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Inflammation > Skin conditions: Eczema and Dermatitis > Flashcards

Skin conditions: Eczema and Dermatitis Flashcards

1
Q

What is the different in pathology of dermatitis and eczema?

A

Eczema is inflammation of the epidermis whereas dermatitis is inflammation of the dermis. However the conditions exist co-dependently (you do not have one without the other).

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2
Q

How would the skin appear with eczema?

A

Dry, irritated, inflammed

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3
Q

How does the inflammation present in eczema?

A

Erythema
Oedema
Oozing
Papules
Crusting
Thickening
Scaling

There is also itching and burning sensation that can occur

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4
Q

What are some of the conditions within eczema?

A

Atopic dermatitis
Contact dermatitis
Seborrheoic dermatitis
Dyshidrotic dermatitis

There are other types but these are the most common

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5
Q

What is the most common type of eczema?

A

Atopic dermatitis

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6
Q

How frequently does flare ups occur in atopic dermatitis?

A

It is characterised by periods of flare ups and remission. A patient may not have any flare ups for long periods of time before re occurring.

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7
Q

Which demographics are most affected by atopic dermatitis?

A

Atopic dermatitis affects only 1-2% of adults but 15-20% of school children.
Sometimes it can clear up completely in childhood and reoccur in adolescence or present for the first time in adulthood.
Males and females are affected equally.

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8
Q

What percentage of skin problems in GP relate to atopic dermatitis?

A

30%

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9
Q

What type of hypersensivity reaction is atopic dermatitis?

A

Type 4 hypersensivity
Eczema is often the first presentation of the atopic triad (alongside asthma and hayfever)

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10
Q

Where does eczema occur on the body?

A

Flexural areas such as the knees and elbows
In addition to the wrist, neck, face (very commonly the cheeks in young children)

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11
Q

What are some of the causes of atopic dermatitis?

A

Genetic predisposition - often atopic families. There appears to be a link to a defect in the filaggrin gene which is responsible for maintaining epidermal integrity.
Therefore in these patients there are defects in the skin barrier where it is difficult for the skin to be repaired and maintained and this is linked to a lack of anti-microbial peptides.
Lack of epidermal integrity weakens the epidermal barrier making the patients more susceptible to infection and irritation which allows allergy inducing substances to enter the skin causing inflammation.

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12
Q

How does the location of eczema differ in children and adults?

A

Children tends to be flexural eczema whereas in adults usually on the hands

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13
Q

What are some of the causes of flare ups?

A

Heat
Dust
Irritants - smoke
Stress
Foods (in children)
Soaps
Feeling unwell / infection

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14
Q

When does the itching associated with a flare up occur?

A

Usually at night, can be severe

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15
Q

Aside from dryness, how else do the eczema patches appear?

A

The dry skin, especially with continued itching can cause the patches to become a red and grey colour (lichenified)
The skin can become raw, sensitive and swollen from this continued scratching
This can lead to skin infections and sores

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16
Q

How are flare ups prevented?

A

Keeping the skin moist - using moisturisers as this prevents the skin from breaking and allergens entering
Identifying and avoiding possible triggers
Using mild soaps and short showers/baths as the skin getting wet does not help

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17
Q

What are the main treatment options for atopic dermatitis?

A

Emollients (keeping the skin moist prevents breaks in the skin)
Topical corticosteroids (works locally to reduce inflammation)
Antibiotics if eczema becomes infected
Phototherapy

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18
Q

If the main/topical treatment strategies for atopic dermatitis are ineffective what is used?

A

First line:
Systemic corticosteroids

Second line:
Topical calcineurin inhibitors - which inhibit the T cell response (preventing production of IL-4)

Other therapies:
Ciclosporin, Azathioprine
Monoclonal antibody Dupilimumab

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19
Q

How does Dupilimumab work?

A

Dupilimumab is a monoclonal antibody that inhibits IL-4 and IL-13 signalling. IL-4 is produced in response to T-cell activation and causes class switching and secretion of IgE antibodies which then triggers activation of the mast cells to produce inflammatory mediators including IL-13 which recruits more immune cells to the area of inflammation driving the inflammatory response. By blocking both of these signalling pathways this enables skin integrity and barrier function to improve.

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20
Q

When is Alitretinoin used?

A

As a form of Vitamin A (retinoid) it is used for chronic hand eczema refractory to steroids.

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21
Q

After atopic what is the most common type?

A

Contact dermatitis

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22
Q

Where is contact dermatitis often seen on the body?

A

In exposed areas of the body such as the hands, legs, arms or face.
And occurs due to contact with a substance/allergen resulting in stripping of the naturally producing skin oils.

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23
Q

What are the two types of contact dermatitis?

A

Irritant dermatitis (75% of cases)
Contact dermatitis

24
Q

Which demographics often suffer with contact dermatitis?

A

More common in adults who are exposed to substances and chemicals often at the workplace such as those who work in:
Healthcare, hairdressers,
catering, labs, cleaners, industrial factory workers
Patients with atopic eczema have increased susceptibility to both types

25
Q

What are the irritants that trigger contact dermatitis?

A

Often a chemical insult such as an acid or results from cumulative exposure to a toxin such as soaps, detergents

26
Q

How is irritant and contact dermatitis differentiated?

A

Using a patch test on the patient which picks up allergens

27
Q

What influences the extent of contact dermatitis?

A

The amount of exposure and for how long

28
Q

Aside from irritants what else can cause contact dermatitis?

A

Excess handwashing
Dribble rashes
Nappy rashes

29
Q

How does diagnosis occur for irritant contact dermatitis?

A

By identification of the substance that is causing irritation

30
Q

What type of reaction is allergic contact dermatitis?

A

Type 4 hypersensivity (similar to atopic eczema) and occurs due to repeated exposure of irritant allowing an immune response to build up

31
Q

What are some examples of irritants?

A

Nickel
Rubber
Perfumes
Preservatives in cosmetics
Dyes

32
Q

What are the main treatments for contact dermatitis?

A

Identification and avoiding irritants and allergens
Emollients
Corticosteroids
Oral corticosteroids
Alitretinoin for chronic hand contact dermatitis refractory to steroids

33
Q

How common is seborrheic dermatitis?

A

Occurs in 1-3% of the UK population
More common in males and those over the age of 20

34
Q

What is the clinical presentation of seborrheic dermatitis?

A

It is characterised by the formation of skin flakes that are itchy, sore, greasy and is white to yellow in appearance.
It can range from dandruff to severe flakes.

35
Q

Where does seborrheic dermatitis occur?

A

It occurs in the zones of the sebaceous skin glands and folds in the skin so the scalp, face, ears, chest, palms of the hands, back

36
Q

What is the cause of seborrheic dermatitis?

A

It caused by the overgrowth of a type of yeast known as Malassezia yeast which metabolise the sebum triggering an inflammatory response.
Not contagious but made worse by stress.

37
Q

When does infantile seborrheic dermatitis occur?

A

Between 3-8 months

38
Q

What is the clinical presentation of infantile seborrheic dermatitis?

A

Yellow, thick waxy scales on the scalp normally and most commonly
However can also include pink flaky patches on the forehead, eyebrows, behind the years and nappy area

39
Q

What is infantile seborrheic dermatitis caused by?

A

Developing sebum glands associated with the Malassezia yeast which metabolise into fatty acids that penetrate the skin causing inflammation.

40
Q

What are the treatment options for infantile seborrheic dermatitis?

A

Emollients or mineral oils (for scalp)
Topical steroids with antifungal (for body)

41
Q

What are some of the treatment options for adults with seborrheic dermatitis?

A

Shampoos with ketoconazole, Zn pyrithione, Se sulfide (anti-yeast)
– Steroid scalp lotions/mousses
– Topical mild corticosteroids with salicylic acid (for scalp)
– Topical mild corticosteroids with anti-yeast creams/ointments (clotrimazole, miconazole and nystatin)
– Oral antifungals (severe cases)

42
Q

Does seborrheic dermatitis respond well to drug treatments?

A

Not really, it tends to be very stubborn and returns easily

43
Q

What is the clinical presentation of nummular dermatitis?

A

Round/oval blistered/dry lesions
Usually lower legs/trunk/arms

44
Q

What is the cause of nummular dermatitis?

A

Unknown

45
Q

Gender split of nummular dermatitis?

A

Affects males and females equally

46
Q

What are the main treatment options of nummular dermatitis?

A

Emollients, steroids, antibiotics and
phototherapy

47
Q

What is the clinical presentation of neurodermatitis?

A

It is a skin condition characterized by chronic itching or scaling.
The skin tends to be raised, rough, itchy and is typically on the neck, wrists, forearms, legs or groin area.
It is aggravated by repeated rubbing or scratching
Tends to be very persistent and reoccurring

48
Q

What demographics are affected by neurodermatitis?

A

Occurs in 12% of the population, commonly in mid to late adulthood (particularly around 30-50 years)

49
Q

What are some of the causes of neurodermatitis?

A

Due to a compressed nerve, presence of other dermatitis, anxiety

50
Q

What is the main treatment for neurodermatitis?

A

Emollients and topical steroids

51
Q

Where does stasis dermatitis occur?

A

Usually occurs in areas of vascular insuffiency such as DVT, leg ulcers, varicose veins.
This causes an increase in pressure within the veins of the legs which ultimately affects the skin around it.

52
Q

Which demographics are more likely to be affected by stasis dermatitis?

A

Women
Overweight
Standing up

53
Q

How does the appearance of the skin change with stasis dermatitis?

A

Skin becomes more fragile, thin, shiny, inflammed, itchy and flaky and is associated with venous hypertension

54
Q

What is the main treatment strategies for stasis dermatitis?

A

Emollients
Steroids
Compression stockings
Exercise
Weight loss
Elevation of the legs
Surgery for varicose veins

55
Q

In which demographics are more likely to suffer from dyshidrotic dermatitis?

A

Common in people with atopic eczema under the age of 40

56
Q

What is the clinical presentation of dyshidrotic dermatitis?

A

Appearance of tiny itchy blisters on the hand and feet that is aggravated by heat and stress

57
Q

What is the main treatment strategies for dyshidrotic dermatitis?

A

Emollients
Steroids
Antibiotics
Systemic immunosuppressants
Phototherapy

Inflammation (11 decks)

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