ECZEMA IN THE ADULT

By Gary M. White, MD

Eczema in an adult.  Head and neck eczema. Eczematous skin, with redness and increased skin markings most prominent on the neck. Head and neck eczema is a common presentation.


Eczema in the adult may be a continuation of childhood atopic dermatitis, or it may occur de novo. One should review the medications to make sure the patient isn't on a calcium-channel blocker (CCB), e.g., Amlodipine (Norvasc), Diltiazem (Cardizem, Tiazac), Felodipine, Isradipine, Nicardipine (Cardene SR), Nifedipine (Procardia), Nisoldipine (Sular), and Verapamil. In large studies, older adults with eczema are more likely to be on CCBs, suggesting causation.

Clinical

The skin develops scattered eczematous patches. The location may be suggestive of triggers or causation. For example, involvement of the lower abdominal skin where a metal buckle contacts may indicated a nickel allergy. Photo-distributed eczema may indicate triggering by UV light. Head and neck eczema is one common presentation (see above photo), and it has been hypothesized that airborne allergens or sensitivity to the yeast Malassezia may play a role.

Workup

Inquiry should be made about any atopic history (childhood eczema, hay fever and/or asthma in the patient or family) and possible triggers (frequent bathing, started a swim class, cold, winter weather). Patch testing may be needed.

Treatment

The standard treatment approach using 1-2 weeks of topical steroid therapy to clear (usually an ointment) followed by daily moisturization to prevent (no lotions please) is indicated. See eczema.

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