Eczema

Question 1

Where is the most common place for atopic eczema to appear in a newborn baby/infants?

Answer 1

On their cheeks

Question 2

According to NICE, atopic eczema should be diagnosed when a child has an itchy skin condition plus 3 other features. What are the possible other features?

Answer 2

1. Visible flexural dermatitis (of the skin creases) - elbows and knees
2. Personal Hx of flexural dermatitis (or cheeks and/or extensor surfaces in infants up to 18m)
3. Personal Hx of dry skin in the last 12m
4. Personal Hx of asthma or allergic rhinitis
5. Onset of Sx under the age of 2

Question 3

In children of Asian, Black Caribbean and Black African heritage, how can atopic eczema differ in its presentation?

Answer 3

It can be on the extensor surfaces of the skin and in a discoid or follicular pattern

Question 4

What tools can we use to categorise the severity of atopic dermatitis in children?

Answer 4

1. Visual analogue scale
2. Sleep loss due to itching over the last 3 days and nights
3. Patient-Oriented Eczema Measure (POEM)
4. Children’s Dermatology Life Quality Index (CDLQI)
5. Infant’s Dermatitis Quality of Life Index (IDQLI)
6. Dermatitis Family Impact (DFI) questionnaire

Question 5

Name the 5 endogenous (constitutional) types of eczema

Answer 5

1. Discoid eczema
2. Atopic eczema
3. Seborrhoeic dermatitis
4. Varicose Eczema
5. Pompholyx eczema

Question 6

Name the 3 exogenous (contact) causes of eczema

Answer 6

1. Irritant
2. Allergic
3. Photodermatitis

Question 7

How might an acute allergic eczema present?

Answer 7

Intensely itchy area of skin which can result in erythema, oedema and vesicles/bullae

Question 8

What is eczema herpeticum?

Answer 8

An area of virally infected atopic eczema that needs treatment

Question 9

What are the signs of eczema herpeticum?

Answer 9

1. Areas of rapidly worsening and painful eczema
2. Clustered vesicles/bullae that are consistent with early stage cold sores
3. Punched out erosions (circular, depressed, ulcerated lesions) 1-3mm that are uniform
4. Possible fever, lethargy or distress

Question 10

What is another name for eczema?

Answer 10

Dermatitis

Question 11

How would you treat; widespread bacterial infection and for how long?

Answer 11

Systemic Abx that are active against S.Aureus and Streptococcus for 1-2 weeks

Question 12

How would you treat; Localised clinical infection?

Answer 12

Topical antibiotics with combined corticosteroids

Question 13

How would you treat; a S.aureus and Strep infection as a first-line?

Answer 13

Flucloxacillin

Question 14

How would you treat; a S.aureus and Strep infection as a first-line if they are penicillin allergic or the infection is penicillin resistant?

Answer 14

Erythromycin

Question 15

How would you treat; a S.aureus and Strep infection as a first-line if they are intolerant to penicillins and erythromycin?

Answer 15

Clarithromycin

Question 16

What 2 organisms can infect atopic eczema?

Answer 16

Bacteria and viruses

Question 17

What is the name of a viral infected eczema?

Answer 17

Eczema herpeticum

Question 18

What are the possible complications of eczema herpeticum if left untreated?

Answer 18

1. Pneumonitis
2. Hepatitis
3. Encephalitis

Question 19

How do emollients work?

Answer 19

They improve the barrier function of the skin and reduced the trans-epiermal water loss

Question 20

Place creams, lotions and ointments in order of water content, from most water content to least.

Answer 20

1. Lotion
2. Creams
3. Ointment

Question 21

How often, as a minimum, should emollients be applied to the skin in someone with atopic eczema?

Answer 21

3 times a day

Question 22

What are second line treatments (after emollient therapy) that can be used in patients with atopic eczema?

Answer 22

• Topical corticosteroids OR

- Calcineurin inhibitors (tacrolimus and pimecrolimus)