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Year 4: Dermatology > Atopic Eczema > Flashcards

Atopic Eczema Flashcards

1
Q

when does atopic eczema typically start

A

80% of cases start in early infancy - affects 1 in 5 children

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2
Q

pathophysiology of eczema

A

epidermal barrier dysfunction – associated with filaggrin deficiency - poor skin barrier function - loss of water + allergens/irritants get in

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3
Q

what immune cell drives atopic eczema

A

TH2 cells

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4
Q

sites affected in infants

A

face + extensors

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5
Q

sites affected in older children

A

flexor surfaces - antecubital + popliteal fossae - writs + ankles

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6
Q

features of atopic eczema

A

dry, erythematous skin itchy - excoriations poorly defined borders in severe cases there may be oozing/blisters/bleeding

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7
Q

what is the atopic march?

A

eczema + asthma + hay fever

  • eczema starts in infancy
  • asthma starts after age of 2
  • hayfever starts later, after 7 years
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8
Q

what is lichenification

A

thickening of epidermis due to chronic scratching

  • exaggerated skin creases
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9
Q

most common cause of infective eczema

A

staph aureus

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10
Q

golden crusted lesions, typically around mouth

A

impetigo

  • staph aureus infection
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11
Q

treatment of localised impetigo

A

topical fusidic acid

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12
Q

treatment of extensive impegito

A

oral flucloxacillin

  • erythromycin if penicillin allergic
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13
Q

what is the cardinal symptom of eczema

A

itch

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14
Q

what is filaggrin?

where is it found?

A

a protein present in keratohyalin granules in the granular layer of epidermis

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15
Q

what is ichthyosis vulgaris

A

dry skin condition caused by fiaggrin deficiency

  • predisposes to atopy: eczema/asthma/hayfever
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16
Q

clinical signs of ichthyosis vulgaris

A

dry fish scale skin

hyperlinear palms

17
Q

sudden onset, painful, monomorphic blisters that leave ‘punched out’ erosions.

What condition?

A

eczema herpeticum

18
Q

what causes eczema herpeticum

A

infection of eczematous skin by HSV 1 or HSV 2

19
Q

treatment eczema herpeticum

A

Oral aciclovir / IV if unable to take oral

  • emergency as can affect multiple organs, including encephalitis, and be fatal
20
Q

what features may make you think of food allergy in infant with eczema?

A

history of worsening eczema + type 1 reactions / GI upset

21
Q

how to you test for type 1 allergic reactions

A

Specific IgE (RAST) testing

skin prick testing

22
Q

what type of hypersensitivty reaction is atopic eczema

A

type 4 delayed hypersensitivity

23
Q

difference between a cream and an ointment

A

cream = water based

ointment = oil based

24
Q

treatment of atopic eczema

A

avoid allergens/irritants

emollients

topical steroids

soap substitutes

25
Q

name steroid ladder from mild to very potent

A

hydrocortisone = mild

eumovate = moderate (clobetasone)

betnovate = potent (betamethasone)

dermovate = very potent (clobetasol)

26
Q

side effects of topical steroids

A

skin thinning - striae

steroid induced acne

telangectasia

increased skin infections

27
Q

treatment of flare of eczema

A

continue with emollient application 3-4 times daily

topical steroids - apply once a day to inflammed area for 1-2 weeks

  • potency of steroid should match severity of flare
  • use mild steroids for delicate areas e.g. face/genitals
28
Q

mode of action topical steroids

A

anti-inflammatory

vasoconstrictive

anti-proliferative

29
Q

second line therapy for severe eczema / high dependance on steroids for maintenance

A

calcineurin inhibitors e.g tacrolimus

  • anti-inflammatory agents without steroid side effects
30
Q

name of calcineurin inhibitor used on face only

A

pimecrolimus

31
Q

what are bandages impregnated with in treatment of eczema

A

cotton bandages impregnanted with zinc oxide

32
Q

what age are anti-histamines contraindicated in

A

under 6 months due to increased risk of cot death

33
Q

what is in:

  • fucidin
  • fucibet
  • fucidin H
A

fucidin - fusicid acid

fucibet - fusidic acid + betnovate

fucidin H - fusicid acid + hydrocortisone

use for infected eczema flares (staph aureus) for max 5-10 days

34
Q

what systemic agents can be used as last resort in very severe atopic eczema

A

azathioprine

methotrexate

cyclosporin

Year 4: Dermatology (17 decks)

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