Eczema - clinical essentials and MCQ

Eczema (atopic dermatitis) is a common, chronic, relapsing, inflammatory skin condition. It typically presents before 1 year of age and can be lifelong.

Allergy testing and elimination diets

• People with eczema often have other allergic conditions, including food allergy, but food allergy does not cause eczema.

• Results from skin or blood tests for food allergies do not predict foods that trigger eczema. Allergy testing should only be undertaken if recommended and interpreted by a clinical immunology/allergy specialist.

• Common triggers for eczema flares include dry climate, overheating, irritants (fragranced products, chemicals, sand, grass or dirt), scratching, allergens (dust mites), stress, sweat and excessive saliva, hormones and infections.

• Avoid elimination diets and changes to infant formulas in those without a confirmed food allergy as this may result in malnutrition, poor growth and the development of new food allergies.

Shared decision-making and care

• To support shared decision-making:

• use the Eczema Care Plan

• follow the Eczema Management Algorithm

Moisturisers

• Improves skin hydration and maintains the skin barrier

• Daily use reduces the number of flares and need for topical corticosteroids

• Moisturisers with ceramides may repair the skin barrier more effectively than others, but patient needs and preferences should be considered

• Avoid products containing:

animal or plant-derived proteins (e.g., nuts, coconut, milk) especially if a person has broken skin and does not readily eat the food or has an allergy to it essential oils aqueous cream containing sodium lauryl sulphate benzalkonium chloride, methylchloroisothiazolinone (MCI) or methylisothiazolinone (MI)

Topical corticosteroids (TCS)

• Beyond the use of daily moisturiser, topical corticosteroids are first-line for management of eczema, showing proven efficacy and safety

• Treat until fully resolved: generously apply TCS before moisturiser, on all areas of inflammation (not just the worst areas) until the skin feels smooth and itch-free - without strict time limits

• Treat early using appropriate potency to avoid a chronic cycle of inflammation

• Prescribe appropriate quantities (consider PBS streamline authorities for higher quantities).

• Ointments are more effective than creams. When choosing a formulation, consider site and patient preference, see algorithm for further details

Eczema beyond the physical symptoms

• Eczema impacts the well-being and quality of life of both individuals and caregivers. 

• Children with eczema are more likely to experience sleep deprivation, mood disturbances, inattention and learning difficulties at school.

• Adults with eczema have an increased risk of mental health disorders, such as anxiety and depression, when compared to adults without the disease.

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