the skin is
very common in Afro-Caribbeans and Asians
Adolescent and adult phase (puberty onwards) lichenification of the skin is very
prominent nowAffects the elbowsknees neck and bottom of the eyes
STAGES of Atopic EczemaPHASES
Distribution
Infantile stage
adult phase
Atopic Derm Adults
Hand Eczema
Foot Eczema
lichenification of the skin
lichenification of the skin
Must haveMajor Features
itchy skin
family history of atopy
typical picture( facial flexures lichenification)
Plus three or more of the followingMinor Features
Xerosisichthyosishyper linear palms keratosis pilaris
periaricular fissuresdennie-morgan lines
chronic scalp scalingpityriasis albacataract
UK Diagnostic criteria Sampson et al
Associated Findings
bull Pityriasis alba
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
bull Serum IgE levels
bull Skin prick tests(Allergy test)
bull Skin patch tests
bull RAST(checks to see if the body is producing
antibodies against common things like house
dustmitepollenscat and dog hair and food
substances)
bull Skin biopsy
INVESTIGATIONS
Patch Test
Skin biopsy
Xerotic eczema
(Charlesworth Am J Med 2002)
CHILDHOOD ECZEMA
Atopic Eczema
Infantile stage ( 0-2 years ) tends to start around 3-6 monthsUsually affects the face
wristsnappy area and when severe every part of the bodyOften gets infected
Childhood stage( 2-12 years )the skin starts to become dry cracked and thickenedUsually
affects the elbowsback of kneesankles and back of earsSevere thickening of the skin is
very common in Afro-Caribbeans and Asians
Adolescent and adult phase (puberty onwards) lichenification of the skin is very
prominent nowAffects the elbowsknees neck and bottom of the eyes
STAGES of Atopic EczemaPHASES
Distribution
Infantile stage
adult phase
Atopic Derm Adults
Hand Eczema
Foot Eczema
lichenification of the skin
lichenification of the skin
Must haveMajor Features
itchy skin
family history of atopy
typical picture( facial flexures lichenification)
Plus three or more of the followingMinor Features
Xerosisichthyosishyper linear palms keratosis pilaris
periaricular fissuresdennie-morgan lines
chronic scalp scalingpityriasis albacataract
UK Diagnostic criteria Sampson et al
Associated Findings
bull Pityriasis alba
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Patch Test
Skin biopsy
Xerotic eczema
(Charlesworth Am J Med 2002)
CHILDHOOD ECZEMA
Atopic Eczema
Infantile stage ( 0-2 years ) tends to start around 3-6 monthsUsually affects the face
wristsnappy area and when severe every part of the bodyOften gets infected
Childhood stage( 2-12 years )the skin starts to become dry cracked and thickenedUsually
affects the elbowsback of kneesankles and back of earsSevere thickening of the skin is
very common in Afro-Caribbeans and Asians
Adolescent and adult phase (puberty onwards) lichenification of the skin is very
prominent nowAffects the elbowsknees neck and bottom of the eyes
STAGES of Atopic EczemaPHASES
Distribution
Infantile stage
adult phase
Atopic Derm Adults
Hand Eczema
Foot Eczema
lichenification of the skin
lichenification of the skin
Must haveMajor Features
itchy skin
family history of atopy
typical picture( facial flexures lichenification)
Plus three or more of the followingMinor Features
Xerosisichthyosishyper linear palms keratosis pilaris
periaricular fissuresdennie-morgan lines
chronic scalp scalingpityriasis albacataract
UK Diagnostic criteria Sampson et al
Associated Findings
bull Pityriasis alba
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Skin biopsy
Xerotic eczema
(Charlesworth Am J Med 2002)
CHILDHOOD ECZEMA
Atopic Eczema
Infantile stage ( 0-2 years ) tends to start around 3-6 monthsUsually affects the face
wristsnappy area and when severe every part of the bodyOften gets infected
Childhood stage( 2-12 years )the skin starts to become dry cracked and thickenedUsually
affects the elbowsback of kneesankles and back of earsSevere thickening of the skin is
very common in Afro-Caribbeans and Asians
Adolescent and adult phase (puberty onwards) lichenification of the skin is very
prominent nowAffects the elbowsknees neck and bottom of the eyes
STAGES of Atopic EczemaPHASES
Distribution
Infantile stage
adult phase
Atopic Derm Adults
Hand Eczema
Foot Eczema
lichenification of the skin
lichenification of the skin
Must haveMajor Features
itchy skin
family history of atopy
typical picture( facial flexures lichenification)
Plus three or more of the followingMinor Features
Xerosisichthyosishyper linear palms keratosis pilaris
periaricular fissuresdennie-morgan lines
chronic scalp scalingpityriasis albacataract
UK Diagnostic criteria Sampson et al
Associated Findings
bull Pityriasis alba
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Xerotic eczema
(Charlesworth Am J Med 2002)
CHILDHOOD ECZEMA
Atopic Eczema
Infantile stage ( 0-2 years ) tends to start around 3-6 monthsUsually affects the face
wristsnappy area and when severe every part of the bodyOften gets infected
Childhood stage( 2-12 years )the skin starts to become dry cracked and thickenedUsually
affects the elbowsback of kneesankles and back of earsSevere thickening of the skin is
very common in Afro-Caribbeans and Asians
Adolescent and adult phase (puberty onwards) lichenification of the skin is very
prominent nowAffects the elbowsknees neck and bottom of the eyes
STAGES of Atopic EczemaPHASES
Distribution
Infantile stage
adult phase
Atopic Derm Adults
Hand Eczema
Foot Eczema
lichenification of the skin
lichenification of the skin
Must haveMajor Features
itchy skin
family history of atopy
typical picture( facial flexures lichenification)
Plus three or more of the followingMinor Features
Xerosisichthyosishyper linear palms keratosis pilaris
periaricular fissuresdennie-morgan lines
chronic scalp scalingpityriasis albacataract
UK Diagnostic criteria Sampson et al
Associated Findings
bull Pityriasis alba
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
CHILDHOOD ECZEMA
Atopic Eczema
Infantile stage ( 0-2 years ) tends to start around 3-6 monthsUsually affects the face
wristsnappy area and when severe every part of the bodyOften gets infected
Childhood stage( 2-12 years )the skin starts to become dry cracked and thickenedUsually
affects the elbowsback of kneesankles and back of earsSevere thickening of the skin is
very common in Afro-Caribbeans and Asians
Adolescent and adult phase (puberty onwards) lichenification of the skin is very
prominent nowAffects the elbowsknees neck and bottom of the eyes
STAGES of Atopic EczemaPHASES
Distribution
Infantile stage
adult phase
Atopic Derm Adults
Hand Eczema
Foot Eczema
lichenification of the skin
lichenification of the skin
Must haveMajor Features
itchy skin
family history of atopy
typical picture( facial flexures lichenification)
Plus three or more of the followingMinor Features
Xerosisichthyosishyper linear palms keratosis pilaris
periaricular fissuresdennie-morgan lines
chronic scalp scalingpityriasis albacataract
UK Diagnostic criteria Sampson et al
Associated Findings
bull Pityriasis alba
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Infantile stage ( 0-2 years ) tends to start around 3-6 monthsUsually affects the face
wristsnappy area and when severe every part of the bodyOften gets infected
Childhood stage( 2-12 years )the skin starts to become dry cracked and thickenedUsually
affects the elbowsback of kneesankles and back of earsSevere thickening of the skin is
very common in Afro-Caribbeans and Asians
Adolescent and adult phase (puberty onwards) lichenification of the skin is very
prominent nowAffects the elbowsknees neck and bottom of the eyes
STAGES of Atopic EczemaPHASES
Distribution
Infantile stage
adult phase
Atopic Derm Adults
Hand Eczema
Foot Eczema
lichenification of the skin
lichenification of the skin
Must haveMajor Features
itchy skin
family history of atopy
typical picture( facial flexures lichenification)
Plus three or more of the followingMinor Features
Xerosisichthyosishyper linear palms keratosis pilaris
periaricular fissuresdennie-morgan lines
chronic scalp scalingpityriasis albacataract
UK Diagnostic criteria Sampson et al
Associated Findings
bull Pityriasis alba
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Distribution
Infantile stage
adult phase
Atopic Derm Adults
Hand Eczema
Foot Eczema
lichenification of the skin
lichenification of the skin
Must haveMajor Features
itchy skin
family history of atopy
typical picture( facial flexures lichenification)
Plus three or more of the followingMinor Features
Xerosisichthyosishyper linear palms keratosis pilaris
periaricular fissuresdennie-morgan lines
chronic scalp scalingpityriasis albacataract
UK Diagnostic criteria Sampson et al
Associated Findings
bull Pityriasis alba
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Atopic Derm Adults
Hand Eczema
Foot Eczema
lichenification of the skin
lichenification of the skin
Must haveMajor Features
itchy skin
family history of atopy
typical picture( facial flexures lichenification)
Plus three or more of the followingMinor Features
Xerosisichthyosishyper linear palms keratosis pilaris
periaricular fissuresdennie-morgan lines
chronic scalp scalingpityriasis albacataract
UK Diagnostic criteria Sampson et al
Associated Findings
bull Pityriasis alba
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Hand Eczema
Foot Eczema
lichenification of the skin
lichenification of the skin
Must haveMajor Features
itchy skin
family history of atopy
typical picture( facial flexures lichenification)
Plus three or more of the followingMinor Features
Xerosisichthyosishyper linear palms keratosis pilaris
periaricular fissuresdennie-morgan lines
chronic scalp scalingpityriasis albacataract
UK Diagnostic criteria Sampson et al
Associated Findings
bull Pityriasis alba
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Foot Eczema
lichenification of the skin
lichenification of the skin
Must haveMajor Features
itchy skin
family history of atopy
typical picture( facial flexures lichenification)
Plus three or more of the followingMinor Features
Xerosisichthyosishyper linear palms keratosis pilaris
periaricular fissuresdennie-morgan lines
chronic scalp scalingpityriasis albacataract
UK Diagnostic criteria Sampson et al
Associated Findings
bull Pityriasis alba
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
lichenification of the skin
lichenification of the skin
Must haveMajor Features
itchy skin
family history of atopy
typical picture( facial flexures lichenification)
Plus three or more of the followingMinor Features
Xerosisichthyosishyper linear palms keratosis pilaris
periaricular fissuresdennie-morgan lines
chronic scalp scalingpityriasis albacataract
UK Diagnostic criteria Sampson et al
Associated Findings
bull Pityriasis alba
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
lichenification of the skin
Must haveMajor Features
itchy skin
family history of atopy
typical picture( facial flexures lichenification)
Plus three or more of the followingMinor Features
Xerosisichthyosishyper linear palms keratosis pilaris
periaricular fissuresdennie-morgan lines
chronic scalp scalingpityriasis albacataract
UK Diagnostic criteria Sampson et al
Associated Findings
bull Pityriasis alba
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Must haveMajor Features
itchy skin
family history of atopy
typical picture( facial flexures lichenification)
Plus three or more of the followingMinor Features
Xerosisichthyosishyper linear palms keratosis pilaris
periaricular fissuresdennie-morgan lines
chronic scalp scalingpityriasis albacataract
UK Diagnostic criteria Sampson et al
Associated Findings
bull Pityriasis alba
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Associated Findings
bull Pityriasis alba
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Associated Findings
bull Xerosis
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Associated Findings
bull Keratosis Pilaris
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Associated Findings
bull Ichthyosis
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Hyperlinear Palmar Creases
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
1048708 VERY 10-20 of children in developed countries (Harper et al2000)1048708 Incidence has trebled over the last 30 years (Harper et al
2000)1048708 Positive correlations of eczema with higher social classes
and airpollution has been confirmed (Simpson Hanifin 2005)
1048708 80 of children will develop eczema in 1st year1048708 50 of children will clear by 2 years of age1048708 85 of children will clear by 5 years of age1048708 About 5 of children with eczema will continue into adulthood
How common is Atopic Eczema
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
1048708 Onset after 2 years of age (Vickers)1048708 Severe eczema in infancy1048708 Atypical location for age of the patient (Eczema to extensors wrists and hands to be more prone to persistence of eczema)1048708 Severity and duration of eczema are correlated to
the incidence of asthma1048708 Biparental history of atopy have shown to be unfavourable
Factors influencing poor prognosis Atopic Eczema
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
1048708 Intractable itch1048708 Sleep depravation1048708 Disruption to family life1048708 Schoolwork absenteeism1048708 Parental marriage problems1048708 Chronic disease1048708 Teasing1048708 Low self esteem
Effects on Life Atopic Eczema
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
1048708 Heat1048708 Dry skin and environment1048708 Prickle1048708 Allergies1048708 Irritants1048708 Infection1048708 Saliva1048708 Water
What aggravates Atopic Eczema
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
1048708 Too many clothes1048708 Hot baths gt29 degrees1048708 Too many blankets1048708 Sportrunning around1048708 Hot cars1048708 Heaters1048708 Hot school classrooms
What makes eczema hot and itchy
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
1048708 Soap use bath oils or washes1048708 Air blowing heaters1048708 Swimming pools1048708 Australia1048708 Therefore apply moisturiser from top to toe regularly and
more often when flaring
What makes eczema dry and itchy
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
1048708 Animal hairdander1048708 Woolen clothes1048708 Sharp seams1048708 Tags1048708dust mitesmolds1048708 rough fabrics
What prickles eczema and makes it itchy
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Diagnosis
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
First appointment is important in managing the eczema effectively and gain the trust of the patient and family
1048708 Family history1048708 Coexisting atopic disease1048708 Immunization1048708 Allergies tests diet manipulation and adequacy1048708 Growth1048708 Previous treatments used and outcomes1048708 Most distressing element1048708 Sleep disturbance1048708 Environmental aggravators assess heatprickledryness1048708 Effect on family life school1048708 Parents expectations from treatment1048708 YOUR expectation from treatment
Taking a good history
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Immunological Features of Atopic Dermatitis
bull Increased IgE productionbull Specific IgE to multiple antigensbull Increased basophil spontaneous histamine releasebull Decreased CD8 suppressorcytotoxic number and
functionbull Increased expression of CD 23 on mononuclear cellsbull macrophage activation with increased secretion of
GM-CSF(IL-5) PGE2 and IL-10bull Decreased numbers of IFN-gamma-secreting from Th
1-like cells
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
1048708 Completely undress child1048708 Look for (SCORAD) httpadserversanteuniv-nantesfrScoradhtml )1048708 Extent (1-10)1048708 Infection (1-3)1048708 Broken skin (1-3)1048708 Erythema (1-3)1048708 Lichenification (1-3)1048708 Xerosis (1-3)1048708 Sleep pattern (1-10)1048708 Itch (1-10) Tottal 8-45
Assessment
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Assessment of severity
Clear ndash normal skin no evidence of active atopic eczema
Mild ndash areas of dry skin frequent itching +- small areas of redness
Moderate - areas of dry skin frequent itching redness +- excoriation and localised thickening
Severe ndash widespread areas of dry skin incessant itching redness (+- excoriation extensive skin
thickening bleeding oozing cracking
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Selection of treatment
This depends on
bull Disease severity
bull Age
bull Compliance
bull Efficacy
bull Safety data
bull Treatment costs
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Every day1048708 avoid aggravators1048708 moisturiser1048708 bath oil
Eczema TreatmentsTopical Treatments
Flaring Treatments 1048708 every day treatments +
1048708 steroid ointments1048708 wet dressings1048708 cool compresses1048708 antibiotics
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
bull Antibiotics(for infected eczema)bull Antiviral agents(for eczema herpeticum)
bull Steroids are better avoided at this stagebull Antihistamines(for itching)
bull Pimecrolimus(thought to work by modifying the immune system)A new form of treatment but its
place in the management is not clearbull Patient may require admission as they
tend to be very unwell
Treatment (contrsquod)
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
1048708 Within 24 hours if cortisone ointments are not clearing the eczema1048708 Child is waking at night1048708 Itchy1048708 Skin is thickened1048708 If there is blood on the sheets
When to use a wet dressing
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
1048708 Reduce itch1048708 Treat Infection1048708 Moisturise the skin1048708 Protect the skin1048708 Promote sleep
Why apply wet dressings
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
bull Phototherapy(using ultraviolet rays UVAnUVB)bull Immunity suppressing drugs(egoral steroidsazathioprineciclosporintacrolimus)bull Diet and nutrition (food allergy)bull Alternative therapies (Chinese medicine herbalism)
Second line treatment(severe cases)All these require specialist treatment in the
Hospital
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
bull Viral infections like eczema herpeticumwarts and
molluscum contagiosum
bull Bacterial infections like impetigo(caused by staph aureus)
bull Cataracts
bull Growth retardation(10 of children are
affected but not thought to be related to steroid use)
COMPLICATIONS
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
1048708 NO TOPICAL STEROIDS1048708 remove crusts1048708 +- oralIV acylovir1048708 most often oral keflex1048708 admission prn
Eczema Herpeticum
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
1048708 REMOVE CRUSTS1048708 Oral keflex 10 days if well1048708 IV flucloxacillin ONLY if unwell or febrile1048708 General Eczema Care1048708 Admission prn
Bacterial infected eczema
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
Education and information Explain cause and course of disease
Demonstrate quantities and frequency of treatments
Inform symptoms and signs of bacterial infections
How to recognise eczema herpeticum about use of complementary therapies explain have not be assessed for safety Should continue
to use emollients as well as complimentary therapies
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
1048708 11 month old1048708 2 month past history of eczema1048708 Erythema1048708 itchy1048708 weeping1048708 waking every 1-2 hours overnight1048708 general flare
Case OneHistory
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
1048708 Infected atopic eczema1048708 admission1048708 remove crustsweeping1048708 oral keflex1048708 cool compressing 1 hourly1048708 wet dressings to limbs bd1048708 baby soap1048708 2 layers of clothing to bed 1048708 heater in the bedroom 1048708 Diet breast fed full diet
Case oneWhat is the diagnosisWhat is the plan
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
1048708 bath oil1048708 dermeze to face1048708 dermeze to limbs qid1048708 hydraderm to trunk qid1048708 wet t-shirt when red or itchy1048708 sigmacort 1 or elidel bd prn
Case oneplan continued
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
1048708 Sigmacort 1 bd to face prn1048708 dermeze(50 soft 50 liquid paraffin) face qid1048708 Elocon nocte to limbs and trunk prn1048708 hydraderm to body qid1048708 keflex for 10days total1048708 cool compress prn1048708 bath oil1048708 follow up 1 -2 weeks
Case oneDischarge plan
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
SUMMARYDermatitis is a common type of skin inflammationDermatitis is a common type of skin inflammation
There are many causes of dermatitisThere are many causes of dermatitis
Dermatitis disrupts the normal functions of skinDermatitis disrupts the normal functions of skin
Investigating causes of dermatitis is as important as Investigating causes of dermatitis is as important as using drug therapy using drug therapy
Traditional agents (glucocorticoids antihistamines) and Traditional agents (glucocorticoids antihistamines) and newer agents are available to treat this conditionnewer agents are available to treat this condition
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
If you require a copy of this seminarplease Visit website atwwwkomakdarscom
Thank you
