Dermatitis/Eczema

INTRODUCTION

Dermatitis is a non-specific inflammatory response of the skin, presenting as an erythematous rash, that is usually itchy, and sometimes scaly. The terms dermatitis and eczema are often used interchangeably.

ATOPIC DERMATITIS (ECZEMA)

Criteria for diagnosis

• Itch

• Typical morphology and distribution

• Dry skin

• History of atopy

• Chronic relapsing dermatitis

Distribution The typical distribution of atopic dermatitis changes as the patient grows older. In infants the rash appears typically on the cheeks of the face, the folds of the neck and scalp. It may then spread to the limbs and groin. The change from infancy to older children is presented in Figures D2 and D3.

Management

Avoid irritants:

• Avoid soap. Use a bland bath oil in the bath and a cleansing bar, e.g. Cetaphil, DermaVeen as a soap substitute.

• Older children should have short, tepid showers

• Avoid rubbing and scratching—keep fingernails short, consider mittens or splints at night if severe

• Avoid sudden changes of temperature

• Wear light, soft, loose clothes, preferably made of cotton. Cotton clothing should be worn next to the skin.

• Avoid wool next to the skin.

• Avoid dusty conditions and sand, esp. sandpits.

• Avoid contact with people with ‘sores’, esp. herpes.

• Consider dust mite reduction strategies: premium grade dust mite covers for bedding, wash linen in hot water >55°C and consider replacing carpets and fabrics on furniture.

Improve skin condition:

• Emollients: apply twice daily to dry skin, choose from:

  • – Ego skin cream

  • – sorbolene alone or with 10% glycerol

  • – QV cream (esp. winter) or lotion (summer only)

  • – paraffin creams (e.g. Dermeze), esp. infants

  • – bath oils (e.g. Alpha Keri, QV)

Medication

Choose a potency of corticosteroid appropriate for the site and apply liberally until the skin is perfectly clear. Most dermatitis should clear within 7–14 days.

Topical corticosteroid therapy

For face, axillae and groin:

• 1% hydrocortisone ointment, daily

• if inadequate response, methylprednisolone aceponate 0.1% ointment or fatty ointment, daily

For trunk and limbs:

• triamcinolone acetonide 0.02% ointment, daily

• if more severe or in the flexures, use:

  • – methylprednisolone aceponate 0.1% ointment or fatty ointment, daily, or

  • – mometasone furoate 0.1% ointment, daily

For hands, feet, lichenified wrists and ankles:

• betamethasone dipropionate 0.05% ointment, daily, or

• mometasone furoate 0.1% ointment, daily

Secondary infection:

• Consider in the event of failure of topical treatment, or if crusting or pustules are present. Take swabs ...