Eczema School.

Department of Dermatology, Aarhus Sygehus,

Anne Braae Olesen, MD, Ph.D. or Mette Deleuran, Chairman, MD,

DMSc.

Purpose/goal for the Eczema School.

• To educate the parents about the disease

• To treat the disease correctly.• To accept the disease.

Different names for the disease

• Child eczema• Asthma eczema• Atopic dermatitis• Atopic eczema• Prurigo Besnier

Atopic eczema – how to describe the disease?

• Chronic skin disease that varies in intensity

• Dominated by severe itch and an increased tendency to itch

• Acute eczema: weeping? and often with infection.

• Chronic eczema: dry, infiltrated skin.

How common is the disease and courses for

the disease?• Affects 15-20 per cent of all Danish children• Increased prevalens• Genetic factors are involved• Increased risk for the disease if the parents and

siblings have the disease• Environment and everyday life also have an impact on

the disease.

Changes in the skin.

• The mechanical barrier is defect

• Decreased amount of fats in the skin

• Increased water loss from the skin

• Increased amount of inflammatory cells in the skin

Skin barrier function

• Altered composition of fatty acids in the strateum corneum

• Increased water lossLBLB

Skin dryness

Atopic Eczema – itch

The skin is leaking

Evaporation – the skin gets dry

The skin is itching and the child itches back

Do you think I sleep well at night?

Development of eczema disease

• 90 per cent develop the disease in the first three years of life

• Early debut can be predictive for severe disease• 75-80 per cent are clear of symptoms in childhood• In 10-20 per cent of the patients the disease comes back

• 25-50 per cent develop hand eczema later

Distribution of eczema

• Infants: especially the face, the scalp and the extensor sides of the extremities

Distribution of eczema

Infants, especially the face, the scalp and the extensor sides of the extremities.

“Lick eczema”

Distribution of eczema.

• Children: flexural areas, head and neck, ankles and wrists.

Distribution of eczema.

• Adults: often face, neck and hands.

Complications• Wound infections with staph.

aureus: impetigo.

Complications

• Impetigo, oozing eczema.

Complications

1. Herpes infections

Complications

1. Molluscum.

Complications

• Warts and condyloma

Increased risks for other diseases

1. Asthma (approximately 33 per cent)

2. Hay fever (approximately 33 per cent)

3. Food allergies (5-7 per cent)

4. Food intolerance

Diet in children with eczema

1. Nursing can postpone eczema debut2. Uncertain whether the eczema can be prevented3. Eczema patients on a diet are not free of symptoms4. Some children do get better on a diet5. A diagnosis of food allergy is based on history,

prick/RAST-test and maybe provocation.

Dietary treatment in patients with eczema

1. Many positive prick/RAST-tests concerning foods are not clinically relevant

2. Some food allergies can disappear when the child grows older

3. Dietary treatment do not always need to be life long4. It is important to consider the diet from time to time.

Dietary treatment in patients with eczema

1. Avoid strict diets in children where you do not have specific suspicion on allergies.

2. Malnutrition has been observed3. How severe the diet should be depends

on the disease history.

Principles for treatment

1. Avoid factors that irritate the skin

Principles for treatment

• Emmollient is basic treatmentControl of dryness and itch

Steroid creamsSteroid creams

Steroid creamsSteroid creams

• Containing cortico-steroids• Are divided into 4 groups• Effect and side effect go hand in hand• Diminish the inflammation in the skin• Contract the block vessels and diminish erythema• Diminish itch

Steroid creams

1. Absorption of cream is greatest in areas with thin skin and intertriginous areas

2. Face and genitals are especially sensitive3. Use milder steroid creams in these areas4. When you use the cream in the right way there are

only few side effects

Steroid side effects• Atrophy• Skin bleedings• Telangiectasiae• Infections• Acne• Worsening of the disease when

you stop the treatment

Treatment principles – steroid cream

• Only apply cream/ointment on active areas• Apply in a thin layer: fingertip units• Wash your hands after applying the cream or

use gloves• Use an effective cream to start with and

reduce the strength when the skin gets better• It is important to reduce gradually to prevent a

flair of the disease

Treatment principles – steroid cream

• Used in the right way there are only few side

effects

• Chronic untreated eczema harms the skin

• We see more under treated than over treated

children

• It is important that the children get a normal life

Tar treatment of eczema

1. Tar is a good treatment for eczema2. It is greasy and it smells3. Tar can sting on the skin if you have open wounds4. Can be used undiluted or diluted in creams5. Increases photo sensitivity

UV-treatment for eczema

1. Sun light and UVB-treatment help most patients

2. UV-treatment is best for bigger children

3. PUVA-treatment for adults

Gamma-linolenic acid1. Unsaturated fatty acids2. It helps a few patients3. It is expensive4. You have to eat a lot of capsules every day5. It can be tried when you have severe eczema for a period6. Stop the treatment if it does not have any effect because

the effect is not documented in larger groups

Alternative treatment

Miralex cream

Treatment of eczema complicated with

impetigo1. Wash with water and mild soap2. Sodium permanganate (red baths)3. Steroid creams with antibiotics4. Antibiotic creams and ointments5. Antibiotics as tablets or mixture

Newer treatments: Elidel and Protopic1. Elidel cream: 1 per cent2. Protopic ointment 0,03 per cent and

0,1 per cent3. Effective for treatment of atopic

dermatitis4. Long term control of atopic dermatitis

for around 80 per cent of the patients

Elidel and ProtopicAdvantages:

• Do not contain steroids• Can be used in all skin areas• Can be used for long term treatment• Does not induce atrophy

Elidel treatment of atopic dermatitis

Elidel and ProtopicSide effects:• Feeling hot on the skin after

application• Bacterial infections in the skin• Herpes infections

Elidel and Protopic

Do not use solarium or get UV-treatment when treated with Elidel and Protopic