Atopic Eczema

Skin Lesion: Ill-defined erythematous, scaly, and itchy patches.

Acute stages: Lesions may show weeping, crusting, and vesicles.

Chronic lesions: Often exhibit lichenification (thickening) due to repetitive scratching.

Dyshidrotic Eczema (Pompholyx):

• Morphology: Small, deep-seated "tapioca-like" vesicles that are intensely pruritic.
• Distribution: Primarily affects the palms, soles, and the lateral aspects of fingers.
• Late Stage: Resolves with desquamation (peeling), leaving behind dry, fissured skin.

Age-Specific Distribution:

• Infant: Predominantly affects the face and may appear patchy elsewhere.
• Toddler: With crawling, the extensor aspects of the elbows, wrists, knees, and ankles are affected. The distribution shifts to flexural once they begin walking.
• Adults: Presents in a variety of forms; mostly flexor (elbow/knee creases) but can also be diffuse.
• Facial Signs: Characteristic periorbital darkening and Dennie-Morgan infraorbital folds.

Psoriasis Vulgaris

• The Clue: Well-demarcated salmon-pink plaques with silvery-white scales.
• Vs Eczema: Psoriasis favors extensor surfaces (elbows/knees); Eczema favors flexures (in adults).

Seborrheic Dermatitis

• The Clue: Yellowish, greasy scales on an erythematous base.
• Vs Eczema: Located in the "T-zone" (eyebrows, nasolabial folds) rather than limb creases.

🚨 URGENT Referral (Within 24 hours):

• Eczema Herpeticum: Clinical suspicion of eczema with widespread herpes simplex infection.
• Severe skin bacterial infection requiring intravenous antibiotics.
• Acute Erythroderma: Eczema affecting more than 80% body surface area.

Non-Urgent Referral Criteria:

• Diagnostic uncertainty.
• Severe or uncontrolled eczema: Treatment failure or requirement for frequent potent TCS.
• Psychological disturbance on the patient or family.

Topical Corticosteroid (TCS) Potency (1-2 times daily):

• Very Potent:
  • Clobetasol Propionate 0.05%
• Potent:
  • Mometasone Furoate 0.1% (Once daily only)
  • Betamethasone Dipropionate 0.05%
  • Betamethasone Valerate 0.1%
  • Triamcinolone Acetonide 0.1%
• Moderate:
  • Clobetasone Butyrate 0.05%
  • Betamethasone Valerate 1:4 (0.025%)
• Mild:
  • Hydrocortisone Acetate 1% (Suitable for face)

Symptomatic Treatment:

• Cetirizine 10mg OD.
  [Child: 0.25mg/kg OD]
• Piriton 4mg ON/TDS.
  [Child: 0.1mg/kg ON/TDS]
• Desloratadine 5mg OD
  [Child: 0.1mg/kg OD] (non-drowsy)

Oral Prednisolone (Short Course):

• Prednisolone: 30mg–50mg OD for 3–5 days.
  [Child: 1-2mg/kg OD] (max: 60mg).

Supportive Care:

• Emollients: Liberal and frequent use. Always apply after TCS application.

⚠️ Safety Pearl: Limit high-potency TCS to <2 weeks duration to avoid skin atrophy.

📸 Images