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Eczema School .

Eczema School . Department of Dermatology, Aarhus Sygehus, Anne Braae Olesen, MD, Ph.D. or Mette Deleuran, Chairman, MD, DMSc. Purpose/goal for the Eczema School . To educate the parents about the disease To treat the disease correctly. To accept the disease. .

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Eczema School .

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  1. Eczema School. Department of Dermatology, Aarhus Sygehus, Anne Braae Olesen, MD, Ph.D. or Mette Deleuran, Chairman, MD, DMSc.

  2. Purpose/goal for the Eczema School. • To educate the parents about the disease • To treat the disease correctly. • To accept the disease.

  3. Different names for the disease • Child eczema • Asthma eczema • Atopic dermatitis • Atopic eczema • Prurigo Besnier

  4. Atopic eczema – how to describe the disease? • Chronic skin disease that varies in intensity • Dominated by severe itch and an increased tendency to itch • Acute eczema: weeping? and often with infection. • Chronic eczema: dry, infiltrated skin.

  5. How common is the disease and courses for the disease? • Affects 15-20 per cent of all Danish children • Increased prevalens • Genetic factors are involved • Increased risk for the disease if the parents and siblings have the disease • Environment and everyday life also have an impact on the disease.

  6. Changes in the skin. • The mechanical barrier is defect • Decreased amount of fats in the skin • Increased water loss from the skin • Increased amount of inflammatory cells in the skin

  7. Skin barrier function • Altered composition of fatty acids in the strateum corneum • Increased water loss LB

  8. Skin dryness

  9. Atopic Eczema – itch The skin is leaking Evaporation – the skin gets dry The skin is itching and the child itches back

  10. Do you think I sleep well at night?

  11. Development of eczema disease • 90 per cent develop the disease in the first three years of life • Early debut can be predictive for severe disease • 75-80 per cent are clear of symptoms in childhood • In 10-20 per cent of the patients the disease comes back • 25-50 per cent develop hand eczema later

  12. Distribution of eczema • Infants: especially the face, the scalp and the extensor sides of the extremities

  13. Distribution of eczema Infants, especially the face, the scalp and the extensor sides of the extremities.

  14. “Lick eczema”

  15. Distribution of eczema. • Children: flexural areas, head and neck, ankles and wrists.

  16. Distribution of eczema. • Adults: often face, neck and hands.

  17. Complications • Wound infections with staph. aureus: impetigo.

  18. Complications • Impetigo, oozing eczema.

  19. Complications • Herpes infections

  20. Complications • Molluscum.

  21. Complications • Warts and condyloma

  22. Increased risks for other diseases • Asthma (approximately 33 per cent) • Hay fever (approximately 33 per cent) • Food allergies (5-7 per cent) • Food intolerance

  23. Diet in children with eczema • Nursing can postpone eczema debut • Uncertain whether the eczema can be prevented • Eczema patients on a diet are not free of symptoms • Some children do get better on a diet • A diagnosis of food allergy is based on history, prick/RAST-test and maybe provocation.

  24. Dietary treatment in patients with eczema • Many positive prick/RAST-tests concerning foods are not clinically relevant • Some food allergies can disappear when the child grows older • Dietary treatment do not always need to be life long • It is important to consider the diet from time to time.

  25. Dietary treatment in patients with eczema • Avoid strict diets in children where you do not have specific suspicion on allergies. • Malnutrition has been observed • How severe the diet should be depends on the disease history.

  26. Principles for treatment • Avoid factors that irritate the skin

  27. Principles for treatment • Emmollient is basic treatmentControl of dryness and itch

  28. Steroid creams

  29. Steroid creams • Containing cortico-steroids • Are divided into 4 groups • Effect and side effect go hand in hand • Diminish the inflammation in the skin • Contract the block vessels and diminish erythema • Diminish itch

  30. Steroid creams • Absorption of cream is greatest in areas with thin skin and intertriginous areas • Face and genitals are especially sensitive • Use milder steroid creams in these areas • When you use the cream in the right way there are only few side effects

  31. Steroid side effects • Atrophy • Skin bleedings • Telangiectasiae • Infections • Acne • Worsening of the disease when you stop the treatment

  32. Treatment principles – steroid cream • Only apply cream/ointment on active areas • Apply in a thin layer: fingertip units • Wash your hands after applying the cream or use gloves • Use an effective cream to start with and reduce the strength when the skin gets better • It is important to reduce gradually to prevent a flair of the disease

  33. Treatment principles – steroid cream • Used in the right way there are only few side effects • Chronic untreated eczema harms the skin • We see more under treated than over treated children • It is important that the children get a normal life

  34. Tar treatment of eczema • Tar is a good treatment for eczema • It is greasy and it smells • Tar can sting on the skin if you have open wounds • Can be used undiluted or diluted in creams • Increases photo sensitivity

  35. UV-treatment for eczema • Sun light and UVB-treatment help most patients • UV-treatment is best for bigger children • PUVA-treatment for adults

  36. Gamma-linolenic acid • Unsaturated fatty acids • It helps a few patients • It is expensive • You have to eat a lot of capsules every day • It can be tried when you have severe eczema for a period • Stop the treatment if it does not have any effect because the effect is not documented in larger groups

  37. Alternative treatment Miralex cream

  38. Treatment of eczema complicated with impetigo • Wash with water and mild soap • Sodium permanganate (red baths) • Steroid creams with antibiotics • Antibiotic creams and ointments • Antibiotics as tablets or mixture

  39. Newer treatments: Elidel and Protopic • Elidel cream: 1 per cent • Protopic ointment 0,03 per cent and 0,1 per cent • Effective for treatment of atopic dermatitis • Long term control of atopic dermatitis for around 80 per cent of the patients

  40. Elidel and Protopic Advantages: • Do not contain steroids • Can be used in all skin areas • Can be used for long term treatment • Does not induce atrophy

  41. Elidel treatment of atopic dermatitis

  42. Elidel and Protopic Side effects: • Feeling hot on the skin after application • Bacterial infections in the skin • Herpes infections

  43. Elidel and Protopic Do not use solarium or get UV-treatment when treated with Elidel and Protopic

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