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