Eczema Flashcards
What is eczema?
eczema and dermatitis mean the same thing
- is used to describe red, dry, itchy skin which can sometimes become weeping, blistered, crusted and scaly
What are atopic condition?
describes a group of conditions which include asthma, eczema and hay fever
- are linked by increased activity of the allergy component of immune system.
What is skin? What is its role?
made up of three layers
- epidermis = elastic layer constantly regenerated
- dermis = contains sweat glands, hair follicles, sebaceous glands
- subcutaneous tissue = connective tissue and fat
main role is
- protection provides a barrier against mechanical, thermal, physical injury and hazardous substances
- prevents loss of moisture
- protects against UV radiation
- sensory organ (touch, temperature etc).
- helps regulate temperature
What is the cause of eczema?
have no known single cause
- are affected by genetic, immunologic and environmental factors
= is cyclical as it goes through phases of being severe,
then less severe before becoming worse again
are not contagious
What are trigger factors of eczema?
materials
- wool (lanolin)
- synthetic fabrics
hormones
teething
sleep deprivation
food allergies
- cow’s milk
- eggs
- food colourings
inhalant allergens
- house dust mite
- moulds
- pollen
- animal dander
What questions should you ask patients with eczema?
who what are the symptoms how long what actions have been taken any other medications
location first time or recurrent any sign of infection triggers family history
What factors important in eczema development?
initiation to eczema formation
- defect in skin barrier (loss of water and fat)
- penetration of allergens
- abnormal inflammatory or allergy response (IgE released is released - immunoglobin E)
Immunoglobulin E (IgE) are antibodies produced by the immune system - travel to cells that release chemicals, causing an allergic reaction
What are symptoms of eczema?
intense itching
skin appearance - red, inflamed and itchy skin - dry and flaky - undergoing lichentification = characterized by thickening of the skin and exaggerated skin lines change in skin pigmentation - hyper or hypopigmentation
during severe flare ups
- moist
- weepy and crusting around the edges
- small water blisters may develop on hands and feet
- may result in sleep disturbances, tiredness and irritability
What are the locations eczema is found on the body?
children and adults
joints
- elbows
- knees
- neck
- wrists
children:
- cheeks, face
- scalp
In Asian and Afro-Caribbean children, may affect extensor surfaces rather than flexures, discoid patterns may be more common
When should eczema be referred?
- if current management strategy is not controlling flare ups
- adverse reaction to emollients
- signs of infection
- psychological implications
- severe fissures in skin
- differential diagnosis suspected
What are differential diagnosis to eczema?
acne vulgaris – usually appears in adolescence
acne rosacea – butterfly rash in middle age
SLE (lupus) – butterfly rash
ADR – photosensitive rash resembling sunburn
shingles – unilateral rash over scalp and forehead, extending to eye + painful
seborrhoeic eczema – scaly rash + erythema (red rash) affecting scalp and forehead (dandruff, cradle cap)
contact dermatitis – allergens or irritants
psoriasis – individual scaly, silvery plaques especially on knees, elbows, scalp
ringworm
scabies
How can patients exercise self care with eczema?
correct use of emollients recognise early signs of flare ups do not scratch - pat skin, do not rub dry keep nails short avoid triggers eczema support signposting complementary therapies recognise symptoms of infection
What are treatment options for eczema? What products should be avoided?
emollients
- first line
= purpose is to hydrate and soothe the skin
topical corticosteroids
- second line
= purpose is to reduce inflammation, itching and redness
avoid aqueous creams
- contains the ingredient sodium lauryl sulphate (SLS), which can irritate the skin and make eczema worse
How do emollients treat eczema? How should they be used?
apply frequently and liberally several times per day
apply to damp skin (during or after washing)
replace soap with emollient (ointment, lotion or bath additive)
most contain no active ingredients but some do
- urea (keratin softener, hydrating agent) e.g. Balneum® Plus
- lauromacrogols (local anaesthetic properties) e.g. E45® Itch Relief Cream
- lanolin or derivatives e.g. hydrous ung, Oilatum® bath additive
- antiseptic e.g. Dermol ®
may increase risk of skin reactions in some patients
How do topical corticosteroids treat eczema? How should they be used?
are varied in strengths
- mild, moderate, potent and very potent
apply thinly once or twice daily to affected areas only
- may help to apply at night as its less likely to wash off
maximum of 7 days treatment
hydrocortisone 1% cream
clobetasone 0.05% cream
