Atopic Dermatitis (Eczema)

Question 1

what is atopic eczema

Answer 1

pruritic papulovesicular skin reaction to endogenous and exogenous agents;

inflammatory skin condition characterised by dry, itchy skin

Question 2

acute vs chronic eczema

Answer 2

acute is described as a flare-up. chronic is chronic inflammation

Question 3

aetiology (endogenous)

Answer 3

atopic, seborrhoeic, pompholyx, varicose, lichen simplex

Question 4

what is pompholyx eczema

Answer 4

type of eczema that affects the hands and feet

Question 5

why may atopic eczema present with varicose veins

Answer 5

increased venous pressure in lower limbs

Question 6

exogenous causes of eczema

Answer 6

irritants, contact dermatitis, atopic

Question 7

what is contact dermatitis due to

Answer 7

delayed type 4 hypersensitivity reaction to an allergen

Question 8

epidemiology of contact dermatitis

Answer 8

prevalence is 4%

Question 9

epidemiology of atopic dermatitis

Answer 9

onset in first year of life, childhood incidence is 10-20%

Question 10

presenting symptoms

Answer 10

itching, heat, tenderness, redness, weeping, crusting, ask about occupational exposure to irritants and ask about personal/.family history of ATOPY

Question 11

signs of atopic eczema on physical examination (acute)

Answer 11

poorly demarcated erythematous oedematous dry scaling patches,

papules,

vesicles with exudation and crusting,

excoriation marks

Question 12

signs of chronic atopic eczema

Answer 12

thickened epidermis, skin lichenification,
fissures,
changes in pigmentation

Question 13

what is lichenification

Answer 13

where the skin becomes thicker and leathery

Question 14

why does skin lichenification happen

Answer 14

the skin is itchy and as the skin is rubbed and itched over a long time, the cells grow

Question 15

types of eczema

Answer 15

atopic- mainly affects face and flexures

seborrhoeic- yellow greasy scales on erythematous plaques. commonly on eyebrows, scalp etc

pompholyx- hands and feet (palms and soles). vesiculobullous eruption

varicose, nummular (coin shaped, on legs and trunk) and asteatotic (dry, crazy pairing pattern)

Question 16

investigations for contact dermatitis

Answer 16

skin patch testing

Question 17

what does a skin patch test involve

Answer 17

a disc containing allergens is diluted and applied on the skin for 48 hrs. It is positive if it causes a red raised lesion

Question 18

investigations for atopic eczema

Answer 18

lab levels; IgE levels

Question 19

risk factors for developing atopic eczema

Answer 19

filaggrin gene mutation, age below 5 years.
family Hx of eczema,
allergic rhinitis,
family Hx of atopy (e.g. asthma)

Question 20

treatment (1st line)

Answer 20

emollients: these improve the skin barrier and rehydrate the skin

Question 21

what else might be used in the management/ treatment

Answer 21

corticosteroids and antibiotic therapy

systemic immunosupressants

Question 22

when may UV light therapy be used

Answer 22

resistance to topical corticosteroids

Question 23

prognosis

Answer 23

Many patients with milder disease can be maintained on emollient treatment with intermittent use of other topical agents during flares. Patients with more severe disease often require combination treatment that includes ultraviolet light therapy and systemic immunosuppressants.

Question 24

largest (most common) complication

Answer 24

psychological stress