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Dermatology > Atopic Eczema/Dermatitis > Flashcards

Atopic Eczema/Dermatitis Flashcards

1
Q

what is corenification?

A

loss of the nucleus during differentiation

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2
Q

cardinal feature of eczema?

A

spongiosis
oedema between keratinocytes
inflammatory cell infiltrate

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3
Q

what separates types of eczema?

A

different pathogenic mechanisms

different causes

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4
Q

acute eczema phase?

A

papulovesicular
erythematous lesions
oedema
ooze, scaling and crusting

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5
Q

chronic eczema phase?

A

thickening (lichenification)
elevated plaques
increased scaling

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6
Q

is eczema well defined?

A

no, ill defined

epidermal inflammation

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7
Q

what types of eczema/dermatitis cause spongiotics dermatitis?

A

contact allergic
contact irritant
atopic
photosensitive

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8
Q

what types of eczema/dermatitis cause spongiotic dermatitis and eosinophils?

A

drug related

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9
Q

what is lichen simplex dermatitis?

A

no underlying skin disease
only happens if you scratch the skin enough
causes spongiotic dermatitis and external trauma

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10
Q

what is stasis/venous dermatitis?

A

in people with peripheral oedema

physical trauma to the skin due to hydrostatic pressure causes spongiotic dermatitis and extravasion of RBCs

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11
Q

most common contact allergic dermatitis?

A

nickel

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12
Q

feature of contact allergic dermatitis?

A

often sharp cut off

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13
Q

is weeping eczema acute or chronic?

A

acute

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14
Q

why do vesicles/bullae occur in eczema?

A

acute spongiosis fluid production occurring so rapidly that they form blisters

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15
Q

immunopathology of contact allergic dermatitis?

A

Langerhans cells in epidermis process antigen and then present it to Th cells in dermis
sensitised Th cells migrate into lymphatics and then to regional nodes where antigen presentation is amplified
on next exposure to antigen, sensitised T cells proliferate and migrate to/infiltrate skin causing dermatitis

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16
Q

how is contact allergic dermatitis diagnosed?

A

patch testing

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17
Q

contact allergic vs contact irritant?

A 
allergic = specific immune response
irritant = non-specific physical irritation response (not immune)
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18
Q

if specific, localised reaction with obvious cause (e.g under a ring)?

A

often a contact allergic but could be irritant

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19
Q

can irritant contact dermatitis overlap with allergic contact?

A

yes can also overlap with atopic dermatitis

underlying disease makes irritant reaction more severe

20
Q

what implications can dermatitis have?

A

impact on career choice

21
Q

advise for irritant dermatitis?

A

create a barrier (e.g gloves)

22
Q

give 5 possible effects of hand dermatitis?

A 
erythema
scaling
fissures
lichenification (thickening of skin)
nail dystrophy
crusting
23
Q

what is nappy rash?

A

irritant contact dermatitis to urine

24
Q

how can irritant dermatitis and fungal infection be differentiated?

A

fungal infections tend to favour flexures

dermatitis often has sparing of flexures

25
Q

sign of fillagrin mutation?

A

increased creasing on hands of children which should be smooth

26
Q

what is the cycle of pruritic?

A

itch > more scratching > more itchy > more scratching

27
Q

what are the features of atopic eczema?

A

pruritis
ill defined erythema and scaling with generalised dry skin
seen most in flexures
associated with atopic disease

28
Q

what is fissuring below the ears pathopneumonic of?

A

atopic eczema

29
Q

what does eczema look like in darker skin?

A

papular appearance
extensive lichenification
hypertrophic scarring
ill defined erythema and scale still present but less obvious

30
Q

chronic changes in atopic eczema?

A

lichenification
excoriation
secondary infection

31
Q

common secondary infection in atopic eczema?

A 
staph aureus (golden crusting)
atopic people more likely to carry staph aureus rather than epidermidis
32
Q

what is eczema herpeticum?

A

eczema infected with herpes simplex virus

causes monomorphic, punched out lesions all over body (like cold sores)

33
Q

how is eczema herpeticum treated?

A

a..tivir

34
Q

how is eczema diagnosed?

A

itch plus 3 or more of:

  • flexural rash
  • history of flexural rash
  • personal history of atopy
  • dry skin
  • onset before 2 years old
35
Q

how is eczema treated?

A
  1. emollients
  2. avoid irritants
  3. topical steroids
  4. treat infection
  5. phototherapy (UVB)
  6. immunosuppresants (azathioprine)
  7. biologic agents
36
Q

what causes atopic eczema?

A

impaired skin barrier function
environmental factors
immunology
possible fillagrin mutation

37
Q

what is discoid eczema?

A

well defined, circular lesions
often get infected
patients are often atopic

38
Q

features of photosensitive eczema?

A

chronic actinic dermatitis
clear cut off seen at border of eczema (e.g at collar, sleeves etc)
can also be caused by photosensitising drugs

39
Q

what causes stasis eczema and what does it look like?

A 
erythema around varicose veins
hydrostatic pressure
oedema
red cell excavation
often at ankles
40
Q

what is seborrheic dermatitis?

A

“cradle cap”

atopic eczema on scalp with co-infection with fungus

41
Q

pompholyx eczema?

A

sudden acute flare of any subtype of eczema with little vesicles (spongiotic)

42
Q

what causes lichen simplex?

A

normal skin
thickening and lesions caused by scratching
treated with topical steroids

43
Q

how do you differentiate between allergic and irritant contact dermatitis?

A

occupational, family and social history

patch testing

44
Q

is pompholyx acute or chronic?

A

acute

45
Q

can herpes simplex and staph aureus occur together?

A

yes

punched out lesions with golden crusting

Dermatology (38 decks)

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