ECZEMA

By Gary M. White, MD

Eczema


Eczema is a broad term used to describe skin that is dry, irritated and pruritic. Atopic dermatitis, nummular eczema, irritant contact dermatitis, allergic contact dermatitis and a variety of other conditions are all forms of eczema.

Clinical

The standard eczematous lesion is red, scaly with an irregular surface, itchy and ill-defined. It often occurs in the setting of dry skin, excessive water contact, dry or cold air. Winter is particularly bad as cold exposure can precipitate eczema which is aggravated by the dry air produced by heating. A related condition is nummular eczema which presents as round, red, scaly areas.

Scratching

Compared with scratching other common itchy diseases, the scratching of eczema is more likely to

  1. Occur.
  2. Be pleasurable.
  3. Lead to excoriations.
  4. Lead to lichenification.

Treatment

The key intervention is to apply a medium to high potency topical steroid ointment (e.g. 0.1% triamcinolone or fluocinonide) immediately after the bath or shower. As the skin improves, the patient should switch over to applying a heavy cream or even an ointment immediately after the shower while the skin is still moist. A dry skin handout is available. Many non-dermatologists treat eczema as an infection with oral antibiotics without success. However, if the eczema is moist and oozy, the combination of a strong topical steroid ointment and an oral antibiotic (e.g. cephalexin) can be beneficial. See any of the above diseases for therapeutic ideas for specific subsets of eczema.

Additional Pictures

A bit of an annular eczema.
Eczema

Moist and oozy eczema. This type often benefits from a strong topical steroid ointment and an oral antibiotic, e.g. cephalexin.
Eczema

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