Dermatitis / Eczema

Question 1

what is seen on a biopsy of dermatitis

Answer 1

spongiosis and inflammatory cell infiltrate

Question 2

4 hallmark symptoms of eczema

Answer 2

itchy
erythematous
ill defined
scaly

Question 3

symptoms of acute eczema

Answer 3

vesicles
erythematous
oedema and weeping
ooze, scale, crust

Question 4

symptoms of chronic eczema

Answer 4

lichenification
excoriations
elevated plaques
increased scaling

Question 5

There are many different subtypes of eczema / dermatitis, true or false

Answer 5

true

Question 6

What type of hypersensitivity is contact allergic dermatitis (CAD)

Answer 6

type 4 - T cell mediated

delayed

Question 7

examples of allergens in CAD

Answer 7

nickel, creams, plants, latex, fragrance…

Question 8

what investigation can be done for CAD and what is involved

Answer 8

patch testing
patches with different chemicals are placed on the patients back and removed after 48 hours
Check for results after 96 hours

Question 9

what is irritant contact dermatitis (ICD)

Answer 9

non-specific physical irritation rather than an allergy

Question 10

CAD and ICD are hard to differentiate, true or false

Answer 10

true

Question 11

examples of irritants in ICD

Answer 11

soap, urine, water, cleaning products, chemicals, detergents

Question 12

in a nappy rash and ICD, there is flexural involvement, true or false

Answer 12

false, there is flexural sparing

involvement of flexures would suggest a fungal infection

Question 13

what is the pathology behind atopic eczema

Answer 13

filaggrin mutation

Question 14

symptoms of atopic eczema

Answer 14

itch 
dry skin 
scaly 
erythema
poorly defined edges
impaired QoL

Question 15

eczema commonly affects the flexures/extensors?

Answer 15

flexures

cubital fossae, behind knees, earlobes, ankles, wrists

Question 16

what is pompholyx

Answer 16

acute eczema that is weeping

Question 17

what is eczema herpeticum and what does it look like

Answer 17

HSV infection on top of eczema
monomorphic punched out lesions
emergency

Question 18

management of atopic eczema

Answer 18

education 
topical: emollients, steroids 
phototherapy 
immunosuppressants 
biologics

Question 19

what is lichen simplex

Answer 19

dry scaly itchy skin from repetitive itching

Question 20

what is discoid eczema

Answer 20

well defined circumscribed areas of dry skin

Question 21

what is asteatotic eczema

Answer 21

very dry skin seen in the elderly

especially in winter

Question 22

what is photosensitive eczema

Answer 22

chronic actinic dermatitis

seen in sun exposed areas

Question 23

what is stasis eczema

Answer 23

results from poor venous drainage

Question 24

what is seborrhoeic dermatitis

Answer 24

flaky skin seen on the scalp, nasal ridges due to infection with malassezia yeast
can be confused for dandruff

Question 25

what are different causes of itch

Answer 25

pruritoceptive neuropathic neurogenic psychogenic

Question 26

what is pruritoceptive itch

Answer 26

inflammation / dryness in the skin causing an itch

Question 27

what is neuropathic itch

Answer 27

damage to central or peripheral nerves causing itch

Question 28

what is neurogenic itch

Answer 28

CNS itself is not damaged but CNS receptors mediate itch

Question 29

what is psychogenic itch

Answer 29

no physical damage | psychological causes e.g. delusion of infestation

Question 30

management of pruritis

Answer 30

antihistamines emollients phototherapy antidepressants

Question 31

what is the atopy triad

Answer 31

eczema asthma hayfever

Question 32

what is the cardinal symptom of eczema

Answer 32

itch

Question 33

what is ichthyosis vulgaris

Answer 33

extremely dry skin - fish scale filaggrin deficiency has a strong association with atopic eczema

Question 34

exacerbating factors of atopic eczema

Answer 34

``` irritants xerosis heat --> sweat infection stress diet - milk and egg allergy in infants scratching inhalant agents ```

Question 35

how much skin area does 1 FTU of steroid cover

Answer 35

2 hands

Question 36

what steroid sparing agents can be used instead of topical steroids

Answer 36

tacrolimus / protopic

Question 37

antihistamines are contraindicated in under 6 month olds, true or false

Answer 37

true - cot death