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Flashcards in Dermatitis Deck (91):

What is dermatitis? 

Dermatitis, also known as eczema, is a group of diseases that result in inflammation of the skin 


What is dermatitis characterised by? 

  • Itchiness
  • Red skin 
  • Rash 



How much of the skin is affected in dermatitis? 

Can range from a small amount to the whole body 


What are the types of dermatitis? 

  • Atopic dermatitis 
  • Allergic contact dermatitis 
  • Irritant contact dermatitis 
  • Stasis dermatitis 



What is atopic dermatitis? 

An inflammation of the skin, that tends to flare up from time to time. It can range from mild to severe 


When does atopic dermatitis usually start? 

In early childhood 


What proportion of children with atopic dermatitis grow out of it by their mid teens? 

About 2/3 


What causes atopic dermatitis? 

The exact cause is unknown, although there is some evidence of genetic, environmental, and immunologic factors 


What suggest a genetic component to atopic dermatitis? 

  • Most people with atopic dermatitis have a family history of atopy
  • About 30% of people with atopic dermatitis have a mutation in the gene for the production of filaggrin 



What is the role of filaggrin? 

It plays an important role in keeping the skin surface slightly acidic, hence giving it anti-microbial effects 


What environmental factors may be involved in atopic dermatitis? 

  • Hygiene hypothesis 
  • Sensitisation to foods 
  • Consumption of hard water



What is the hygiene hypothesis? 

A theory that children who are raised in a sanitary environment are more likely to develop allergies - there is some support for this theory with regard to atopic dermatitis 




What are the symptoms of atopic dermatitis? 

  • Dry skin 
  • Some areas of the skin become red and inflamed. The inflamed skin is itchy, and may become blistered and weepy 



What areas of skin are most commonly affected in atopic dermatitis? 

The areas next to skin creases, such as the front of the elbows and wrists, backs of knees, and around the neck, however any area of skin might be affected 


What typically happens to inflamed areas of skin in atopic dermatitis? 

They tend to flare up from time to time, and then settle down 


How do flare-ups of atopic dermatitis vary? 

The severity and duration of flare-ups varies from person to person, and from time to time in the same person


What might a flare-up cause in mild cases? 

One or two small patches of inflammation 


What might a flare-up cause in severe cases? 

Inflammation covering many areas of skin that lasts for several weeks or more 


On what basis is atopic dermatitis diagnosed? 



What are the UK diagnostic criteria of atopic dermatitis? 

The person must have itchy skin, or evidence of rubbing/scratching, plus 3 or more of; 

  • Involvement of skin creases
  • History of asthma or allergic rhinitis 
  • Symptoms began before age 2 (if patient >4 years old)
  • History of dry skin (within past year) 
  • Dermatitis visible on flexural surfaces (patient >4), or on cheeks, forehead, and extensor surfaces (patients <4) 


How often should you assess atopic dermatitis? 

At every consultation 


Why is it important to assess atopic dermatitis at every consultation? 

In order to determine the most approrpiate treatment 


How should assessment of severity of atopic dermatitis be done? 

Examine all areas of affected skin, and ask about itching 


What can dermatitis be categorised as, based on severity?

  • Clear
  • Mild 
  • Moderate
  • Severe
  • Infected



What is classified as clear in atopic dermatitis? 

Normal skin, no evidence of acute dermatitis 



What is classified as mild in atopic dermatitis? 

Areas of dry skin, and infrequent itching (with or without small areas of redness)



What is classified as moderate in atopic dermatitis? 

Areas of dry skin, frequent itching, and redness



What is classified as severe in atopic dermatitis? 

Widespread areas of dry skin, incessant itching, redness, may be extensive skin thickening, bleeding, oozing, cracking, and alteration of pigmentation 



What is classified as infected in atopic dermatitis? 

Weeping, crusted, pustules, fever, malaise 


How is mild atopic dermatitis managed? 

  • Prescribe generous amounts of emollients, and advise frequent and liberal use 
  • Consider prescribing a mild topical corticosteroid (such as hydrocortisone 1%) for areas of red skin. Treatment should be continued for 48 hours after flare has been controlled
  • Give appropriate information and advice 



What information and advice should be given to patients with mild atopic dermatitis? 

  • How to maintain skin and reduce risk of flares
  • Self care advice 
  • Avoid trigger factors a=


What are the potential trigger factors of atopic dermatitis? 

  • Soaps and detergents
  • Animals 
  • Heat
  •  Synthetic fibres
  • House-dust mits
  • Stess and habit scratching 
  • Pregnancy and pre-menstural hormone changes 



How is a current flare of moderate atopic dermatitis managed? 

  • Consider possibility of trigger factors or infection, which can precipitate or worsen a flare 
  • Prescribe a general amount of emollients, and advise frequent and liberal use 
  • If the skin is inflamed, prescribe a moderately potent topical corticosteroid, for example betamethasome valerate 0.025% to be used on inflamed areas. Treatment should be continued for 48 hours after falre has improved
  • If severe itch or urticarial, consider prescribing one month trial of non-sedating antihistamine 



What should preventative treatment be prescribed based on in moderate atopic dermatitis? 

The usual severity of the condition between flares


What is the first line option in the prevention of future flares in moderate atopic dermatitis? 

A maintenance regime of topical corticosteroids to control areas of skin prone to frequent flares (not recommended for face, genitals, or axilla) 


What is the second line option in the prevention of future flares in moderate atopic dermatitis? 

Topical calcinneurin inhibitors 


What does optimal follow-up time depend on in moderate atopic dermatitis? 

A number of factors, such as severity of condition, treatment the person is receiving, and their health/age


How often should emollient use be reviewed in moderate atopic dermatitis? 

Annual basis 


What is the purpose of annual review of emollient use in moderate atopic dermatitis? 

Ensure optimal usage


How often should topical corticosteroid use be reviewed in moderate atopic dermatitis? 

Regular review if there is heavy useage, however this is unlikely to be necessary with moderate dermatitis 


How often should the use of non-sedating antihistamines be reviewed in moderate atopic dermatitis? 

Every 3 months 


How is severe atopic dermatitis management? 

  • Treatment largely the same as for moderate flare, except use a more potent topical corticosteroid on inflamed areas, such as betamethasone valerate 0.1%
  • If itching is severe and affecting sleep, consider prescribing short course (maximum 2 weeks) of sedating antihistamine 
  • If there is severe, extensive dermatitis causing psychological distress, consider prescribing short course of oral corticosteroid



What needs to be done in all people who have had a severe and extensive flare requiring treatment with oral corticosteroids or oral antibiotics? 

Need reviewing after course is finished, and consider the need for referral


How is currently infected dermatitis managed when there is extensive areas of infected eczema? 

Swab the skin and prescribe an oral antibiotic 


What is the first line oral antibiotic in the treatment of extensive infected dermatitis? 



What oral antibiotic is prescribed in extensive infected dermatitis if flucoxacillin is contraindicated (e.g. penicillin allergy) or if there is known resistance? 



What oral antibiotic is prescribed in extensive infected dermatitis if the person has been unable to tolerate erythromycin? 



What should be done in extensive infected dermatitis if the first line antibiotic is ineffective? 

Prescribe an alternative


How is currently infected dermatitis that is localised managed? 

Topical antibiotics 


How long should topical antibiotics be used for in infected eczema? 

No longer than 2 weeks 


How are future occurences of infected dermatitis prevented? 

  • Prescribe new supplies of topical products for use after infection as cleared, and advise the person to discard old products
  • Consider the use of topical antiseptic preparation as an adjunct to standard treatment to reduce bacterial load in areas prone to infection 



What is contact dermatitis? 

An inflammatory skin reaction in response to an external stimulus, acting as either an allergen or an irritant 


What are the types of contact dermatitis? 

  • Allergic contact dermatitis 
  • Irritant contact dermatitis 



What is allergic contact dermatitis? 

A type IV delayed hypersensitivity reaction that occurs after sensitisation and subsequent re-exposure to an allergen 


What is irritant contact dermatitis? 

An inflammatory response that occurs after damage to the skin, usually by chemicals 


Is irritant contact dermatitis an allergy? 

No, it can occur in any individual significantly exposed to an irritant 


Is irritant contact dermatitis acute or chronic? 

Can be either


What can the insults causing contact dermatitis be classified into? 

Chemical, biological, or physical 


How can contact with allergens arise? 

  • Immersion
  • Direct handling of contaminated substances
  • From workbenches, tools, or clothing
  • Splashing
  • Dust from air 



Give some common irritants 

  • Water, especially if hard, chalky, or heavily chlorinated 
  • Detergents and soaps
  • Solvents and abrasives
  • Machining oils
  • Acids and alkalis, including cement
  • Reducing agents and oxidising agents
  • Powders, dust, and soil
  • Some plants



Give some common allergens

  • Cosmetics
  • Metals, particularly nickel and coblat in jewellery and chromate in cement
  • Topical medications
  • Rubber additives
  • Textiles
  • Epoxy resin adhesives
  • Plants



What symptoms do both irritant and allergic contact dermatitis present with? 

  • Redness
  • Vesicles or papules on affected area
  • Crusting and scaling of skin
    Itching of affected area
  • Pain or burning sensation from affected area



What features may arise in contact dermatitis with chronic exposure? 

  • Fissures
  • Hyperpigmentation 



What are the predominant featues of irritant contact dermatitis? 

  • Burning
  • Stinging
  • Soreness



What are the predominant features of allergic contact dermatitis? 

  • Redness
  • Itching 
  • Scaling


Describe the onset of irritant contact dermatitis? 

Within 48 hours, may be immediate 


Describe the onset of allergic contact dermatitis? 

Delayed onset 


Describe the location of the rash in irritant contact dermatitis

Rash only in areas of skin exposed to irritant 


Describe the location of the rash in allergic contact dermatitis 

Rash may be in areas which have not been in contact with the allergen 


Describe the resolution of the rash in irritant contact dermatitis?

Resolution occurs quickly after removal of irritant, typically within 4 days 


Describe the resolution of allergic contact dermatitis

Resolution may take longer than irritant contact dermatitis, with or without treatment 


What is irritant contact dermatitis commonly associated with? 

Atopic eczema


What makes a diagnosis of irritant contact dermatitis more likely? 

Exposure to friction, soap, detergents, solvents, or wet work 


What is the clinical relevance of the presentation and pattern of skin change in contact dermatitis?

It may give some indication of the likely irritant 


What area of the body is most commonly affected with direct contact? 



Where might chemicals on clothing cause contact dermatitis? 

  • Axillae
  • Groin
  • Feet



Where are dust irritants most likely to cause contact dermatitis? 

Areas where dust might collect, such as collar line, belt line, sock line, or in flexural areas


Where are irritants in vapour/mist most likely to affect? 

The face and neck 


What investigations are done into contact dermatitis? 

In many cases, no investigations will be required, and diagnosis is made based on clinical findings and history. 

Some patients may require referral to a specialist clinic for patch testing 


What are the indications for referral to a specialist clinic for patch testing in contact dermatitis? 

  • Severe or recurrent distressing symptoms despite adequate treatment with topical corticosteroids
  • Suspicion of contact dermatitis without clear history of exposure 


What are the differential diagnoses of contact dermatitis? 

  • Atopic dermatitis 
  • Seborrhoiec dermatitis
  • Ringworm
  • Urticaria
  • Psoriasis
  • Acute infections, such as cellulitis, impetigo, shingles, and chickenpox



What is the most effective form of management of contact dermatitis? 

Avoid the irritant producing the dermatitis, when it has been identified. 


When might avoidance of the irritant producing the contact dermatitis be the only treatment required? 

In milder cases of recent origin


How long will it take for dermatitis after removal of the irritant in milder cases of recent origin? 

Approximately 3 weeks 


When can simple emollients be used in the management of contact dermatitis? 

When the skin barrier has not been breached 


When will contact dermatitis require medication? 

In more severe or chronic cases 


What medication is used in contact dermatitis? 

Topical corticosteroid cream, or a short course of oral corticosteroid for acute, severe episodes


What is the strength and period of use of corticosteroid cream in contact dermatitis adjusted based on? 

The severity of the condition 


What are the second line options for use in contact dermatitis? 

  • PUVA treatment
  • Ciclosporin
  • Azathioprine

These are used for chronic, steroid-resistant dermatitis


What are the complications of contact dermatitis? 

Secondary bacterial infection


How does a secondary bacterial infection in contact dermatitis present? 

As worsening of the skin condition, or as typical impetigo