Unit
- Atopic dermatitis: A chronic inflammatory skin condition characterized by pruritus, erythema, and lichenification. It often begins in childhood and follows a relapsing-remitting course. The term eczema is used interchangeably with atopic dermatitis in clinical practice, though other forms exist.
- Prevalence and epidemiology: Affects 15-20% of children and 1-3% of adults globally. Prevalence has increased over recent decades, especially in urbanized settings. Genetic and environmental factors both contribute to disease expression.
- Clinical presentation: Red, itchy patches typically appear on flexural areas like the elbows and knees. In infants, the face and scalp are commonly involved. Chronic scratching leads to thickened skin and increased risk of secondary infection.
- Diagnostic criteria: Diagnosis relies on clinical history and physical exam. Key features include pruritus, eczematous morphology, chronic or relapsing course, and personal or family history of atopy (asthma, allergic rhinitis, food allergy).
- Disease burden: Eczema causes significant sleep disturbance, social stigma, and productivity loss. Quality of life can be as impaired as in other chronic diseases like diabetes. Caregivers also experience high emotional and financial strain.
- Atopic march: Many children with eczema later develop food allergies, asthma, or allergic rhinitis. This progression, known as the atopic march, underscores the interconnected nature of allergic diseases and highlights the need for early intervention.
- Role of allergy: Eczema is strongly associated with type 2 inflammation and immunoglobulin E sensitization. Allergens can trigger or exacerbate flares, making allergy assessment a key component of management.
- Classification: Eczema is sometimes classified by age of onset (infantile, childhood, adult) and severity (mild, moderate, severe based on area and intensity). Scoring systems like SCORAD help standardize severity assessment.
- Pathophysiology: Skin barrier dysfunction due to filaggrin mutations and immune dysregulation with Th2‐dominant inflammation are central. Reduced ceramides and antimicrobial peptides increase transepidermal water loss and susceptibility to infection and allergen penetration.
- Common triggers: Irritants like soaps and detergents, allergens such as dust mites and pollen, microbial factors including Staphylococcus aureus colonization, and environmental extremes (dry air, heat) can provoke flares. Psychological stress also worsens disease activity.
- Treatment principles: Management centers on skin barrier repair with emollients, anti‐inflammatory therapy using topical corticosteroids or calcineurin inhibitors, and avoidance of triggers. Severe cases may require systemic treatments like dupilumab, cyclosporine, or phototherapy.
- Comorbidities: Eczema is linked to higher rates of sleep disorders, attention‐deficit/hyperactivity disorder, depression, and anxiety. Recurrent skin infections, especially with Staphylococcus and herpes simplex virus, are common. Nutritional concerns may arise from avoidance diets.
Scope of Practice
Role: Eczema Care Coordinator in Outpatient Allergy Clinic
Within scope:
- Educating patients and families on eczema basics and trigger avoidance
- Assisting with allergy testing coordination and result interpretation support
- Documenting flare patterns and treatment responses in the health record
- Providing written action plans for skin care and flare management
- Facilitating referrals to dermatology, nutrition, or behavioral health
Outside scope:
- Diagnosing eczema or allergic conditions independently
- Prescribing topical corticosteroids or other medications
- Performing or interpreting allergy skin tests
- Modifying treatment plans without provider authorization
- Conducting patch testing or food challenges
Quick Revision
- Eczema is a chronic inflammatory skin disease closely linked to allergy.
- Diagnosis is clinical; severity scoring aids management.
- The atopic march shows eczema as a first step in allergic disease progression.
- Care coordinators support education, documentation, and referral; not diagnosis or prescription.