In this presentation, there is a full description of eczema, steps to manage it as pharmacists, the factors that worsen the case, and when to refer to a physician

1. 1

2. • Eczema; also used synonymously with atopic dermatitis, is a condition that
makes your skin red and itchy, It's common in children but can occur at any
age.
• Atopic dermatitis is a long lasting (chronic) condition, and it tends to
flare periodically, It may be accompanied by asthma or hay fever.​
• No cure has been found for atopic dermatitis. But treatments and self-care
measures can relieve itching and prevent new outbreaks.
• So knowing this condition, how it happens and what are
the management steps whether self or by us the pharmacists are very crucial
• In this presentation we will cover the important topics regarding this condition
INTRODUCTION
Serena Z. Hijazeen 2

3. Epidemiology
Eczema affects up to 20% of children, in many of whom it disappears or greatly improves
with age. Such that 2–10% of adults are affected.
Atopy is a term that is used to describe a group of three conditions; eczema, asthma, and hay
fever.​
The rash of eczema typically presents as dry flaky skin that may be inflamed and have small
red spots, the skin may be cracked and weepy and sometimes become thickened.
The rash is irritating and can be extremely itchy.
If it isn’t itchy, it is unlikely to be eczema.
Serena Z. Hijazeen 3

4. • The distribution of the rash of atopic eczema tends to vary with age and
ethnicity
During infancy; atopic eczema primarily involves the face, the scalp and the extensor
surfaces of the limbs , the nappy area is usually spared.​
In white older children; the rash is most marked in the flexures: behind the knees, on
the inside of the elbow joints and around the wrists. As well as the hands, ankles, neck
and around the eyes.​
In black and Asian children; the rash is often on the extensor surface of the joints and
may have a more follicular or ‘rougher’ appearance.​
In adults; the neck, the backs of the hands, the flexures of the elbows and knees and
ankles, and the feet are the most common sites for atopic eczema.​
• This is often associated with generalized dryness and itching.
EPIDEMIOLOGY
Serena Z. Hijazeen 4

5. • Signs and symptoms vary widely from person to person, they include:​
1. Dry skin​
2. Itching, which may be severe, especially at night​
3. Red to brownish-gray patches, especially on the hands, feet, ankles, wrists,
neck, upper chest, eyelids, inside the bend of the elbows and knees, and in
infants, the face and scalp​
4. Small, raised bumps, which may leak fluid and crust over when scratched​
5. Thickened, cracked, scaly skin​
6. Raw, sensitive, swollen skin from scratching​
CLINICAL PRESENTATION
Serena Z. Hijazeen 5

6. Atopic eczema may be worse during the hay fever season and aggravated
by house dust or animal danders, emotional factors like stress and worry
can sometimes exacerbate eczema.​
Hormonal changes in women are recognized as aggravating factors or
triggers. Premenstrual flares of atopic eczema occur in 30% of women,
and pregnancy can adversely affect eczema in up to 50% of women.​
Factors that dry the skin such as soaps or detergents and cold wind can
aggravate the condition.
Certain clothing such as woolen material can irritate the skin.​
In a small minority of sufferers (<5%), cow’s milk, eggs and
food colouring (tartrazine) have been implicated.​
AGGRAVATING
FACTORS
Serena Z. Hijazeen 6

7. • Many atopic eczema sufferers have associated hay fever and/or asthma.
• In adult; most will have developed their first symptoms of eczema in the first 1–2 years
of life (this is regarded as a diagnostic feature).
• There is often a family history (in about 80% of cases) of eczema, hay fever or asthma.
The pharmacist can enquire about the family history of these conditions.​
• More than half of young children with atopic dermatitis develop asthma and hay fever
by age 13.
AGGRAVATING FACTORS
Serena Z. Hijazeen 7

8. Management of
AD
Non-
pharmacological
Pharmacological
Its important to mention that the management of eczema involves both the
removal and treatment of every contributing factor
Serena Z. Hijazeen 8

9. • Use wet-wrap therapy
• Keep child’s fingernails filed short
• Select clothing made of soft cotton
fabric
• Keep the child cool
• Identify and remove irritants and
allergens
• Parents should also learn to identify
infections and seek treatment promptly.
• Moisturizing frequently throughout the
day, moisturizers are a standard of care
for AD
• Giving lukewarm baths
• Use non-soap cleanser that have
neutral pH, hypoallergenic, fragrance
free
• Humidity of the house should be at or
above 50% and room temperature kept
on the cool side
Serena Z. Hijazeen 9

10. Types of skin infections
Bacterial Infections
Viral infections
Parasite Infection
Fungal Infections
Serena Z. Hijazeen 10

11. Serena Z. Hijazeen 11

12. PHARMACOLOGICAL ARM
• Topical Corticosteroids
They relief itching and reduce inflammation
Low to moderate potencies CS are used
The choice of TCS should
match the severity and the
site of disease in order to
maximize anti-inflammatory
benefit and minimize
adverse effects
Hydrocortisone 1%  Used from 10 years of
age, for no longer than a week
Alclometasone 0.05 and Clobetasone 0.05% 
from 12 years of age, for short term treatment
and control of AD
Betamethasone 0.1%  Medium potency TCS
may be used for the body, should be used for
short-term management
Half a fingertip unit cover a patch
of the same size as the palms
Stretch marks Skin atrophy Rosacea
Serena Z. Hijazeen
12

13. • Topical Calcineurin Inhibitors
They inhibit the activation of key cells involved in AD, including T
cells and mast cells, blocking the production of proinflammatory
cytokines and mediators
PHARMACOLOGICAL ARM
They are considered first line when TCS are not suitable, approved from 2
years of age and older  Tacrolimus 0.03%, 0.1% and Pimecrolimus 1%
They have a black-box warning as
they have a risk of developing cancer
Its preferred to apply sun-blocks
when using TCIs
• Antipruritics
Preparations that inhibit itching
Calamine and Crotamine  used in
mild to moderate eczema cases, there
is no evidence on their efficacy
Serena Z. Hijazeen 13

14. • It should also be noted that itching caused by eczema is not histamine derived
so the use of anti-histamines is not recommended, unless the patient has
trouble sleeping because of the itching then we consider first-generation anti-
histamine.
• We refer to physicians whenever there is:
1. Signs of infection
2. Severe conditions
3. Medication fail
4. No identifiable cause
5. No improvement after one week of TCS
PHARMACOLOGICAL ARM
Serena Z. Hijazeen 14

15. THERAPEUTIC OUTCOMES
• Most cases of mild-to-moderate eczema respond
to self care and treatment with OTC products
• If no response if reported within a week, its better
to refer to a GP
Serena Z. Hijazeen 15

16. References
1. Duerden, Martin & Benkinsopp, Alison & Blenkinsopp, John. (2018). Symptoms in the Pharmacy (8th Edition).
2. DIPIRO, J. T., TALBERT, R. L., YEE, G. C., MATZKE, G. R., WELLS, B. G., & POSEY, L. M. (2014). Pharmacotherapy: a
pathophysiologic approach.
3. https://eczema.org/
4. https://www.medscape.com/pharmacists
Serena Z. Hijazeen 16