VARICOSE ECZEMA
Presentation
- Common in elderly, occurs on lower legs secondary to varicose veins
- Usually starts around the medial malleoli
- Related to blood leakage/activation of inflammatory cells and fibroblasts
- Lipodermatosclerosis and more pigmentation often seen
Management
- Diagnosis usually clinical
- General advice – elevate legs, avoid trauma, keep active
- Regular use of emollients and topical steroids for flares
- Below-knee compression hose, following Doppler assessment of arterial competence
Atopic eczema
ATOPIC ECZEMA
Presentation
- Most common form of eczema, mainly affects children
- Usually affects popliteal and antecubital fossae, but can occur anywhere
- Often associated with other atopic conditions, such as asthma, rhinitis and hay fever
- May have a genetic component
Management
- Mostly managed in primary care; mainstay is regular emollients
- Topical steroids often required, depending on severity and location
- Secondary infection may occur, requiring antibiotics
- Alternatives to steroids include topical immunosuppressants
Emollient contact dermatitis
EMMOLLIENT CONTACT DERMATITIS
Presentation
- Rare type of contact dermatitis
- Can occur due to allergy to lanolin, as in this case
- Occurs after use of emollients, but may be seen with topical steroids
- Redness and irritation usually worse after applying cream
- Consider if underlying skin condition fails to respond or worsens with treatment
Management
- Diagnosis may be difficult
- If suspected, an alternative emollient can be tried initially
- Patch testing may be required to determine exact cause
Asteatotic eczema
ASTEATOTIC ECZEMA
Presentation
- Distinctive type of eczema with ‘crazy paving’ appearance
- Usually on lower legs in elderly; more common in winter
- May be extremely itchy – underlying problem is dry skin
- Causes include dry or hot environment, overuse of soaps, malnutrition, diuretics
Management
- Mainstay is regular application of thick emollients; advise bathing less and avoiding irritants
- Avoid direct exposure to heat; increasing humidity may help
- In severe cases, topical steroids may be required
Dr Nigel Stollery is a GP in Leicestershire
