CME.ppt for common skin conditions in children

Skin conditions

2. Atopic Eczema: Case
4 years old Malay boy with underlying atopic eczema since 1
year old.
Admitted from derm clinic for rashes x2/12 that initially
started on the abdomen, lower limb, upper limb and faces
Associated with itchiness
Unsure trigger factors
No discharge
No fever, GI losses, URTI symptoms

3. Dietary history
Morning : Biscuits, Milk
Lunch: Rice + Vege+ Chicken
Dinner : Food at babysitters home with occasionally packet
drinks
Blood investigations
CRP <0.5
WCC 8.95
PLT 736

4. Management
Syrup cefuroxime 200mg BD
Syrup Itraconazole 67.5mg OD
Syrup Predinisolone 12.5mg OD, tapering 2.5mg every 5 days till 2.5mg
OD
Syrup piriton 1.5mg ON
Syrup desloratadine 2.5mg OM
Topicals
LA Aqeous cream BD (bath)
LA Aqeuous + 25% Glycerine TDS
LA Mometasone BD
LA Protopic 0.03% BD
LA Liquid Paraffin BD

5. Introduction
•Complex, chronic and recurrent inflammatory itchy skin
disorder
•The prevalence of AE can be as high as 20% in some
countries
•Clinically, AE has both acute and chronic presentations.
Acute eczema is characterised by papulo-vesicular eruption
with erythema, weeping, oedema and excoriation. Whereas
chronic eczema is characterised by lichenification and dry
skin (xerosis). The choice of treatment depends on the
clinical presentation of AE.

7. Diagnostic criteria

8. Investigations
•Serum immunoglobulin E
•Skin prick test
•Patch test
•Skin biopsy

9. Co-morbids
•Skin infection
•Atopy
•Contact Dermatitis
•Food allergy
•Cardiovascular disease

10. Severity assessment
SCORing Atopic Dermatitis (SCORAD)
 Eczema Area and Severity Index (EASI)
Investigators’ Global Assessment (IGA)
 Six Area, Six Signs Atopic Dermatitis (SASSAD)
 Others [e.g. Patient-Orientated Eczema Measure (POEM)]

11. QoL Assessment
•Dermatology Life Quality Index (DLQI)
•Children’s Dermatology Life Quality Index (CDLQI)
•Infant’s Dermatology Quality of Life Index (IDQOL)
•Dermatitis Family Impact (DFI)

12. Aggravating/Triggering factors
•aeroallergen
• physical irritants
• environmental factors
• food
• microbial colonisation/infection
• patient factors (e.g. pregnancy)

13. Treatment
•Emollient/Moisturiser
•Topical Corticosteroids
•Topical Calcineurin Inhibitors
•Wet Wrap Therapy
•Phototherapy

14. •Antihistamine
•Immunomodulating agents
•Systemic corticosteroids
•Azathioprine
•Cyclosporin A
•Methotrexate
•Mycophenolate mofetil/ Mycophenolate sodium
•Biologics

15. Non pharmacological
•Bathing practices
•Food avoidance
•Breast feeding
•Soy formula
•Hydrolysed formula
•Probiotic/ Prebiotics
•Fish oil/Mineral/Vitamins

16. Referrals
Urgent referrals
AE with clinical suspicion of eczema herpeticum
AE with severe skin bacterial infection requiring intravenous
antibiotics
AE with acute eryyhtroderma where the eczema affects >80%
BSA

17. Non urgent referrals
•Diagnostic uncertainty
• Severe or uncontrolled eczema:
• requirement of potent and very potent TCS
•frequent infections
• poor sleep or excessive scratching
• treatment failure with appropriate topical therapy regimen
• Parental concern
•Need for treatment demonstration/education
• Involvement of sites that are difficult to treat
• Psychological disturbance on the patient or family