Eczema commonly presents with dry, itchy skin.
Typically there is erythema, scaling, vesicles, or lichenification in skin flexures.
Diagnosis is primarily clinical.
First-line treatment is with emollients and topical corticosteroids.
Other options that may be used in patients unresponsive to first-line therapy include topical calcineurin inhibitors, phototherapy, biological agents, or immunomodulatory agents.
Eczema is an inflammatory skin condition characterised by dry, pruritic skin with a chronic relapsing course. It can affect all age groups, but it is most commonly diagnosed before 5 years of age and affects 10% to 20% of children. Patients often have a personal or family history of other atopic diseases such as asthma or allergic rhinitis. Food allergies may occur at increased rates in this population. Eczema can be described as acute or chronic. Acute eczema is used to describe a flare-up of symptoms. Chronic is used to describe the condition when the patient develops signs of chronic inflammation (e.g., lichenification).
History and exam
Key diagnostic factors
- presence of risk factors
- xerosis (dry skin)
- sites of skin involvement
Other diagnostic factors
- keratosis pilaris
- filaggrin gene mutation
- age <5 years
- family history of eczema
- allergic rhinitis
- active and passive exposure to smoke
- female sex
- African-American ethnicity
1st investigations to order
- clinical diagnosis
Investigations to consider
- IgE levels
- skin-prick testing
- oral food challenge
- trial elimination diet
- patch testing
- skin biopsy
chronic or relapsing disease (non-refractory)
refractory chronic or relapsing disease
- Seborrhoeic dermatitis
- Irritant contact dermatitis
- Allergic contact dermatitis
- Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis
- Guideline for the systemic treatment of atopic eczema
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