“An inflammatory skin condition characterised by dry, itchy skin with a chronic relapsing course. Although it can affect all ages, it is commonly diagnosed before 5 years of age”

Risk Factors
  • Age <5 years
  • Family history of eczema, asthma and/or allergic rhinitis
  • Anthelmintic treatment in utero
  • Exposure to cigarette smoke
Aetiology
  • Multifactorial combination of genetic susceptibility and environmental factors
Pathophysiology
  • (Type 4 hypersensitivity reaction) abnormal skin barrier function allows allergens to transverse the skin
  • Allergens are taken up by antigen-present cells (APCs)
  • APCs present allergen to naïve T-cell
  • Naïve T-cell turns into a Th2 cell
  • Th2 cell stimulates B cells to produce allergen-specific IgE antibodies
  • IgE antibodies bind to mast cells and basophils, enabling sensitisation to the allergen
  • Further exposure to the allergen causes degranulation
  • Leading to release of histamines, leukotrienes and proteases and recruitment of eosinophils
  • The skin barrier becomes leakier allowing further entry to allergen and loss of water
  • Skin becomes dry and scaly
  • Persistent inflammation can cause the skin to become lichenified
Clinical Presentation
  • Patchy or widespread itchy, dry and cracked skin that often affects flexor surfaces (creases of wrists, insides of elbows, backs of knees) and exposed surfaces (scalp, face, hands, feet); comes in flareups; red on lighter skin/purple of grey or darker skin; hypopigmentation; lasts longer than 12 months; worst at night
Investigations
  • Diagnosed clinically
Management
  • Identification and avoidance of triggers, emollients, topical corticosteroids, topical calcineurin inhibitors, bandages, phototherapy
Complications
  • Social stigma (depression, social anxiety)
  • Limitation of everyday activities and psychosocial functioning
  • Loss of sleep

Leave a Reply

Search Our Notes

Get Updates

Get updates direct to your inbox as we post more notes!

Our Latest Notes