Flexural Eczema

Definition: Atopic dermatitis that develops in flexural areas (backs of knees, inner elbows, wrists).

Location:

• Eczema refers to skin conditions causing itchy, inflamed, cracked, and sore patches.Flexural eczema occurs where skin bends or folds (e.g., joints, skin creases).Common areas: inner elbows, behind knees, wrists, ankles.

Affected Population:

• Common in late childhood to adulthood.Affects children between 2 years and puberty (creases of knees, elbows, neck, crease between buttocks and legs).

Symptoms:

• Dry, itchy skin, rash.85% of atopic dermatitis patients report itching.Other symptoms: trouble sleeping, rashes bleeding or weeping fluid, skin dryness and discoloration, thickened skin from scratching.

Causes and Triggers:

• Genetics and environmental factors.Decreased Barrier Function:
  • Changes in genes (e.g., FLG gene affecting filaggrin protein).Lower levels of ceramides affecting barrier function.
  Environmental Triggers:
  • Overactive immune system reacting to pollen, pollution.Associated with hay fever, asthma, food allergies.Other triggers: chemicals, detergents, dry skin, stress.

Treatment:

• Dermatologist-assisted treatment plan:
  • Skin care: Regular bathing, moisturizers.Trigger management: Identifying and avoiding triggers.Topical medications: Corticosteroids, crisaborole, coal tar, pimecrolimus, tacrolimus.Phototherapy: UV light exposure.Systemic medications: Cyclosporine, methotrexate, mycophenolate mofetil, azathioprine, dupilumab.
  Follow doctor’s instructions, regular appointments for symptom review and medication adjustment.

Management and Self-care:

• Bathing in lukewarm water daily.Applying moisturizers within 5 minutes of bathing.Using fragrance- and preservative-free skin care products.Testing new products on small skin patches.Wearing loose-fitting, 100% cotton clothing.Taking antihistamines, keeping a trigger journal.

Diagnosis:

• Dermatologist review of medical and family history, skin examination.Skin biopsy if diagnosis is unclear.Flexural eczema diagnosis based on joint or crease location.

Outlook:

• Generally positive with regular treatment.Identifying triggers, making home changes, avoiding scented products.Immediate treatment of flare-ups with topical medications.Dermatologist guidance for treatment adjustments.