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Atopic Eczema PowerPoint Presentation

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Description : This medical presentation titled ""Atopic Eczema"" tells us about atopic eczema, its classification, chronic eczema, its exacerbating factors and clinical features, and its Treatment.

Tags : Allergy, pruritus, erythema, vesiculation, Chronic eczema, pruritus, xerosis, lichenification, hyperkeratosis, fissuring, Atopic dermatitis, Pathogenesis, Exacerbating factors, Itch-Scratch cycle, Discoid eczema, Seborrhoeic, Seborrhoeic eczema, Lichen simplex, Pompholyx, Follicular, Contact dermatitis, exogenous, Allergic, irritant, Complications, Treatment, steroid

Published on : Apr 24, 2021 | Views : 2233 | Downloads : 23

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Atopic Eczema Sharon Wong Suzy Tinker
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Classification Endogenous vs Exogenous Acute vs Chronic
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Acute eczema Acute: pruritus, erythema, vesiculation
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Chronic eczema Chronic: pruritus, xerosis, lichenification, hyperkeratosis, +/- fissuring
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Chronic eczema
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Eczema – clinical subtypes Irritant contact dermatitis Allergic contact dermatitis Atopic Discoid Seborrhoeic Venous Pompholyx Asteatotic Follicular/papular Exogenous Endogenous
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Atopic dermatitis Chronic relapsing skin disorder (prevalence 20%) Onset <5 years in 80% 40-60% remain symptomatic as adult 85% ↑ IgE, 80% associated with asthma/allergy Family Hx of atopy
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Pathogenesis of AD Interaction of skin barrier, genetic, environmental, pharmacologic, and immunologic factors Release of vasoactive substances from mast cells and basophils, that have been sentitized by the interaction of the antigen with IgE.
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Exacerbating factors Inhalants (dust mites, pollens) Infections Autoallergens (IgE) Foods (eggs, milk, peanuts, soy-beans, fish, wheat) Contact irritants (wools) Season (improves in summer, flares in winter) Emotional stress
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Clinical features
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Atopic eczema
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The Itch-Scratch cycle Pruritus usually begins and causes itch sensation Scratch causes skin trauma and precipitates skin inflammation Chronic inflammation leads to lichenification
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Clinical variants
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Discoid eczema
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Seborrhoeic
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Seborrhoeic eczema
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Lichen simplex
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Pompholyx
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Follicular
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Contact dermatitis (exogenous)
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Allergic vs irritant Immunological Type IV hypersensitivity Lifelong Positive patch test Non-immunological Can affect anyone More common atopics
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Complications of Atopic Dermatitis
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Impact of Atopic Dermatitis Hinders social interactions Disrupts sleep Disturbs schooling Failure to thrive Affects entire family
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Treatment
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Aim To get the eczema under control Keep the eczema under control
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Basic stuff Avoid provoking factors (wool, bubble baths, soaps, perfumes) Avoid dryness: Bath oils (Oilatum, Hydromol, Aveeno, Dermol) Soap substitutes (Aqueous cream, Dermol) Emollients (500g in 2 weeks) Treat any infection Antihistamines Reduce inflammation
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Reduce inflammation Topical steroids Topical immunomodulators Oral prednisolone Oral immunosuppressives Phototherapy
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Topical steroids Ointments better than creams Learn 3 topical steroids I) Hydrocortisone ii) Eumovate iii) Betnovate/Elocon
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Common topical steroid myths Can’t apply to infected or broken skin Can’t use topical steroids for more than 1 week non stop Hydrocortisone topically can thin the skin Cannot use potent topical steroids on the face
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To get the eczema under control Apply steroid daily until skin is back to normal Then stop or wean down Continue emollients
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To keep the eczema under control Apply topical steroid immediately the eczema flares Consider maintenance Rx (eg Protopic) Eumovate >30g per month- baby- refer Betnovate>60g per month –child-refer
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Tacrolimus ointment Inhibits T cell activation & suppresses cytokine gene transcription Inhibits IgE-induced histamine release from mast cells and basophils Down-regulates high affinity IgE receptor on Langerhans cells
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Important instructions to patients Burning/stinging sensation following application which will spontaneously resolve Avoid application after a hot bath or shower Recommend adequate application of tacrolimus ointment, it is NOT a topical steroid Care in sun - long term immunosuppression???
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Particular indications for topical tacrolimus ointment Peri-ocular involvement Flexural involvement Facial involvement Requirement for maintenance treatment with moderately potent or potent topical steroids Presence of topical steroid-induced cutaneous atrophy or striae Pigmented skin
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Not winning? Compliance? Infected? Contact dermatitis Difficult eczema?
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Dressings & bandaging Dressings Wet wraps Comfifast, tubifast, dermasilk garments Over emollient / weak steroids Quality Nursing Care
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Phototherapy UVB/TLO1 Psoralen + UVA = PUVA Methoxypsoralen Topical or systemic Whole body or regional
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Systemic treatments Short courses prednisolone Ciclosporin Azathioprine Methotrexate Mycophenolate mofetil
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Steroid side effects - local Skin atrophy Telangiectasiae Acne Pigmentaion change ALL MORE MARKED IN FLEXURAL SITES!
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Steroid side effects - systemic suppression HPA axis cataracts growth suppression loss bone density diabetes cushings
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Take home messages Bath oils, soap substitutes and emollients - all stages/severity of eczema Use the most appropriate strength of steroid for the severity and site Steroids can be used for longer than a week – arrange follow-up to review and step down when skin improved Check compliance – ask how long a tube of steroid/pot of emollient lasts Prompt treatment of coexistent infection Assess severity by asking about sleep/school disturbance, weight/height gain (red book), mood, family dynamics