ECZEMA

KENYA METHODIST UNIVERSITY

SCHOOL OF MEDICINE AND HEALTH SCIENCE

DEPARTMENT OF NURSING

TASK : ASSIGNMENT
LECTURER: MADAM LAURENCIA WANJA
GROUP :3
GROUP MEMBERS

 Benedict Mulevu Mwati Bsn-1-8201-3/2019

 Bendi Grace BSN-1-8175-3/2018
 Billy Macharia Kirigwi BSN-1-1121-3/2019
 Dorcas Memo BSN-1-8179-3/2019
DEFINATION

 It is a chronic inflammatory skin condition, which presents with indistinct

rash, itching, dryness and scaling.
 The term is derived from two greek words;
 1)"ek" meaning to bubble out
 2)"zeo" meaning to boil through
 Eczema, also known as atopic dermatitis, is a chronic inflammatory skin
condition. It is characterized by dry, itchy, and red patches of skin that can
sometimes be accompanied by blisters, oozing, or crusting. Eczema often
appears in childhood and can persist into adulthood, although it can also
develop later in life.
 The exact cause of eczema is unknown, but it is believed to result from a
combination of genetic and environmental factors. People with eczema may
have a dysfunctional skin barrier that allows moisture to escape and irritants
to enter, leading to inflammation and itching.
 Eczema is not contagious and cannot be spread from person to person. It can,
however, be triggered or aggravated by certain factors, such as dry skin,
irritants (such as soaps or detergents), allergens (such as pollen or pet
dander), stress, temperature changes, and certain foods.
TYPES

 1. A topic Dermatitis Is the most severe and chronic ( long –lasting) kind of
eczema It typically affects the insides of the elbows: backs of the knees and the
face Its symptoms are dry: itchy , scaly skin cracks behind the ears and rashes
on the cheeks arms and leg
 2. Contact Dermatitis: This type of eczema occurs when the skin comes into
contact with an irritant or an allergen. It can be further divided into two
subtypes:
 Allergic Contact Dermatitis: It develops as a result of an allergic reaction to
substances like certain metals (e.g., nickel), fragrances, preservatives, latex, or
certain plants (e.g., poison ivy)
 .Irritant Contact Dermatitis: This occurs when the skin is repeatedly exposed to
irritating substances such as harsh chemicals, detergents, solvents, or soaps.
 3.Nummular dermatitis: This type of eczema appears as coin-shaped or oval
patches of irritated skin. It is often triggered by dry skin, environmental
factors, or allergic reactions.
 4.Dyshidrotic eczema: Dyshidrotic eczema typically affects the hands and feet
and is characterized by small, itchy blisters on the palms, fingers, soles, or
toes. It can be triggered by factors like stress, allergies, or exposure to
certain metals.
 5.Seborrheic dermatitis: This form of eczema affects areas rich in oil glands,
such as the scalp, face, and upper chest. It causes red, scaly patches or
dandruff-like flakes. Seborrheic dermatitis is commonly seen in infants
(known as cradle cap) and can also affect adults.
PREDISPOSING FACTORS

 There are different types with different causes-Genetic— mostly, esp. Atopic
typeIt is often associated with allergic diseasesOthers include
 , Allergy to chemicals, sun, diet and other substances.
 A personal or family history of eczema, Allergies, Hay fever or Asthma
 Being a health care worker, which is linked to hand Dermatitis
 Contact with rough or coarse materials may cause skin to become itchy eg
 products like soap and detergents eg Dettol
 Upper respiratory infection or colds may also trigge
 rPerson engaged in wet works eg baby sitting food handlers
PATHOPHYSIOLOGY

 A profoundly disturbed epidermal barrier leads to dry skin as a consequence of a

high transepidermal water loss on the one hand and to enhance penetration of
irritative substances and allergens into the skin on the other side. The disruption
of the epidermal barrier may be caused by genetic alterations such as null
mutations in the gene filaggrin that strongly predispose to development of E or
ichthyosis. Filaggrin is expressed in the upper layers of the stratum corneum and
is encoded within the epidermal differentiation complex (EDC). Also other genes
of the EDC such as hornerin might be associated with the development of
E.Besides genetic determination, the epidermal barrier function also depends on
the immune system. It has been demonstrated that Th2 cytokines such as IL-4
inhibit the expression of filaggrin and S100 proteins and thus impair the
epidermal barrier. Mechanical (scratching) or physical (hot water, UV exposure,
sweating) irritation further weakens the epidermal barrier.Deviated immune
response, allergy, and impaired innate immunity.
CLINICAL FEATURES/ SIGNS AND
SYMPTOMS
 Some of the signs and symptoms include:
 Excessively dry skin
 Severe itching (particularly at night)
 Red or brown patches on the body, especially around the joints, neck, hands,
feet, and ankles.
 Infants may show these patches on the scalp and face.
 Small, raised bumps
 Leaking fluids
 Scaly skin
 Raw, sensitive skin
MEDICAL MANAGEMENT

 Topical steroids and anti-inflammatory creams- For mild facial eczema use a

weaker potency (than for body) steroid cream such as hydrocortisone 1%
twice a day as required
 For moderate facial eczema which is non-responsive to steroids a
pimecrolimus (Elideltm cream) can be used twice a day as requiredUse
stronger steroid for the body (than for face) example Advantantm or
Elocontm. These are available in cream, ointment, fatty ointment and lotion.
 Medications such as antibiotics or antivirals may be prescribed for treatment
of organisms causing secondary infected eczema. Usually oral antibiotics are
required however intravenous may be needed for severely infected eczema
and sepsis.
NURSING MANAGEMENT

 Wet dressings are used for moderate to severe eczema.. The aim of wet
dressing is to have greater penetration of topical moisturizers and to over
hydrate the skin, also to sooth, cool and act as a barrier to scratching.
 The Wet dressing/clothes regime is as follows: Mild eczema-Not
required  Moderate eczema-Once to twice daily for 3days. Nightly
until the eczema is clear and then recommence nightly if flaring
Severe eczema-Four times a day for 3 days only (Admission or HITH may be
referred to assist during this acute phase).Then taper to twice daily for one
week. Then nightly until the eczema is clear and then recommence nightly if
flaring.Cool compressing for immediate relief of itch -Apply to wet cloth to
itchy areas for 5 -10 minutes, then apply a moisturiser post compressing
 Alley anxiety by reassuring the patient and provide positive body image to
boost self esteem.
COLLABORATIVE MANAGEMENT

 Heat; such as thick layers of clothes, hot heaters, hot cars, classrooms, hot
baths, thick blankets, woolen underlays or electric blankets and hot water
bottles
 Prickly/rough material for example wool, sandpits, clothing tags
 Irritation; avoid products that contain plants, perfumes and foods
 Regular moisturizer, should be applied from top to toe at least twice a day
even if the skin is clear of eczema to reduce the skin dryness
 Daily cool bath with non irritating bath soaps
 Consider Vitamin D oral daily supplementation for moderate to severe
eczema. 
COMPLICATIONS

 Asthma and hay fever before or after developing eczema

Lichen simplex chronicus –neurodermatitis due to increased scratching

 Skin infections due to repeated scratching that causes open sores

NURSING DIAGNOSIS
ACTUAL:
 Impaired Skin Integrity: Related to inflammation, itching, scratching, and
secondary infection resulting from eczema lesions, as evidenced by redness,
dryness, rash, excoriation, and/or crusting
 Impaired comfort :related to in adequate situational control and
inflammation ,itching and scratching,as evidenced by patient expressing
itching and expressing discomfort.
 Impaired skin integrity related to itchy, scratchy and sensitive skin as
evidenced by dry skin with red,brown patches o n the skin.
 Deficit knowledge related to inadequate information of the disease process
and misinformation on the disease as evidenced by patient asking questions
about the changes and appearance of red and brown patches on the skin.
RISK DIAGNOSIS

 Risk for Infection: Related to compromised skin integrity, presence of open

lesions, and excessive scratching, as evidenced by the increased susceptibility
to bacterial or fungal infections.
 Risk for Disturbed Sleep Pattern: Related to intense itching, discomfort, and
pain associated with eczema, as evidenced by reports of difficulty falling
asleep, frequent waking during the night, and excessive daytime sleepiness.