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  1. Infection
    Bacterial especially Staph. aureus, viral, and fungal infections are common, and so as scabies. Eczema herpeticum, which is widespread herpes simplex infection in eczematous skin is characterized by multiple, painful, vesiculopustular lesions; and often become haemorrhagic, eroded and crusted. Affected areas may be very edematous; regional lymphadenopathy occurs and secondary bacterial infection is common. Diagnosis can be established by Tzanck smears or electron microscopy from scraping of the skin lesions.
  2. Exfoliative Dermatitis
    This is severe and requires hospitalization.
  3. EYE
    An increased incidence of anterior subcapsular cataract may be due to extensive use of systemic steroid, and to topical steroid applying around the eyes. Keratoconus is corneal degeneration characterized by increasing conicity of the cornea resulting from a raised intraocular pressure. Visual disturbance occurs.
  4. Retarded Growth
    1. May be attributed to a combination of reduced exercises, infections, and malnutrition secondary to inappropriate dietary restriction; however, frequent use of systemic/topical steroid is perhaps a more important contributing factor.
    2. Criteria for Diagnosis of Atopic Eczema (Hannifin and Rajka’s criteria)
      Major criteria include:
      1. Pruritus
      2. Flexural lichenification
      3. Chronically relapsing course
      4. A personal or family history of atopy.
      5. There are 23 minor criteria, the most relevant of which are:
      6. Xerosis
      7. Ichthyosis
      8. Immediate skin test reactivity
      9. Elevated serum IgE
      10. Early age of onset
      11. Tendency for developing cutaneous infections
      12. Tendency for developing non-specific hand or foot dermatitis
      13. Dennie-Morgan infraorbital fold
      14. Keratoconus
      15. Anterior subcapsular cataracts
      16. Orbital darkening
      17. Facial pallor/erythema
      18. Pityriasis alba
      19. Itch when sweating
      20. Intolerance to wool and lipid solvents
      21. Perifollicular accentuation
      22. Food intolerance
      23. The influence of emotional factors
      24. White dermographism/delayed blanch.
To fulfill the criteria, the patient must have three or more of the major and three or more of the minor criteria. Additional features identified in patients are scaling of the scalp and infra-auricular fissures.
  1. Differential Diagnosis
    Infantile seborrhoeic dermatitis has an earlier onset than AD. The presence of family history, scratching, possible food intolerance, and high IgE level in AD is absent in seborrhoeic eczema. Allergic contact dermatitis with autosensitisation, psoriasis, candidiasis, dermatophytosis, pityriasis rosea, scabies, nutritional deficiency may at times cause confusion.
  2. Management Of Dry Skin - Emollients And Soap Substitutes
    Dry skin is more prone to itch and chapping and hence risk of infection and subsequent perpetuation of eczema. A good dry skin care can be achieved by:
    1. Keep bathing time short and to a minimum necessary
    2. Use lukewarm water not too hot
    3. Use soap substitute e.g. emulsifying ointment
    4. Avoid vigorous rubbing and cleaning at the skin
    5. Pat dry, and
    6. Apply emollients e.g., aqueous cream, as soon as after getting out of the bath.
Emollients minimize dryness and is the mainstay in treating mild AD. Some emollients are also humectants, e.g. urea cream. Humectants attract water into the skin, and are useful on unbroken skin but can cause stinging. Emollients should be applied as frequently as possible according to patient's need. It is believed that regular and frequent use of emollients can reduce 10-20% of the amount of topical steroids used in the maintenance treatment of AD.
  1. Ichthammol And Tar Preparations (0.5-1%)
    Ichthammol impregnated bandages are used for treating childhood eczema.
  2. Topical Steroids
    Is the mainstay of treatment for inflammatory aspect of atopic eczema.
    "Wet-Wrap" is a newly developed way of using topical steroid under the occlusion of wet tube gauze.
  3. Control of Infections
    Staph. aureus infection is a frequent cause of eczema flare requiring systemic antibiotics, e.g., erythromycin or cloxacillin.
  4. Systemic Corticosteroid
    It is not a routine management of atopic eczema and it should be avoided at times of puberty. Sometimes, a short course of systemic corticosteroid is effective in gaining control of a severe eczema flare.
  5. Systemic Antihistamines
    Recommended doses can be given during periods of excessive scratching.
  6. Puva, Nbuvb
    It is useful in chronic lichenified eczema where pruritus is intractable and a useful adjunct to leaving off topical steroids at the time of pubertal growth spurt.
  7. Immunosuppressive
    Azathioprine or cyclosporin are helpful in severe cases. Nevertheless, drug toxicity and long-term hazards are a definite risk. They should only be considered for chronic severe AD with poor response to the usual treatment.

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