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Dermatology > Lecture 4 Eczema > Flashcards

Lecture 4 Eczema Flashcards

1
Q

T cell responsible for acute stage of eczema

A

Th2

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2
Q

T cel responsible for chronic sage of eczema

A

Th1

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3
Q

Clinical features of Atopic eczema

A

• Itchy skin condition in the last 12 months

Plus 3 of the following:
•	Onset before age 2
•	History of flexural involvement
•	History of generally dry skin
•	History of other atopic disease 
•	History in 1st degree relative if under 4 yrs
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4
Q

Pathogenesis of Eczema

A

– Key role for Filaggrin gene
– Atopic family history

  • Epidermal barrier dysfunction
  • Environmental factors
  • Immune system dysregulation
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5
Q

Pathology of eczema

A
  • Spongiosis (intercellular oedema) within the epidermis.
  • Acanthosis (thickening of the epidermis).
  • Inflammation - Superficial perivascular lymphohistiocytic infiltrate
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6
Q

Histological features of acute dermatitis

A

Oedema in epidermis

superficial perivascular infiltrate with lymphocytes, histiocytes and occasional neutrophils and eosinophils.

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7
Q

Histological features of chronic dermatitis

A
  • Chronic spongiotic dermatitis- degree of spongiosis is often mild and difficult to appreciate
  • Significant acanthosis which may show a psoriasiform pattern with hyperkeratosis, hypergranulosis and miminal parakeratosis.
  • Fibrosis of the papillary dermis may be present.
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8
Q

Clinical features of Atopic dermatitis/eczema

A 
•	Itch
•	Distribution
–	Flexures, Neck, Eyelids, Face, Hands and feet
–	Tends to spare nappy area
•	Acute changes
–	Pruritus, Erythema, Scale, Papules, Vesicles
–	Exudate, crusting, excoriation
•	Chronic changes
–	Lichenification, Plaques, Fissuring
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9
Q

External types eczema

A 
•	Contact dermatitis
–	Irritant 
–	Allergic
•	Lichen simplex
•	Photoallergic or photoaggravated eczema
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10
Q

Internal types of eczema

A 
–	Atopic
–	Discoid
–	Venous
–	Seborrhoeic dermatitis
–	Pompholyx
–	Juvenile plantar dermatitis
•	Asteatotic
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11
Q

What type of sensitivity is allergic contact dermatitis

A

Type 4 Hypersensitivity

Delayed can take 48-72 hours

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12
Q

What are the causes of irritant contact dermatitis

A
  1. Friction- micro-trauma, cumulative
  2. Environmental factors
    – Overexposure to water
    – Chemicals such as acids, alkalis, detergents and solvents
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13
Q

What occupations increased for risk of developing irritant contact dermatitis

A

Hairdressers
NHS staff
Cleaners

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14
Q

Describe the process of patch testing

A
  • Applied Monday (3 days)
  • Remove Wednesday
  • Re-assess Friday (2 days after removing)
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15
Q

What is Seborrhoeic dermatitis in infants

A
  • Distinctive pattern
  • Predilection for scalp, proximal flexures.
  • <6months age usually.
  • Often clears within weeks of treatment
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16
Q

What is Seborrhoeic Eczema- Adults

A
  • Malassezia yeast increased in the scaly epidermis of dandruff and seborrehoic dermatitis.
  • Red, sharply marginated lesions covered with greasy looking scales.
  • Distinctive distribution – areas rich in supply of sebaceous glands (scalp, face, upper trunk
17
Q

How do you treat Seborrhoeic Eczema- Adults

A

• Treat with topical anti-yeast (ketoconazole).

18
Q

Describe discoid eczema

A
  • Circular plaques of eczema.
  • Cause often unknown.
  • May develop at sites of trauma/irritation
19
Q

Clinical features of Pompholyx/Vesicular Eczema

A
  • Palms and soles.
  • Intensely itchy.
  • More common under 40 years.
  • Sudden onset of crops of vesicles.
  • Resolution can include desquamation
20
Q

Clinical features of Asteatotic eczema

A
  • Very dry skin.
  • Cracked scaly appearance.
  • Most commonly shins affected.
  • Climate – heat
  • Excessive washing/soaps
21
Q

Clinical features of venous Eczema

A
  • Increased venous pressure.
  • Oedema.
  • Ankle and lower leg involved.
  • Resolution of oedema can help – compression stockings.
22
Q

Topical steroids that can be used to treat eczema

A
  • hydrocortisone (low)

* Betamethasone (potent)

23
Q

Calcineuron Inhibitors that can be used to treat eczema

A

– Topical Pimecrolimus and Tacrolimus

24
Q

Treatment for severe eczema

A 
•	Ultraviolet light.
•	Immunosuppression.
–	Azathioprine
–	Ciclosporin
–	Mycophenolate mofetil
–	Methotrexate

Dermatology (11 decks)

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