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A Handout for the Non-Dermatologist


Eczema - atopic, contact, and non-specific dermatitis

An acute, sub-acute, or chronic itchy inflammation of epidermis and dermis, often occurring in person with family history of or personal history of atopy.

In acute cases, lesions are ill-defined erythematous patches or papules often with scale and edema. Erosions may appear crusted. Excoriations can be present. Sometimes it is superinfected.
In chronic cases, lesions are lichenified - thick, hyperlinear skin secondary to scratching. Fissures, hair loss, and periorbital pigmentation possible.
These lesions are commonly found on flexures, sides of neck, face, wrists, and dorsa of feet. In the case of contact dermatitis, look for linear lesions often with blisters and sparing of covered areas.

Acute:   Oral anti-histamine for itching, copious use of emollients QID, and a potent steroid like Lidex (0.05% cream) for 2 weeks BID. For infants and young children consider hydrocortisone 2.5%.

Chronic:   As above except use mid-potency steroid such as triamcinolone 0.025% cream, Cutivate 0.05% cream or Locoid 0.1% cream in 2 week bursts. Use Elidel (1% cream) or Protopic (0.1% ointment) if steroids insufficient. Chronic dermatitis, as the name implies, is a long-term problem; switching corticosteroids, adding secondary therapies from time-to-time, etc., are useful in managing patients.

Acute contact dermatitis: Use Prednisone approximately 2 week course from 40mg QAM tapering by 10 mg after every 3 days. Consider supplementing with a brief 2 week course of Class I steroid such as Temovate cream 0.05% BID but not in folds or on the face.

Secondary therapy: Consider therapy for superinfection such as oral antibiotics (e.g., Keflex, azithromycin). This may be helpful even when patients do not look grossly infected. UVA-UVB therapy, bursts of PO steroids for acute or chronic eczema, cyclosporine, and higher potency topical steroids may be used.

(Closely based on Color Atlas and Synopsis of Clinical Dermatology, 3rd Edition, by Fitzpatrick, et al.)

To preserve appointments for patients who need dermatologic consultations, UM Dermatology does not accept patients for eczema that has not been evaluated and previously treated. Patients’ personal physicians are the best source for such evaluations and initial therapies.