Eczema: Diagnosis and treatment

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Diagnosis
In most cases the diagnosis of AD is clinical and requires no further exploration. In atypical forms can be used in certain laboratory tests (specific IgE, Phadiatop, etc..) And allergy.
Prick tests to aeroallergens (mites, pollens, etc..) And food allergens (food).
Lower cost, they have almost the same sensitivity and same specificity as the measurement of specific IgE.
An exploration allergy will be decided when the lesions persist despite treatment well followed, or when lesions appear on atypical locations of atopic dermatitis. It may include depending on the etiology suspected, the installation of patch tests in search of contact sensitization. Tests to foods, supplemented if positive tests for reintroduction are considered mainly in children and severe forms of eczema.
The allergens most frequently found in atopic dermatitis of the child in order of frequency are: egg white, peanut, mustard, cow's milk and fish.
Photobiological exploration will be considered in case of worsening during sun exposure.

Complications
Superinfection of lesions and exudative excoriated.
Bacterial and fungal favored by itching, scratching and corticosteroids.

Viral.
Kaposi's sarcoma-Juliusberg varioliform or pustulosis. This is a serious complication caused by a skin-tropic virus, usually herpes (primary infection mainly), rarely coxsackie and influenza. The eruption highly febrile with altered general condition, occurs in a exacerbation of atopic dermatitis. It begins quite suddenly on the face and then spreads in the form of vesiculo-pustules varioliform umbilicated, necrotic and hemorrhagic.
The evolution is favorable in antiviral. Complications from visceral dissemination are now rare (herpes encephalitis).
Prevention in atopic thrust should be the removal of all about the environment herpes.

Warts, multiple and chronic molluscum contagiosum frequent and profuse.

Erythroderma: sometimes secondary to an abrupt withdrawal of corticosteroids or local extent of corticosteroids (cons-indicated).
Relationship problems. Possible complications secondary to psycho chronic itching in erythematous skin or oozing lichenified must be taken into account in the treatment of atopic dermatitis.


Treatment
The treatment consists of several points: the treatment of pressure that will appeal mainly to topical corticosteroids, and treatment of etiology when possible (foreclosure of a contact allergen, elimination of aggravating factors). This treatment is not always easy to explain and must therefore be assured that it was well understood by the patient.

Treatment of eczema flare: antisepsis, topical steroids and antihistamines.
Antisepsis and potentially draining lesions. Be used antiseptics colorless and low awareness such as chlorhexidine, silver nitrate 0.5% in water (weeping forms), etc.. The mercury derivatives, hexamidine potentially allergenic will be avoided. Topical antibiotics are not necessary in uncomplicated forms.
1. Local corticosteroid.
Corticosteroid therapy is generally essential for the treatment of eczema flare, and it must be short to avoid the complications and habituation. Creams are preferred for areas hairless and child, ointments for very dry forms, and lotions for hairy areas. The application method can be done according to several schemes: one twice daily for 5-7 days with gradual reduction over a week, or morning and evening for five days, in the evening for 5 days, 1 night of 2 for 8 days.

2. Tacrolimus (Protopic)
This new treatment can be an alternative when there is a failure of topical corticosteroids. It does not cause skin atrophy and can be used on the eyelids without risk to the eye. However, it induces side effects, the most important thing is irritation sometimes requiring discontinuation.
It can be prescribed by dermatologists and pediatricians on special orders.
3. Antihistamines.
They are often very effective, but may be associated with the start of treatment in cases of pruritus bothersome.
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