import json data = { "topic": "Eczema", "slug": "eczema", "category_id": 15092, "summary": "Eczema (atopic dermatitis) is a common, chronic, itchy inflammatory skin condition of childhood whose distribution shifts with age, is frequently the first step of the atopic march toward respiratory allergy, and is managed with emollients, trigger avoidance, and topical anti-inflammatory therapy.", "written_by": "claude-sonnet", "references": [ {"title": "Illustrated Textbook of Paediatrics (Tom Lissauer, Will Carroll)", "author": "Lissauer, Tom,Carroll, Will", "pages": [460, 461]}, {"title": "Your Childs Allergies and Asthma. The American Academy of Pediatrics Guide to Breathing Easy and Bringing up Healthy, Active… (American Academy of Pediatrics.Welch etc.).epub", "author": None, "pages": []}, {"title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024", "author": None, "pages": [4129, 4196]}, {"title": "Zitelli and Davis' Atlas of Pediatric Physical Diagnosis: Expert Consult - Online", "author": None, "pages": [327]}, {"title": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub", "author": None, "pages": []}, {"title": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition", "author": "Hay, William W., Levin, Myron J., Deterding, Robin R., Abzug, Mark J.", "pages": [445]} ], "short": [ {"title": "In short", "content": ( "- Eczema (dermatitis) affects 5-10% of children and usually - though not always - resolves before adulthood\n" "- Most children develop skin symptoms in the first 1-2 years of life, and almost all by age 5\n" "- Distribution changes with age: infants show involvement of the face (sparing the area around the nose), scalp, trunk, and limbs, but almost never the diaper area; older children show characteristic flexural involvement (cubital and popliteal fossae) and friction areas (neck, wrists, ankles)\n" "- Before 4-6 months of age, infants lack the coordination to scratch and instead rub their face against bedding/crib sides, which can break the skin and cause weeping, crusting, and secondary infection\n" "- About 50-75% of children with eczema go on to develop another allergic condition (hay fever, asthma - the \"atopic march\"), and eczema tends to precede earlier-onset asthma; however, about 20% of eczema patients never show any sign of allergy and often lack a family history of allergy\n" "- Airborne allergens (pollen, mold) are not important eczema triggers, but dust mites and animal dander can worsen it in a subset of children; nonallergic aggravating factors include temperature/humidity swings, dry air, tight/scratchy clothing (especially wool), sweating, and emotional stress/overtiredness\n" "- Common exacerbating factors include bacterial infection (Staphylococcus, Streptococcus), viral infection (herpes simplex virus), ingested allergens (e.g., egg - the most common food allergens causing eczema are egg and cow's milk), contact irritants/allergens, and environmental heat/humidity\n" "- For moderate-severe eczema with suspected food allergy (especially with gut dysmotility symptoms or faltering growth), allergen-specific IgE and skin prick testing can help but need cautious interpretation; a 4-6 week dietary elimination (under dietician supervision) plus food challenge may be needed to confirm a food trigger\n" "- In formula-fed infants under 6 months with severe eczema uncontrolled by optimal emollient/moderate topical steroid treatment, a trial of extensively hydrolyzed or amino acid formula in place of cow's milk formula may be considered\n" "- Management toolkit: avoiding soap, frequent emollient use, avoiding wool/nylon clothing, topical corticosteroids, topical immunomodulators, occlusive bandages, and antibiotics/antivirals for secondary infection, plus antihistamines and psychosocial support for the family given how disruptive severe eczema can be" )} ], "long": [ {"title": "Definition", "content": ( "Eczema and dermatitis are used interchangeably in dermatology, although \"eczema\" strictly denotes an acute weeping dermatosis. Eczematous disorders are a broad group of cutaneous eruptions characterized by erythema, edema, and pruritus. Acute lesions show erythema, weeping, oozing, and microvesicle formation within the epidermis; chronic lesions become thickened, dry, and scaly, with lichenification (thickened skin with a shiny surface and exaggerated skin markings from chronic rubbing/scratching) and altered pigmentation. The most common type of eczema in children is atopic dermatitis, though seborrheic dermatitis, allergic and irritant contact dermatitis, nummular eczema, and acute palmoplantar eczema (dyshidrosis) also occur." )}, {"title": "Epidemiology", "content": ( "Eczema affects between 5% and 10% of children and usually, though not always, resolves before adulthood. Most children develop their first skin symptoms in the first 1-2 years of life, and almost all do so before age 5. Eczema is strongly linked to the broader atopic phenotype: 50-75% of children with eczema go on to develop another allergic condition such as hay fever or asthma, and children who start with eczema tend to develop asthma at an earlier age. However, this association is not universal - about 20% of children with eczema never show any sign of allergy and typically lack a family history of allergic disease, underscoring that eczema does not fit neatly into a simple allergic disease model despite children with eczema often having elevated blood IgE levels." )}, {"title": "Clinical features", "content": ( "The distribution of atopic eczema characteristically changes with age. In infants older than about 2 months, eczema predominantly affects the face (though typically sparing the area around the nose), scalp, and trunk; it almost never spreads to the diaper area. Because infants under 4-6 months lack the muscular coordination to scratch effectively, they instead rub their faces against bedclothes or crib sides to relieve the itch, which can break the skin surface and cause weeping, crusting, and increased discomfort, especially if the broken skin becomes secondarily infected. In older children, the rash is typically confined to the neck and skin flexures/friction surfaces - the cubital and popliteal fossae, wrists, and ankles - and, in more severe cases, can extend further. Exacerbating factors include bacterial infection (Staphylococcus, Streptococcus species), viral infection (particularly herpes simplex virus), ingestion of a food allergen (egg is a leading trigger), contact with an irritant or contact allergen, and environmental heat or humidity. Airborne allergens such as pollen and mold spores do not appear to be important eczema triggers, though dust mites and animal dander can worsen the rash in a subset of affected children. Nonallergic factors that can aggravate eczema include wide swings in temperature or humidity, very dry air, tight or scratchy clothing (wool is frequently poorly tolerated), sweating, and being overtired, nervous, or emotionally upset." )}, {"title": "Diagnostics", "content": ( "Diagnosis is clinical, based on the characteristic distribution, appearance, and course of the rash. A structured assessment should evaluate: the distribution of the eczema and whether the skin is excoriated, weeping, crusted, or lichenified; how troublesome the itching is and whether it is worse or better than usual; identifiable exacerbating factors (food or other allergens, irritants, medications, stress); whether it disturbs sleep or interferes with daily life; and whether there is evidence of secondary bacterial or herpes simplex virus infection. In children with moderate or severe atopic eczema, particularly when accompanied by gut dysmotility symptoms (colic, vomiting, altered bowel habit) or faltering growth, evaluation for a coexistent food allergy is warranted; egg and cow's milk are the most common food allergens implicated. Allergen-specific IgE testing and skin prick testing can help identify a food trigger but must be interpreted cautiously, since they can be falsely positive or identify allergens that are not clinically significant contributors. A 4-6 week dietary elimination trial, ideally under dietician supervision to ensure nutritional adequacy, may be needed to detect a response, followed by a food challenge to confirm the diagnosis objectively." )}, {"title": "Differential diagnosis", "content": ( "Several distinct entities can resemble or be confused with atopic eczema. Psoriasis presents as an itchy rash that spreads and coalesces into irregular, thickly scaled white patches, most often on the elbows, knees, and scalp, or around the navel - unlike eczema, it is not an allergic condition. Asteatotic (winter/xerotic) eczema presents as dry, cracked skin with red fissures and scale resembling cracked porcelain, typically on the extremities of adolescents in winter, associated with overbathing using drying soaps; it responds to gentle soap and thick emollients rather than the broader eczema management approach. Ecthyma, a deeper bacterial skin infection (usually group A Streptococcus, sometimes with secondary Staphylococcus aureus), presents with painful crusted erosions/ulcers and should not be confused with an eczema flare, though it can complicate excoriated eczematous skin through autoinoculation from scratching." )}, {"title": "Treatment", "content": ( "Management centers on avoiding soap, using emollients frequently, and avoiding wool and nylon clothing next to the skin. Medication escalation depends on severity and includes topical corticosteroids, topical immunomodulators, occlusive bandages, and antibiotics or antiviral agents when secondary bacterial or herpes simplex infection is present; antihistamines can help with associated itching and sleep disturbance. When a food allergy is suspected and confirmed as a trigger, dietary elimination under dietician supervision is appropriate; in formula-fed infants younger than 6 months with severe atopic eczema not controlled by optimal emollient and moderately potent topical corticosteroid treatment, a trial of an extensively hydrolyzed protein formula or amino acid formula in place of standard cow's milk formula may be undertaken. Because eczema can be severe enough to disrupt both the child and the whole family, psychosocial support - advice, help, and connection with other affected families or support organizations - is an important part of comprehensive management." )} ], "clinical": [ {"title": "Approach at the bedside", "content": ( "When assessing a child with eczema, work through a structured checklist: characterize the distribution and skin findings (excoriated, weeping, crusted, or lichenified), grade the itch and whether it is worse or better than the child's baseline, identify exacerbating factors (food, contact irritants/allergens, medications, stress, heat/humidity, wool clothing), and check for secondary bacterial or herpes simplex infection - both of which change management (adding antibiotics or antivirals) and should be actively looked for whenever a previously controlled eczema flares acutely or looks atypical.\n\nStart or reinforce the basic regimen at every visit: frequent emollient use, avoiding soap and wool/nylon fabrics, and stepping up to topical corticosteroids or topical immunomodulators as needed for flares, with occlusive bandaging as an option for resistant areas. Only pursue a food allergy workup (IgE/skin prick testing, and if indicated, a 4-6 week elimination trial with dietician support followed by a food challenge) in moderate-to-severe eczema, particularly when there are accompanying GI symptoms or faltering growth - egg and cow's milk are the leading culprits. In a formula-fed infant under 6 months with severe eczema refractory to optimal emollient and moderate-potency topical steroid therapy, consider a trial of extensively hydrolyzed or amino-acid formula. Throughout, ask about the impact on sleep and daily life and on the family as a whole, since eczema's psychosocial burden is significant and support resources/counseling should be offered when the condition is disrupting the household." )} ] } with open("/tmp/eczema.article.json", "w") as f: json.dump(data, f, indent=1) print("written")