Atopic Eczema

Question 1

when does atopic eczema typically start

Answer 1

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

Question 2

pathophysiology of eczema

Answer 2

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

Question 3

what immune cell drives atopic eczema

Answer 3

TH2 cells

Question 4

sites affected in infants

Answer 4

face + extensors

Question 5

sites affected in older children

Answer 5

flexor surfaces - antecubital + popliteal fossae - writs + ankles

Question 6

features of atopic eczema

Answer 6

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

Question 7

what is the atopic march?

Answer 7

eczema + asthma + hay fever

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

Question 8

what is lichenification

Answer 8

thickening of epidermis due to chronic scratching

• exaggerated skin creases

Question 9

most common cause of infective eczema

Answer 9

staph aureus

Question 10

golden crusted lesions, typically around mouth

Answer 10

impetigo

• staph aureus infection

Question 11

treatment of localised impetigo

Answer 11

topical fusidic acid

Question 12

treatment of extensive impegito

Answer 12

oral flucloxacillin

• erythromycin if penicillin allergic

Question 13

what is the cardinal symptom of eczema

Answer 13

itch

Question 14

what is filaggrin?

where is it found?

Answer 14

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

Question 15

what is ichthyosis vulgaris

Answer 15

dry skin condition caused by fiaggrin deficiency

• predisposes to atopy: eczema/asthma/hayfever

Question 16

clinical signs of ichthyosis vulgaris

Answer 16

dry fish scale skin

hyperlinear palms

Question 17

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

What condition?

Answer 17

eczema herpeticum

Question 18

what causes eczema herpeticum

Answer 18

infection of eczematous skin by HSV 1 or HSV 2

Question 19

treatment eczema herpeticum

Answer 19

Oral aciclovir / IV if unable to take oral

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

Question 20

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

Answer 20

history of worsening eczema + type 1 reactions / GI upset

Question 21

how to you test for type 1 allergic reactions

Answer 21

Specific IgE (RAST) testing

skin prick testing

Question 22

what type of hypersensitivty reaction is atopic eczema

Answer 22

type 4 delayed hypersensitivity

Question 23

difference between a cream and an ointment

Answer 23

cream = water based

ointment = oil based

Question 24

treatment of atopic eczema

Answer 24

avoid allergens/irritants

emollients

topical steroids

soap substitutes

Question 25

name steroid ladder from mild to very potent

Answer 25

hydrocortisone = mild eumovate = moderate (clobetasone) betnovate = potent (betamethasone) dermovate = very potent (clobetasol)

Question 26

side effects of topical steroids

Answer 26

skin thinning - striae steroid induced acne telangectasia increased skin infections

Question 27

treatment of flare of eczema

Answer 27

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

Question 28

mode of action topical steroids

Answer 28

anti-inflammatory vasoconstrictive anti-proliferative

Question 29

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

Answer 29

calcineurin inhibitors e.g tacrolimus - anti-inflammatory agents without steroid side effects

Question 30

name of calcineurin inhibitor used on face only

Answer 30

pimecrolimus

Question 31

what are bandages impregnated with in treatment of eczema

Answer 31

cotton bandages impregnanted with zinc oxide

Question 32

what age are anti-histamines contraindicated in

Answer 32

under 6 months due to increased risk of cot death

Question 33

what is in: - fucidin - fucibet - fucidin H

Answer 33

fucidin - fusicid acid fucibet - fusidic acid + betnovate fucidin H - fusicid acid + hydrocortisone use for infected eczema flares (staph aureus) for max 5-10 days

Question 34

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

Answer 34

azathioprine methotrexate cyclosporin