Presentation on theme: "Eczema School. Department of Dermatology, Aarhus Sygehus,"— Presentation transcript:
1 Eczema School. Department of Dermatology, Aarhus Sygehus, Anne Braae Olesen, MD, Ph.D. orMette Deleuran, Chairman, MD, DMSc.
2 Purpose/goal for the Eczema School. To educate the parents about the diseaseTo treat the disease correctly.To accept the disease.
3 Different names for the disease Child eczemaAsthma eczemaAtopic dermatitisAtopic eczemaPrurigo Besnier
4 Atopic eczema – how to describe the disease? Chronic skin disease that varies in intensityDominated by severe itch and an increased tendency to itchAcute eczema: weeping? and often with infection.Chronic eczema: dry, infiltrated skin.
5 How common is the disease and courses for the disease? Affects per cent of all Danish childrenIncreased prevalensGenetic factors are involvedIncreased risk for the disease if the parents and siblings have the diseaseEnvironment 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 skinIncreased water loss from the skinIncreased amount of inflammatory cells in the skin
7 Skin barrier functionAltered composition of fatty acids in the strateum corneumIncreased water lossLB
8 Skin drynessKrakeleret eksemHuden knastør og skællende
9 Atopic Eczema – itch The skin is leaking Evaporation – the skin gets dryThe skin is itching and the child itches back”Definition” af kløe (1600-tallet): en ubehagelig fornemmelse som medfører et ønske om at kradse sigDet er ikke nogen rationel refleks. Kløe og krads medfører yderligere hudirritation og likenisering samt eksem(Smerte er en anti-kløe tilstand)TomgangsbevægelsePolerede negleUndgå bebrejdelser (operant betingning)
11 Development of eczema disease 90 per cent develop the disease in the first three years of lifeEarly debut can be predictive for severe disease75-80 per cent are clear of symptoms in childhoodIn per cent of the patients the disease comes back25-50 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”Cheilitistørt fissureret eksem omkring mund og læber
15 Distribution of eczema. Children: flexural areas, head and neck, ankles and wrists.
16 Distribution of eczema. Adults: often face, neck and hands.
17 ComplicationsWound infections with staph. aureus: impetigo.
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 debutUncertain whether the eczema can be preventedEczema patients on a diet are not free of symptomsSome children do get better on a dietA 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 relevantSome food allergies can disappear when the child grows olderDietary treatment do not always need to be life longIt 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 observedHow 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 treatment Control of dryness and itch
29 Steroid creams Containing cortico-steroids Are divided into 4 groups Effect and side effect go hand in handDiminish the inflammation in the skinContract the block vessels and diminish erythemaDiminish itch
30 Steroid creamsAbsorption of cream is greatest in areas with thin skin and intertriginous areasFace and genitals are especially sensitiveUse milder steroid creams in these areasWhen you use the cream in the right way there are only few side effects
31 Steroid side effects Atrophy Skin bleedings Telangiectasiae Infections AcneWorsening of the disease when you stop the treatment
32 Treatment principles – steroid cream Only apply cream/ointment on active areasApply in a thin layer: fingertip unitsWash your hands after applying the cream or use glovesUse an effective cream to start with and reduce the strength when the skin gets betterIt 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 effectsChronic untreated eczema harms the skinWe see more under treated than over treated childrenIt is important that the children get a normal life
34 Tar treatment of eczema Tar is a good treatment for eczemaIt is greasy and it smellsTar can sting on the skin if you have open woundsCan be used undiluted or diluted in creamsIncreases photo sensitivity
35 UV-treatment for eczema Sun light and UVB-treatment help most patientsUV-treatment is best for bigger childrenPUVA-treatment for adults
36 Gamma-linolenic acid Unsaturated fatty acids It helps a few patients It is expensiveYou have to eat a lot of capsules every dayIt can be tried when you have severe eczema for a periodStop the treatment if it does not have any effect because the effect is not documented in larger groups
38 Treatment of eczema complicated with impetigo Wash with water and mild soapSodium permanganate (red baths)Steroid creams with antibioticsAntibiotic creams and ointmentsAntibiotics as tablets or mixture
39 Newer treatments: Elidel and Protopic Elidel cream: 1 per centProtopic ointment 0,03 per cent and 0,1 per centEffective for treatment of atopic dermatitisLong 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 areasCan be used for long term treatmentDoes not induce atrophy
41 Elidel treatment of atopic dermatitis Elidel må bruges efter 2 årBehnadlingsfri interval på 14 dage før vaccination (28 dage ved levende vaccination)Protopic 0,03 % må bruges hos børn over 2 årProtopic 0,1% hos børn over 16 årDe samme regler for vaccination
42 Elidel and Protopic Side effects: Feeling hot on the skin after applicationBacterial infections in the skinHerpes infections
43 Elidel and ProtopicDo not use solarium or get UV-treatment when treated with Elidel and Protopic