13.03.15 Eczema

Atopic march

    • Eczema 0-2 years

    • Hayfever 3-5 years

    • Then asthma

Baby eczema

    • Different distribution: Face, Trunk, Flexors

      • Extensors come later

    • Symptoms: Reduced feeding, FTT, Scratching +/- bleeding, Not sleeping, Infection (pustules, vesicles, weeping)

Management

    • Keep the water in and the allergens out with barrier moisturiser

    • Bathe every day (good for hydration + cleaning)

    • Steroids: Hit it hard, in bursts

      • Carry on until settled and for 3 more days

      • Don't ever go above eumovate for face/neck

      • Apply until you can see a shimmer (don't be shy)

      • Side effect: Thin skin with prolonged use

    • Protopics (tacrolimus)

      • Only if >2

      • ? Skin cancer risk

    • Treat infections

Steroid ladder

    • Hannah

      • 0.5% hydrocortisone is homeopathic

      • 1% is only any good for very, very mild eczema

    • Every

    • Boy's

    • Dream

Notes

    • Don't ever use calomine for anyything ever

    • Potassium permangenate

      • Antiseptic/astringent

      • Generally reserved for adults

      • Use it pink, never purple

    • Eczema flare look raised/rough and are more itchy

    • Untreated childhood eczema predisposes to severe, refractory adult eczema