Snapshot A 5-month-old boy is brought to urgent care for a wet rash on his cheeks. His mother reports that he has been dealing with this rash for the past few weeks, though it has gotten much worse in the past few days. She has wrapped his hands in socks to prevent scratching, especially during sleep. Family history includes childhood asthma and eczema. On physical exam, his bilateral cheeks are erythematous with oozing papulovesicles and excoriations. The physician prescribes a topical corticosteroid. Introduction Clinical definition a chronic and pruritic inflammatory skin disease also known as eczema Epidemiology prevalence very common 10-20% prevalence demographics primarily affects children but can affect all ages risk factors family history living in urban setting Western diet Etiology combination of genetic, dietary, and environmental causes Pathogenesis filaggrin deficiency or dysfunction may contribute to decreased water retention, impaired tight-junction formation, and reduced ceramide content cutaneous inflammation with infiltrating T-cells can cause epidermal thickening, contributing to functional impairment of epidermal barrier Genetics mutations loss of function mutation in filaggrin (FLG) gene login to view 2 more bullets Associated conditions atopic triad eczema (atopic dermatitis) asthma allergic rhinitis food allergy Wiskott-Aldrich syndrome suspect when there is eczema along with recurrent infections and thrombocytopenia selective IgA deficiency suspect when you have eczema and recurrent sinus, pulmonary, and GI infections hyper-IgE syndrome suspect when there is eczema along with recurrent cold abscesses and high serum IgE Prognosis majority of childhood eczema will improve or resolve as they get older adult eczema often evolve into chronic hand eczema Presentation Symptoms pruritus may result in sleep disturbance excoriations from scratching Physical exam dry and rough skin acute flares diffuse erythematous patches and plaques with oozing and crusting papules/vesicles chronic lesions poorly demarcated patches and plaques with scales, excoriation, and lichenification hyperlinearity of palms or soles location commonly on skin flexures in children and adults commonly on the face in infancy Studies Labs may have ↑ serum IgE Biopsy indication to confirm diagnosis findings epidermal intercellular edema (spongiosis) Making the diagnosis most cases are clinically diagnosed Differential Seborrheic dermatitis Contact dermatitis Ichthyosis vulgaris Nutritional deficiency Treatment Conservative emollients and moisturizers indications login to view 2 more bullets Medical topical therapy corticosteroids login to view 9 more bullets calcineurin inhibitors login to view 6 more bullets systemic therapy indication login to view 1 more bullet drugs login to view 3 more bullets Procedural phototherapy indications login to view 2 more bullets modalities login to view 2 more bullets Complications Secondary bacterial infection Eczema herpeticum