Eczema

Hey guys welcome to your lesson on eczema. This is a pretty common diagnosis for pediatric patients so we are going to spend some time talking about how to identify and classify it and then look at our nursing care for a kid with eczema.

Eczema is the same thing as dermatitis which just means inflammation and irritation of the skin.

Ok so there are four types of eczema that you need to be familiar with.

Atopic eczema- atopic literally just means we are talking about allergies that are associated with a genetic element. So usually if the child has it, you're going to find out that someone else in the family has it also. And guys other things that can be atopic are season allergies and asthma. So during your clinical you see this pattern where kids have all three of these atopic diagnosis.

Contact Eczema or contact dermatitis occurs when the skin comes into contact with something irritating. For some people this might be strawberries or some kind of detergent or even a plant.

Xerotic eczema happens when you've got really dry skin plus frequent rubbing or irritation. A common example is with babies who are crawling around a lot on their knees. They can get patches of xerotic eczema on their skin.

Seborrhoeic eczema is only seen on the head and face. Another word for it is cradle cap and basically that's just dry skin that peels off.

For this lesson - we are focusing on Atopic Eczema.

So for your assessment, you need to know that eczema is red, inflamed and super itchy. Sometimes the rash can have vesicles, pustules and crusty lesions on it as well.

Letś take a look at these photos to guide us through some things we need to be on the lookout for.

The first photo is an example of infantile atopic dermatitis- infantile dermatitis is more widespread and often on the face, trunk and extremities. This is different than childhood dermatitis that is usually on flexural areas. Flexural just means places on the body that we bend and move a lot like elbows, ankles, feet, hands wrists. You can see in the second photo what eczema looks like on a flexural surface.

Photo 3 here is a really great example of what is called lichenification.
Lichenification is basically thickened, hardened and even scarred skin in areas that are constantly being irritated and scratched.

The last photo here is an example of a secondary infection that can occur with eczema. It’s eczema herpeticum. So the eczema has been infected by the herpes virus. We see this sometimes in the hospital because it is super painful and usually needs IV meds. Another infection you might see is Impetigo- with it you’ll notice a unique honey-coloured crust on the rash. We have a lesson on Impetigo so check that out for more info on how we treat it.

The last thing that’s really important to assess how it’s impacting them and how they are coping. If they aren’t sleeping well and can’t do all the things kids need to be doing, then it’s not being managed properly and we need figure out why.

So our first priority with managing eczema is to reduce and relieve itching. The itching is the root of the whole problem with eczema. If it itches, the kid is going to scratch it, the scratching causes the skin to become more dry, more irritated, more red, which causes it to itch and hurt even more, so the kid scratches more. Eventually - the skin becomes broken and the area becomes infected. So if we can stop the itching we minimize discomfort and risk for infection.

First we need to identify what irritants are making the eczema worse. Then families need to try and get these irritants out of the kids life- a very common one is cow’s milk.

Next, we need to educate the family on how to minimize itching. The most helpful thing is to keep the skin moist. Lukewarm baths for no longer than 5 minutes, up to 3 times a day followed immediately by the application of emollients. Emollients are just non-cosmetic ointments and lotions that don’t have any of the ingredients that might irritate or dry out the skin. Some use the phrase “Soak and Seal”. These interventions plus things like bandages and ensuring that nails are kept short will help keep the skin intact.

Some medications that are used with eczema are antihistamines, topical steroids and topical immunomodulators. These all help reduce itching and irritation and help the child be more comfortable.

Antihistamines can be really helpful with giving the child some relief from the itching so they can get the rest they need. The steroids reduce inflammation and help decrease itching as well. Some steroids like cortisone can be OTC. Steroids should always be applied very thinly - the opposite of what we said about emollients so make sure parents are clear on this- and only prescribed steroids can be used on the face. Remember steroids have a lot of side effects so we do have to monitor kids that are using them! One of those side effects is growth suppression. Immunomodulators are being used much more often now because they have fewer side effects than steroids - and they basically just reduce or minimize the immune response to irritants by inhibiting t-cell activation.

All of these efforts put together - should help the kid be more comfortable and prevent infection of the rash.

Your priority nursing concepts for a pediatric patient with eczema are tissue/skin integrity, comfort and coping.

Alright that’s it for this lesson on eczema! Let’s summarize what we’ve talked about. First, remember, eczema is just irritation and inflammation of the skin that can be triggered by a variety of different irritants. Second, Our ultimate goal is to maximize the kids comfort by avoiding and treating pruritus and we do this by keeping the skin from drying out and providing medications like antihistamines, steroids and immunomodulators. Third, we really want to prevent secondary infection like Impetigo and Eczema Herpeticum by keeping that skin intact.

That’s it for our lesson on eczema! . Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!