ATOPIC ECZEMA

By- Dr. Armaan Singh

Atopic eczema is a chronic, relapsing, inflammatory skin

condition characterised by an itchy red rash that favours the skin creases such as the folds of the elbows or behind the

knees.

TRIGGER FACTORSO Irritants, eg soaps and detergents (including shampoos,

bubble baths, shower gels and washing-up liquids).O Skin infections: Staphylococcus aureus is believed to be an

important exacerbating factor in atopic eczema. O Contact allergens.O Extremes of temperature and humidity. Most patients

improve in summer and are worse in winter. Sweating induced by heat or exercise can provoke an exacerbation.[-

O Abrasive fabrics, eg wool.O Dietary factors aggravate atopic eczema in about 10% of

children but much less frequently in adults. Food allergy should be suspected in children with atopic eczema who have reacted previously to a food, with immediate symptoms, or in infants and young children with moderate or severe atopic eczema that has not been controlled by optimum management, particularly if associated with gut dysmotility (colic, vomiting, altered bowel habit) or failure to thrive.

O Stress may exacerbate atopic eczema, which itself may be a cause of psychological distress.

O Hormonal changes in women - eg premenstrual flare-ups, deterioration in pregnancy.

DIFFERENTIAL DIAGNOSISO Psoriasis

O Contact dermatitisO Seborrhoeic dermatitisO Fungal infectionsO Lichen simplex chronicusO Scabies and other infestations

INVESTIGATIONSO Estimation of immunoglobulin E (IgE)

and specific radio allergosorbant tests (RASTs) only confirm the atopic nature of the individual.

O Swabs for bacteriology are particularly useful if patients do not respond to treatment, in order to identify antibiotic-resistant strains of S. aureus or to detect additiona lstreptococcal infection.