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10. Year 2: Dermatology > Ezcema > Flashcards

Ezcema Flashcards

1
Q

What percentage of children will be diagnosed with eczema at somepoint in childhood?

A

24%

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2
Q

Is the prevalence of eczema increasing or decreasing?

A

Increasing, currently at 4%

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3
Q

What is eczema also known as?

A

Dermatitis

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4
Q

What is eczema?

A

Eczema is a condition where patches of skin become inflamed, itchy, red, cracked, and rough. Blisters may sometimes occur.

Is an inflammatory skin condition

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5
Q

What parts of the body does eczema often impact?

A

Flexural areas

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6
Q

What does eczema lead to generally?

A

It is irritated skin that leads to barrier dysfunction and inflammation

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7
Q

What is atopic eczema?

A

An 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 years old
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8
Q

What is the pathogenesis of atopic eczema?

A

Genetics:

  • Many genes implicated
  • Role for filaggrin gene
  • Atopic family history
    • Atopic eczema, asthma hay fever (allergic rhinitis), food allergy

Epidermal barrier dysfunction

Environmental factors

Immune system dysregulation

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9
Q

What gene is involved in the development of atopic eczema?

A

Filaggrin gene

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10
Q

What is the pathology of atopic eczema?

A

Spongiosis (intercellular oedema) within the epidermis

Acanthosis (thickening of the epidermis)

Inflammation, superficial perivascular lymphohistiocystic infiltrate

The epidermis is the outermost layer of skin, the dermis contains blood vessels, lymph vessels, hair follicles and sweat glands

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11
Q

What is spongiosis?

A

Intercellular oedema

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12
Q

What is acanthosis?

A

Thickening of the epidermis

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13
Q

What is the pathology of acute dermatitis?

A
  • Intercellular oedema within the epidermis
  • Can lead to accumulation of intra-epidermal vesicles
  • Infiltration of the epidermis with lymphocytes is common
  • Dermal changes include varying degrees of oedema and a superficial perivascular infiltrate with lymphocytes, histiocytes and occasional neutrophils and eosinophils
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14
Q

What is the pathology of chronic (spongiotic) dermatitis?

A
  • Degree of spongiosis is often mild
  • Significant epidermal acanthosis (thickening of epidermis)
  • Fibrosis of papillary dermis may be present
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15
Q

What are the clinical features of atopic 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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16
Q

What is the distribution of atopic eczema?

A
  • Flexures, neck, eyelids, face, hands and feet
  • Tends to spare nappy area
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17
Q

Other than atopic eczema, what are some other types of eczema?

A

Exogenous (external):

  • Contact dermatitis
    • Irritant
    • Allergic
  • Lichen simplex
  • Photoallergic or photoaggravated eczema

Endogenous (internal):

  • Atopic
  • Discoid
  • Venous
  • Seborrhoeic dermatitis
  • Pompholyx
  • Juvenile plantar dermatitis
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18
Q

What is allergic contact dermatitis?

A

Type 4 hypersensitivity:

  • Delayed hypersensitivity can take 48-72 hours to develop reaction
  • Antigen presenting cells take hapten/allergen to LN and present to naïve T cells
  • Clonal expansion of T cells, released into blood stream
  • When these T cells next encounter hapten
    • Mast cell degranulation, vasodilation and neutrophils
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19
Q

What is hapten?

A

A small molecule which, when combined with a larger carrier such as a protein, can elicit the production of antibodies which bind specifically to it (in the free or combined state)

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20
Q

What kind of hypersensitivity reaction is allergic contact dermatitis?

A

Type 4

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21
Q

What is irritant contact dermatitis?

A

Form of contact dermatitis, in which the skin is injured by friction, environmental factors such as cold, over-exposure to water, or chemicals such as acids, alkalis, detergents and solvents

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22
Q

What can the skin be injured by to cause irritant contact dermatitis?

A

Skin injured by:

  • Friction
    • Micro-trauma, cumulative
  • Environmental factors
    • Cold
    • Over-exposure to water
    • Chemicals such as acids, alkalis, detergents and solvents
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23
Q

What is a major risk factor for irritant contact dermatitis?

A

Occupation puts people at risk:

  • Hairdressers
  • NHS staff
  • Cleaners
  • Dermatitis
  • Nappy rash
24
Q

What investigation should be done with irritant contact dermatitis?

A

Patch testing:

  • Finds out whether or not skin condition is caused or aggravated by an allergy
  • Potential allergen is applied
25
Q

What is deborrhoeic dermatitis?

A

A common, chronic or relapsing form of eczema/dermatitis that mainly affects the sebaceous, gland-rich regions of the scalp, face, and trunk .

26
Q

What is the clinical presentation presentation of seborrhoeic dermatitis in infants?

A

Distinctive pattern

Predelection for scalp, proximal flexures

<6 months age usually

Often clears within weeks without treatment

27
Q

Is seborrhoeic eczema chronic or acute?

A

Chronic dermatitis

28
Q

What is the clinical presentation of seborrhoeic eczema?

A
  • Red, sharply marinated lesions covered with greasy looking scales
  • Distinctive distribution, areas rich in supply of sebaceous glands (scalp, face, upper trunk)
29
Q

What yeast is increased in seborrhoeic eczema in adults?

A

Malassezia yeast

30
Q

What is the treatment of seborrhoeic eczema for adults?

A

Treat with topical anti-yeast (ketoconazole)

If severe, consider HIV test

31
Q

What is discoid eczema?

A

Circular plaques of eczema

Cause is often unknown

32
Q

Where does discoid eczema often develop?

A

Sites of trauma/irritation

33
Q

What is pompholyx eczema?

A

Type of eczema that causes tiny blisters to develop across the fingers, palms of the hands and sometimes the soles of the feet

34
Q

What is vesicular eczema?

A

form of hand eczema characterised by vesicles or bullae (blisters)

35
Q

Where does pomphyloyx eczema affect?

A

Palms of hands, sometimes soles of feet

36
Q

Where does vesicular eczema affect?

A

Palms of hands

37
Q

In what age group is pompholyx/vesicular eczema most common?

A

<40 years

38
Q

What is asteatotic eczema?

A

Very dry skin

39
Q

What are risk factors for asteototic eczema?

A

Hot climate

Excessive washing/soaps

40
Q

What is the clinical presentation of asteatotic eczema?

A

Cracked scaly apeparance

Most commonly shins affected

41
Q

What is venous eczema also known as?

A

Stasis eczema or varicose eczema

42
Q

What is the clinical presentation of venous eczema?

A
  • Increased venous pressure
  • Oedema
  • Ankle and lower leg involved
43
Q

What is the treatment of venous eczema?

A

Resolution of oedema can help – compression stockings

44
Q

What is venous eczema?

A

Long-term skin condition that affects the lower legs. It’s common in people with varicose veins

45
Q

What is eczema herpeticum?

A

Disseminated viral infection

46
Q

What is the clinical presentation of eczema herpeticum?

A
  • Fever and often unwell
  • Itchy clusters of blisters and erosions
  • Swollen lymph glands
47
Q

What is eczema herpeticum caused by?

A

Herpes simplex 1 and 2

48
Q

What is the treatment of eczema herpeticum?

A
  • Admission
  • Antivirals
  • Consider secondary bacterial infection
49
Q

What is the treatment of eczema?

A
  • Patient education
  • Avoid causative/exacerbating factors
  • Emollients (moisturisers)
    • Ointment, greasy but effective
    • Creams, lighter
    • Lotions, more watery
  • Soap substitutes
  • Intermittent topical steroids
    • Different potency
    • Hydrocortisone (low)
    • Betamethasone (potent)
  • Sometimes need antihistamines or antimicrobials
  • Calcineurin inhibitors
    • Topical pimecrolimus and tacrolimus
50
Q

What is the treatment of severe eczema?

A
  • UV light
  • Immunosuppresion
    • Azathioprine
    • Ciclosporin
    • Mycophenolate mofetil
    • Methotrexate
51
Q

What immunosuppression drugs can be used to treat severe eczema?

A
  • Azathioprine
  • Ciclosporin
  • Mycophenolate mofetil
  • Methotrexate
52
Q

What are different kinds of emollients that can be used for eczema?

A
  • Ointment, greasy but effective
  • Creams, lighter
  • Lotions, more watery
53
Q

What are emollients?

A

Moisturisers

54
Q

What are some intermittent topical steroids for eczema?

A
  • Different potency
  • Hydrocortisone (low)
  • Betamethasone (potent)
55
Q

What are some future treatments for eczema?

A

Crisaborole:

  • Topical PDE-4 inhibitor
  • FDA approved

Dupilumab:

  • 1st biologic for eczema patients
  • IL-4/IL-13 inhibitor
56
Q

What is crisaborole?

A

Topical PDE-4 inhibitor

57
Q

What is dupilumab?

A
  • 1st biologic for eczema patients
  • IL-4/IL-13 inhibitor

10. Year 2: Dermatology (11 decks)

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