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eczematous dermatitis (eczema)

Etiology: - atopic dermatitis* - contact dermatitis* - allergic contact dermatitis - irritant contact dermatitis - hand dermatitis* - seborrheic dermatitis* - asteatotic dermatitis (xerotic eczema) - exudative dermatitis (nummular dermatitis) - stasis dermatitis - antihypertensives associated with 29% increase in eczematous dermatitis - risk highest for diuretics & calcium channel blockers, lowest for ACE inhibitors & beta-blockers [4] - high sodium intake * types described in [1] Clinical manifestations: - inflammation, xeroderma, erythema, pruritus - papules & vesicles, crusting, oozing Laboratory: - peanut IgE Ab in serum (severe eczema) Complications: - increased risk for cardiovascular disease in adults [3] - unstable angina (RR=1.4), heart failure (RR=1.7) - increased risk for atrial fibrillation, myocardial infarction, & cardiovascular death in adults with eczema [3] - topical calcineurin inhibitors & crisaborole 2% most likely to cause local application-site reactions - topical glucocorticoids least likely [6] - increased skin thinning with longer-term topical glucocorticoids - not so with short-term topical glucocorticoids [6] - caution: tachyphylaxis may occur with prolonged treatment of endogenous eczema Management: 1) potent topical glucocorticoids, JAK inhibitors & tacrolimus 0.1% most effective topical anti-inflammatory treatments for eczema [6] - mild topical glucocorticoids, PDE-4 inhibitors, & tapinarof 1% among the least effective treatments [6] 2) low sodium diet 3) bath emollients may not be of benefit [2] 4) see dermatitis Notes: - often used interchangeably with the term dermatitis - used in Aaushi in to imply 1 or 5 specific conditions

Interactions

disease interactions

Specific

asteatotic dermatitis; eczema craquelatum; xerotic eczema; winter itch atopic dermatitis (atopic eczema) contact dermatitis (exogenous eczema) nummular (discoid) eczema; exudative dermatitis stasis dermatitis; venous eczema; gravitational dermatitis

General

chronic skin disease (chronic dermatologic disorder, chronic dermatopathy, chronic dermatosis) dermatitis

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  2. Santer M, Ridd MJ, Francis NA et al Emollient bath additives for the treatment of childhood eczema (BATHE): multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness. BMJ 2018;361:k1332 PMID: 29724749 Free PMC Article https://www.bmj.com/content/361/bmj.k1332 - Flohr C, Ahmed A. New evidence challenges use of bath emollients for children with eczema. BMJ 2018;361:k1791 PMID: 29724863 https://www.bmj.com/content/361/bmj.k1791
  3. Silverwood RJ, Forbes HJ, Abuabara K et al Severe and predominantly active atopic eczema in adulthood and long term risk of cardiovascular disease: population based cohort study. BMJ 2018;361:k1786 PMID: 29792314 Free full text https://www.bmj.com/content/361/bmj.k1786 - Ingram JR Atopic eczema and cardiovascular disease. BMJ 2018;361:k2064 PMID: 29794003 https://www.bmj.com/content/361/bmj.k2064
  4. Ye M, Chan LN, Douglas I et al. Antihypertensive medications and eczematous dermatitis in older adults. JAMA Dermatol 2024 Jul; 160:710 PMID: 38776099 https://jamanetwork.com/journals/jamadermatology/fullarticle/2819258
  5. Brunk D High Sodium Intake Linked to Greater Risk for Eczema. Medscape. June 4, 2024 https://www.medscape.com/viewarticle/high-sodium-intake-linked-greater-risk-eczema-2024a1000ajl
  6. Lax SJ, Van Vogt E, Candy B, et al. Topical anti-inflammatory treatments for eczema: network meta-analysis. Cochrane Database Syst Rev. 2024 Aug 6;8(8):CD015064. PMID: 39105474 PMCID: PMC11301992 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11301992/