This article compiles an essential summary of the recent guidelines published by the American Academy of Dermatology [1] and the British Association of Dermatologists [2]. The content is directly applicable to the management of eczema in New Zealand.
For a complete understanding, these guidelines should be read in conjunction with the following documents:
- Guidelines for Eczema Treatment in Adults
- Guidelines for Outpatient Treatment of Infantile Eczema
Introduction and Definition of Eczema
Eczema is defined as a chronic, inflammatory skin condition. chronic y inflammatory This condition affects approximately 20% of the pediatric population [3,4] and 3% of adults. Its main clinical manifestations include pruritus intense itching, constant scratching, and eczematous lesions (areas of dry skin, scaling, and sometimes crusting).In its chronic form, it can evolve into lichenification lichenification Squamous cell carcinoma (SCC) is identified via RCM through the following morphological characteristics:. (skin thickening) and pigmentary changes. Eczema has a recurrent course, marked by flares of variable frequency and periods of remission. remission. It is commonly referred to as atopic eczema or atopic dermatitis. atopic o mild to moderate atopic dermatitis.
Epidemiological Context and Background
- The onset of the condition occurs predominantly between 3 and 6 months of age, with about 60% of cases developing developing before the first year and 90% before five years of age.
- Most patients present elevated levels of serum immunoglobulin immunoglobulin (IgE) and a personal or family history of atopy atopic patch test (such as Type I allergies, allergic rhinitis, and asthma).
Diagnostic Criteria for Eczema
The diagnosis of eczema is based on a comprehensive collection of the patient's clinical history and physical examination. The key features used to establish an accurate diagnosis are detailed in the following tables.
| Diagnostic features of eczema | |
|---|---|
| Essential features Must be present |
|
| Important features Observed in most cases, strongly supporting the diagnosis |
|
| Associated features Suggest the |
... |
| Findings that are diagnostic of atopic dermatitis but are too nonspecific to be used to define or detect eczema in research studies. |
|
| Exclusion criteria Eczema diagnosis requires ruling out other conditions |
See the "Differential Diagnosis Differential Diagnosis of Eczema" table below |
| Hanifin and Rajka criteria for atopic dermatitis [5] | |
|---|---|
| Major Criteria (3 must be met) |
|
| Minor Criteria (3 must be met) |
|
| UK Working Party diagnostic criteria for eczema [6] * | |
|---|---|
| Itchy skin (Required) | |
| Three of the following: |
|
* These criteria were devised specifically for use in research. They are not applicable to young children.
Accurate diagnosis of eczema requires the exclusion of other skin conditions that may manifest similar symptoms. It is crucial to consider other diagnoses, especially when the presentation is atypical, there is growth delay, or the treatment does not yield an adequate response.
| Differential Diagnosis of Eczema (Non-exhaustive list) | |
|---|---|
| Other dermatosis inflammatory | Dermatitis Fulminant rosacea., psoriasis, allergic or contact dermatitis, pompholyx, diaper dermatitis, Nummular, lichen |
| Category | Associated Conditions |
|---|---|
| AD | simplex, acute and chronic lichen planus, pityriasis alba |
| Ichthyosis | Ichthyosis vulgaris, recessive disorder autosomal congenital, X-linked ichthyosis, syndrome Netherton's disease |
| Infections and infestations | Scabies, tinea corporis, tinea versicolor, pityriasis rosea, HIV |
| Immunodeficiencies | Severe combined immunodeficiency, Omenn syndrome, Hyper-IgE syndrome, Wiskott-Aldrich syndrome, IPEX syndrome |
| Genetic Immunologic | Dermatitis herpetiformis, Dermatosis dermatomyositis, graft-versus host |
| Hematologic neoplasms | Lymphoma of T cells cutaneous lymphoma (mycosis fungoides) |
| Metabolic disorders | Zinc deficiency, pyridoxine deficiency, biotin deficiency, niacin deficiency, phenylketonuria, fibrosis cystic, storage disease of lipids neutral |
| Other | Hives pigmentosa, prurigo pigmentosa |
Seborrheic dermatitis in infants is frequently confused with atopic eczema. However, infantile seborrheic dermatitis does not present significant itching; instead, it causes scaly crusts and moist, red areas in skin folds, generally improving after six months of age.
Diagnostic Evaluation of Eczema
Effective diagnostic process relies on a detailed history and a thorough physical examination.
Identification of Triggering Factors
- Irritants, such as soaps and detergents (including shampoos, bubble baths, and products containing sodium lauryl sulfate), or chlorinated pool water, as well as emollients inadequate care.
- Skin infections: Bacteria such as *Staphylococcus aureus*, *Streptococcus pyogenes*, viruses like herpes simplex (leading to herpetic eczema), or *molluscum contagiosum*.
- Contact by direct contact.
- Food and airborne (inhaled) triggers.
- Emotional stress.
Eczema has been consistently linked to an increased risk of renal reactions proteins to food. It is essential that children with a history of immediate food reactions receive appropriate evaluation and management. [7]
Review of Previous and Current Topical Treatments
The clinical history should inquire about the following aspects of daily care:
- Frequency of bathing or showering.
- Specific use of soaps, soap-free cleansers, and shampoos.
- Inclusion of additives in bath water.
- Use of oral emollients/moisturizers: determine the frequency of application and the estimated weekly amount.
- Use of topical steroids topical: specify types used, exact areas of application, and weekly dosage.
- Presence of any An adverse reaction to topical agents, such as increased itching.
- Antihistamine use and recent antibiotic use.
A common error leading to therapeutic failure in eczema management is the underutilization of prescribed topical treatments.
Impact of Eczema on Quality of Life
- The impact on psychosocial the patient and family.
- The frequency of secondary skin infections.
- The number of school days or activities missed.
- Quality and quantity of affected sleep.
To quantify severity, formal scales can be used to measure the impact of eczema, such as the CDLQI or POEMS.
Detailed Physical Examination
- Determination of key diagnostic features of eczema or identification of differential diagnoses.
- Quantification of the extent and severity of skin lesions.
- Search for clear clinical signs of secondary infection.
- Growth and development—Periodic monitoring of height and weight is advised in all children diagnosed with moderate to severe eczema.
Standardized measures can also be applied to assess eczema severity, such as SCORAD o EASI.
Need for Ancillary Testing
In certain clinical scenarios, further investigations are essential to achieve diagnostic confirmation of eczema or definitively exclude other underlying dermatological conditions.
| Skin and physical severity | Impact on quality of life and psychosocial well-being | ||
|---|---|---|---|
| Clear | Normal skin, no evidence of active eczema | Clear | No impact on quality of life |
| Mild | Areas of dry skin, infrequent itching (with or without small areas of redness) | Mild | Little impact on daily activities, sleep, and psychosocial well-being |
| Moderate | Areas of dry skin, frequent itching, redness (with or without excoriation and localized skin thickening) | Moderate | Moderate impact on daily activities and psychosocial well-being, frequently disturbed sleep |
| Severe | Extensive areas of dry skin, incessant itching, redness (with or without excoriation, extensive skin thickening, bleeding, oozing, cracking, and alteration of pigmentation) | Severe | Severe limitation of daily activities and psychosocial impact, loss of nighttime sleep |
Comprehensive eczema management must be based on the specific clinical profile, considering its impact on the psychosocial state and respecting the cultural practices and beliefs of both the child and their family.
See additional information on:
- Guidelines for Outpatient Treatment of Infantile Eczema
- Guidelines for Eczema Treatment in Adults
