The clinical features of eczema often vary with age.3 Acute lesions predominate in infants and chronic lesions such as lichenification may develop with time. Pruritis is a universal feature.
Infants typically have lesions on the cheeks with oedematous papules and papulovesicular that can form large plaques with oozing and crusting. They develop cradle cap and extensor surfaces and the trunk can be involved, with sparing of the nappy area.
In childhood the acute lesions occur with more chronic lichenified lesions particularly affecting the flexures and periorificial areas. Xerosis is more prominent.
Adolescents and adults tend to have lesions affecting the classical areas of the head, neck, and flexures. Chronic hand dermatitis can occur. Women often have periorbital involvement.
The elderly can have extensive eczematous, even erythrodermic lesions, with prominent pruritis.
The patient’s ethnicity can also affect the clinical pattern of eczema. For example, East Asian patients have clinically more pronounced demarcation and lichenification of lesions.4 African Americans have more extensor and less flexural involvement than East Asian patients. Diffuse xerosis, Dennie-Morgan lines and hyperlinearity of the palms are more common in darker-skinned patients. Lichenification, prurigo nodularis and postinflammatory hypopigmentation are also more prominent in black than in white patients.5
Diagnoses such as allergic contact dermatitis and cutaneous T-cell lymphoma should be considered in the differential diagnosis.
The majority of eczema is mild, but eczema can also be moderate and severe in nature. An assessment should be made of its impact on the patient’s (and particularly in the case of a child, the family’s) quality of life.
There are different formalised scoring systems to measure disease severity and quality of life. The HOME (Harmonising Outcomes Measures for Eczema) Consortium recommends the EASI (Eczema Area and Severity Index) to assess the clinical signs, the POEM (Patient Orientated Eczema Measure) to assess patient-reported symptoms of eczema, and the following instruments to assess quality of life: Dermatology Life Quality Index (DLQI) for adults, Children’s Dermatology Life Quality Index (CDLQI) for children and Infants’ Dermatitis Quality of Life Index (IDQOL) for infants.