Extensive Rashes

  • Brian K. Y. ChiaEmail author
  • Emily Y. Gan

Practical Points

  • Severe and recalcitrant eczema can be a cutaneous manifestation of multiple syndromes such as HIES, SCID, A-T and Netherton syndrome

  • Adequate prescription of topical steroids is important in management of atopic dermatitis and use of the fingertip unit gives a good estimation of the amount required

  • To relief excessive pruritus in atopic dermatitis, first-generation, sedating antihistamines work better than new, non-sedating antihistamines

  • Oral cyclosporine is effective in severe, treatment refractory atopic dermatitis

  • Side-effects such as hypertension, hyperkalemia and hypomagnesemia should be monitored when using cyclosporine


Hyper IgE syndrome Finger-tip-unit Body surface area Narrow-band ultraviolet 


  1. 1.
    Grimbacher B, Holland SM, Gallin JI, Greenberg F, Hill SC, Malech HL, Miller JA, O’Connell AC, Puck JM. Hyper-IgE syndrome with recurrent infections--an autosomal dominant multisystem disorder. N Engl J Med. 1999;340(9):692–702.CrossRefGoogle Scholar
  2. 2.
    Eberting CL, Davis J, Puck JM, Holland SM, Turner ML. Dermatitis and the newborn rash of hyper-IgE syndrome. Arch Dermatol. 2004;140(9):1119–25.CrossRefGoogle Scholar
  3. 3.
    Buckley RH. The multiple causes of human SCID. J Clin Invest. 2004;114(10):1409–11.CrossRefGoogle Scholar
  4. 4.
    Bolognia J, Jorizzo JL, Schaffer JV. Dermatology. Edinburgh: Elsevier/Saunders; 2012.Google Scholar
  5. 5.
    Wilkinson RD, Curtis GH, Hawk WA. Netherton’s disease; trichorrhexis invaginata (bamboo hair), congenital ichthyosiform erythroderma and the atopic diathesis. A histopathologic study. Arch Dermatol. 1964;89:46–54.CrossRefGoogle Scholar
  6. 6.
    Hanifin J, Gupta AK, Rajagopalan R. Intermittent dosing of fluticasone propionate cream for reducing the risk of relapse in atopic dermatitis patients. Br J Dermatol. 2002;147(3):528–37.CrossRefGoogle Scholar
  7. 7.
    Ring J, Alomar A, Bieber T, Deleuran M, Fink-Wagner A, Gelmetti C, Gieler U, Lipozencic J, Luger T, Oranje AP, Schafer T, Schwennesen T, Seidenari S, Simon D, Stander S, Stingl G, Szalai S, Szepietowski JC, Taieb A, Werfel T, Wollenberg A, Darsow U. Guidelines for treatment of atopic eczema (atopic dermatitis) part I. J Eur Acad Dermatol Venereol. 2012;26(8):1045–60.CrossRefGoogle Scholar
  8. 8.
    Nelson AA, Miller AD, Fleischer AB, Balkrishnan R, Feldman SR. How much of a topical agent should be prescribed for children of different sizes? J Dermatolog Treat. 2006;17(4):224–8.CrossRefGoogle Scholar
  9. 9.
    Chunharas A, Wisuthsarewong W, Wananukul S, Viravan S. Therapeutic efficacy and safety of loratadine syrup in childhood atopic dermatitis treated with mometasone furoate 0.1 per cent cream. J Med Assoc Thai. 2002;85(4):482–7.PubMedGoogle Scholar
  10. 10.
    Hannuksela M, Kalimo K, Lammintausta K, Mattila T, Turjanmaa K, Varjonen E, Coulie PJ. Dose ranging study: cetirizine in the treatment of atopic dermatitis in adults. Ann Allergy. 1993;70(2):127–33.PubMedGoogle Scholar
  11. 11.
    Weisshaar E, Heyer G, Forster C, Handwerker HO. Effect of topical capsaicin on the cutaneous reactions and itching to histamine in atopic eczema compared to healthy skin. Arch Dermatol Res. 1998;290(6):306–11.CrossRefGoogle Scholar
  12. 12.
    Boguniewicz M, Fiedler VC, Raimer S, Lawrence ID, Leung DY, Hanifin JM. A randomized, vehicle-controlled trial of tacrolimus ointment for treatment of atopic dermatitis in children. Pediatric Tacrolimus Study Group. J Allergy Clin Immunol. 1998;102(4 Pt 1):637–44.CrossRefGoogle Scholar
  13. 13.
    Eichenfield LF, Thaci D, de Prost Y, Puig L, Paul C. Clinical management of atopic eczema with pimecrolimus cream 1% (Elidel) in paediatric patients. Dermatology. 2007;215(Suppl 1):3–17.CrossRefGoogle Scholar
  14. 14.
    Reynolds NJ, Franklin V, Gray JC, Diffey BL, Farr PM. Narrow-band ultraviolet B and broad-band ultraviolet A phototherapy in adult atopic eczema: a randomised controlled trial. Lancet. 2001;357(9273):2012–6.CrossRefGoogle Scholar
  15. 15.
    Eberlein B, Eicke C, Reinhardt HW, Ring J. Adjuvant treatment of atopic eczema: assessment of an emollient containing N-palmitoylethanolamine (ATOPA study). J Eur Acad Dermatol Venereol. 2008;22(1):73–82.PubMedGoogle Scholar
  16. 16.
    Wollenberg A, Wetzel S, Burgdorf WH, Haas J. Viral infections in atopic dermatitis: pathogenic aspects and clinical management. J Allergy Clin Immunol. 2003;112(4):667–74.CrossRefGoogle Scholar
  17. 17.
    Kunz B, Oranje AP, Labreze L, Stalder JF, Ring J, Taieb A. Clinical validation and guidelines for the SCORAD index: consensus report of the European Task Force on Atopic Dermatitis. Dermatology. 1997;195(1):10–9.CrossRefGoogle Scholar
  18. 18.
    Ring J, Alomar A, Bieber T, Deleuran M, Fink-Wagner A, Gelmetti C, Gieler U, Lipozencic J, Luger T, Oranje AP, Schafer T, Schwennesen T, Seidenari S, Simon D, Stander S, Stingl G, Szalai S, Szepietowski JC, Taieb A, Werfel T, Wollenberg A, Darsow U. Guidelines for treatment of atopic eczema (atopic dermatitis) Part II. J Eur Acad Dermatol Venereol. 2012;26(9):1176–93.CrossRefGoogle Scholar
  19. 19.
    Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic eczema. Health Technol Assess (Winch Eng). 2000;4(37):1–191.Google Scholar
  20. 20.
    Lee CH, Kim GH. Electrolyte and Acid-base disturbances induced by calcineurin inhibitors. Electrol Blood Press. 2007;5(2):126–30.CrossRefGoogle Scholar
  21. 21.
    Lin HY, Rocher LL, McQuillan MA, Schmaltz S, Palella TD, Fox IH. Cyclosporine-induced hyperuricemia and gout. N Engl J Med. 1989;321(5):287–92.CrossRefGoogle Scholar
  22. 22.
    Nozue T, Kobayashi A, Kodama T, Uemasu F, Endoh H, Sako A, Takagi Y. Pathogenesis of cyclosporine-induced hypomagnesemia. J Pediatr. 1992;120(4 Pt 1):638–40.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.National Skin CentreSingaporeSingapore
  2. 2.Department of DermatologyKK Women’s and Children’s HospitalSingaporeSingapore

Personalised recommendations