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Dermatology Week 2 2017/18 > 7: Dermatitis / atopic eczema > Flashcards

7: Dermatitis / atopic eczema Flashcards

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1
Q

What is another name for dermatitis?

A

Eczema

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2
Q

What is another name for eczema?

A

Dermatitis

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3
Q

What is papillomatosis?

A

Irregular epithelial thickening

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4
Q

What is the characteristic histological feature of eczema?

A

Spongiosis (oedema between keratinocytes)

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5
Q

Which immune cells infiltrate the epidermis in eczema?

A

Neutrophils

Lymphocytes

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6
Q

What is the common symptom for all types of eczema?

A

Pruritus (itching)

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7
Q

What are the two phases of an eczema reaction?

A

Acute phase

Chronic phase

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8
Q

What happens in the acute phase of an eczema reaction?

A

Rapid acute inflammation

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9
Q

What does eczema look like in the acute phase?

A

Papulovesicular

Erythematous

Spongiotic

Oozing / scaly / crusty

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10
Q

What does eczema look like in the chronic phase?

A

Thickened (lichenification)

Elevated patches –> PLAQUES

Even scalier

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11
Q

What are the four defining morphological features of eczema?

A

Itchy

Ill-defined

Erythematous

Scaly

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12
Q

What type of eczema is brought about by a Type IV hypersensitivity reaction?

A

Contact allergic eczema

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13
Q

What type of eczema reaction is brought about by substances which aren’t allergens?

A

Contact irritant eczema

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14
Q

Give two examples of substances which cause contact irritant eczema.

A

Soap

Water

Urine

Faeces

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15
Q

What is atopic eczema?

A

Inflammation of the skin due to genetic and environmental factors versus allergens or irritants

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16
Q

Which types of hypersensitivity reactions occur in drug-related eczema?

A

Type I

Type IV

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17
Q

Which immune cells are seen in drug-related eczema?

A

Eosinophils

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18
Q

What is the histological feature common to ALL types of eczema?

A

Spongiosis (oedema between keratinocytes)

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19
Q

If a patient has eczema on sun-exposed areas only, which type of eczema may they have?

A

Photosensitive eczema

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20
Q

What is lichen simplex eczema?

A

Inflammation due to scratching

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21
Q

What is stasis dermatitis?

A

Skin inflammation due to hydrostatic pressure in legs with poor circulation (see also: varicose veins)

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22
Q

Which cells leak into the extracellular compartment and cause inflammation in stasis dermatitis?

Why?

A

Red blood cells

Increase in capillary hydrostatic pressure (in turn due to decreased venous circulation, e.g heart failure or peripheral vascular disease)

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23
Q

Give some examples of allergens which cause contact allergic dermatitis.

A

Chemicals

Drugs (e.g penicillin)

Nickel!!!!

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24
Q

Where is nickel commonly found which can cause contact allergic dermatitis?

A

Belt buckles, buttons

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25
Why do people tend to get worse contact allergic reactions on the **dorsal** surfaces of their hands?
The skin is **thinner**
26
Which substance, increasingly found in the air, can cause contact allergic reactions on the face?
**Perfume**
27
What is typically seen in the **acute phase** of eczema?
**Weeping blisters** (due to rapid severe spongiosis)
28
Which cells, found in the epidermis, bind to antigens on the skin?
**Langerhans cells**
29
Where do Langerhans cells take antigens for transport to T cells?
**Lymphatic vessels**
30
Which cells do Langerhans cells present antigen to?
**T cells**
31
Which immune cells are responsible for **spongiosis** in the epidermis upon contact with an allergen?
**Lymphocytes**
32
Which cells trigger dermatitis?
**Lymphocytes**
33
What are the two main histological features of contact allergic eczema?
**Lymphocyte infiltration** **Spongiosis**
34
Which investigation allows you to figure out which allergens a patient is allergic to?
**Patch testing**
35
If the patient is allergic to one of the substances in a patch test, what will be seen in that battery 96 hours later?
**Contact allergic eczema**
36
**Irritant contact eczema** is a **(specific / non-specific)** reaction to a substance.
**non-specific**
37
Why do people wearing **rings** develop dermatitis even though they aren't allergic to the metal in them?
**Soap is trapped under the ring during hand washing**
37
Name five clinical features of severe hand dermatitis.
**Oedema** **Erosions** **Lichenification** **Fissures** **Scales** **Nail dystrophy**
38
What kind of eczema is "nappy rash"?
**Contact irritant eczema**
39
Why may a patient have irritant dermatitis around their lips?
**They've been licking them** i.e saliva
40
Which kind of eczema is associated with **asthma** and **hayfever**?
**Atopic eczema**
41
What is the main symptom of atopic eczema in children?
**Pruritus**
42
What is a major quality of life impact of pruritus?
**Sleep disturbance \> Fatigue \> Poor school/work/life performance**
43
Apart from itching, what are other signs and symptoms of atopic eczema?
**Ill-defined erythema** **Scales** **Dry skin**
44
On which surfaces is atopic eczema seen?
Flexural surfaces
45
Apart from flexural surfaces, where else is atopic eczema found?
**Face** **Groin** **Bit below ear**
46
If a child has a patch of dermatitis below the fold in their ear, what do they probably have?
**Atopic eczema**
47
What are skin changes seen in chronic atopic eczema?
**Lichenification** **Excorciation** (erosion caused by scratching) **Secondary infection**
48
What commensal bacteria are seen in far greater numbers in people with atopic eczema, and may contribute to secondary infection?
**Staph. aureus** **Staph. epidermidis**
49
What does **crusting** (golden/yellow) indicate in a patient with atopic eczema?
**Staph. aureus**
50
What infection does **eczema herpeticum** (rash on the buttocks) indicate?
**Herpes simplex**
51
How would you describe **eczema herpeticum**?
**Monomorphic punched-out lesions**
52
How should eczema herpeticum be treated?
**Oral acyclovir**
53
Is eczema herpeticum a one-off infection?
**No, tends to recur**
54
What should be used to address dryness in patients with eczema?
**Emollients**
55
Which products should be avoided in patients with eczema?
**Irritants -** e.g shampoos and soaps
56
If emollients and antigen/irritant avoidance don't work, how can you treat eczema?
**Topical steroids** **Phototherapy (UVB)** **Immunosuppression**
57
When should topical steroid be stopped?
**When the eczema dies down**
58
What are biologic agents?
**Monoclonal antibodies** used to treat skin conditions (e.g psoriasis, eczema)
59
The gene for which protein is important in the genetic cause of atopic eczema?
**Filaggrin**
60
Round, scaly, **WELL-DEFINED** eczema found on the **extensor** aspects of the arms is...
**Discoid eczema**
61
What is the difference between **discoid eczema** and **psoriasis**?
Discoid eczema produces **PATCHES** Psoriasis produces **PLAQUES**
62
A patient has a cut-off of their eczema at the collar line. What type of eczema do they have?
**Photosensitive eczema**
63
What can trigger photosensitive eczema in a patient who isn't normally photosensitive?
**Drugs**
64
What are some examples of drugs which cause photosensitivity in some patients?
**Antibiotics** (tetracyclines) **NSAIDs** (ibuprofen) **Diuretics** **Retinoids**
65
What type of eczema is found around swollen varicose veins?
**Stasis eczema**
66
What is another name for **cradle cap**?
**Seborrhoeic dermatitis**
67
What is the name for a sub-type of eczema where the oedema can't escape and instead forms itchy vesicles on the palms and fingers?
**Pompholyx**
68
What is the pathomechanism of lichen simplex eczema?
**Scratching**

Dermatology Week 2 2017/18 (8 decks)

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