Eczema

Author: Liv Matthews

Chief Editor: Dr Daniel Keith

Eczema is a common presentation in primary care. It is a chronic inflammatory skin condition characterised by itching and discomfort. In adults and adolescents, eczema tends to occur on flexural areas but in infants, it commonly affects the face and trunk.

Macroscopic Appearance

Dry skin with areas of fine scale
Lichenification
Poorly defined areas of erythema
On darker skin tones there may be areas of hyper or hypo pigmentation
During an acute flare dry skin may become weepy with vesicles

Dermoscopic Appearance

Dermoscopic features of eczema may vary according to the disease stage.

In the acute phase:

Yellow scales and serocrusts resulting from hyperkeratosis and spongiosis/exocytosis
Dotted vessels distributed in clusters or randomly (unspecific arrangement)
Dilated capillaries in irregularly elongated dermal papillae
Hemorrhages may also be seen as a result of intense itching

In chronic phases (where lichenification has occurred) more or less uniform dotted vessels are surrounded by a white halo. In clinical practice, overlapping pictures are seen.

In the sections below, you will find examples of the dermoscopic appearance of three types of eczema - discoid, atopic, and erythrodermic.

Discoid Eczema

Also known as nummular ezcema

Macroscopic appearance of discoid eczema demonstrates an erythematous lesion with dry skin and a fine scale.

Dermoscopic image of discoid eczema (unannotated).

Dermoscopic image of discoid eczema (annotated). This image shows findings seen in the acute phase of eczema including patchy dotted vessels and yellow and white serocrusts.

Atopic Eczema

Example of the dermoscopic view in atopic eczema (unanottated)

Example of the dermoscopic view in atopic eczema (anottated). This image shows small patchy dotted vessels, typically seen in acute phase of eczema.

Erythrodermic Eczema

Erythrodermic eczema under dermoscopy (unannotated)

Erythrodermic eczema under dermoscopy (annotated)

This image shows similarities to the discoid eczema example above, demonstrating dermatoscopic feautes of eczema in the acute phase.

These features include:

yellow serocrusts typically seen in acute phases
dotted vessels

A further example of erythrodermic eczema (annotated). This image shows patchily distributed vessels. By contrast, in chronic phases vessels would be almost uniform.

Lichen Simplex Chronicus

This can be regarded as a variant of eczema/dermatitis. The macroscopic image adjacent shows this condition following topical treatment in Fitzpatrick Skin Type 6.

The following images below demonstrate the dermoscopic appearances in skin of colour following treatment with topical steroids. As such, the features are not as prominent, and the dominant feature seen is post-inflammatory hyperpigmentation.