Eczema

Question 1

Define eczema

Answer 1

dermatitis

terms can be used interchangeably

Question 2

List eczema types

Answer 2

atopic eczema
irritant contact eczema
allergic contact eczema
varicose eczema
stasis/gravitational eczema
asteatotic eczema
discoid
seborrhoeic
lichen simplex

Question 3

Describe pompholyx

Answer 3

itchy bubbles of fluid down sides of fingers

Question 4

Atopic eczema causes

Answer 4

atopic genes

Question 5

Irritant contact eczema causes

Answer 5

irritants

Question 6

Allergic contact eczema causes

Answer 6

contact allergy

Question 7

Varicose eczema causes

Answer 7

varicose veins

Question 8

Gravitational/stasis eczema causes

Answer 8

standing
occupation
wheelchair

Question 9

Seborrhoeic eczema causes

Answer 9

yeast sensitivity

Question 10

Discoid eczema causes

Answer 10

bacteria on skin

Question 11

Lichen simplex causes

Answer 11

eczema
scratch cycle

Question 12

Eczema symptoms

Answer 12

Itch:
- scratch
- bleed
- affected sleep
- concentration loss
- anger

Question 13

What is DLQI?

Answer 13

Dermatology Life Quality Index
effect of dermatological condition on patient’s life

Question 14

Eczema signs

Answer 14

erythema
scale
excoriation (scratch marks)
exudate (weeping)
crusting (scab)
hyperkeratosis (thick skin)
lichenification (increased skin markings due to rubbing)
vesicles (little blisters)

Question 15

What causes erythema?

Answer 15

more blood or more translucent skin

Question 16

What causes scale?

Answer 16

excessive production of epidermis which peels off or stays stuck to the top layer sp becomes thick`

Question 17

What is lichenification?

Answer 17

thickened hyperkeratotic skin due to rubbing with more lines/wrinkles

Question 18

What causes exudate?

Answer 18

fluid oozing which dris to form crust

Question 19

What causes vesicles?

Answer 19

fluid accumulating in epidermis due to inflammation

Question 20

Describe atopic eczema

Answer 20

adult or child
associated with fillagrin gene abnormalities
makes skin ‘leaky’
so things irritate easily
use oil on skin to ‘waterproof’ skin
linked with other atopic diseases (asthma, hayfever, urticaria)

Question 21

List 4 atopic diseases

Answer 21

asthma
hayfever (allergic rhinitis)
eczema
urticaria

Question 22

Difference between cream and ointment?

Answer 22

ointment has more oil than cream

Question 23

What units are used for steroid creams?

Answer 23

fingertip units

Question 24

Mild steroid example

Answer 24

Hydrocortisone 1%

Question 25

Medium steroid example

Answer 25

Eumovate generic name = clobitasone

Question 26

Potent steroid example

Answer 26

Betnovate

Question 27

Very potent steroid example

Answer 27

Dermovate generic name = clobitasol

Question 28

What is asteatotic eczema?

Answer 28

lack of oil more oil removed than produced looks like dry river bed

Question 29

Asteatotic eczema treatment

Answer 29

bathe less often, shorter and cooler use less detergent apply oil to skin

Question 30

Describe irritant contact eczema

Answer 30

many chemicals can irritate skin cells irritation is not the same as allergy (allergy = due to immune process) yellow crust = secondary infection

Question 31

Describe allergic contact eczema

Answer 31

few to 96 hours after contact common causes = nickel, fragrance, rubber accelerators, chromate, formaldehyde, plants investigate with patch tests

Question 32

Describe how to carry out a patch test

Answer 32

apply patches day 1 remove day 3 read days 3 and 5 select batteries according to history and distribution

Question 33

Describe varicose eczema

Answer 33

stasis = gravitational important as commonly breaks down (infection or scratching) to form leg ulcer

Question 34

How is venous stasis treated?

Answer 34

lose weight exercise elevate legs avoid standing/sitting for long periods compression bandages varicose vein surgery

Question 35

Why should you use weaker steroids on occluded areas?

Answer 35

occlusion causes increased penetration of steroid eg. armpits

Question 36

Describe infected eczema

Answer 36

often due to scratching commonly due to staph aureus infection produce yellow crusts and/or blisters of impetigo (impetiginised eczema)

Question 37

Viral causes of infected eczema

Answer 37

Herpes Simplex -causes cold sores Eczema Herpeticum

Question 38

Describe discoid eczema

Answer 38

round/disc-shaped variant of bacterial infected eczema odd pattern often confused with psoriasis - has follicular areas, less well-defined and lacks psoriasis scale antibiotic or antiseptic/steroid combinations needed often co-exists with small areas of follicular eczema

Question 39

Describe pompholyx eczema

Answer 39

little blisters down sides of fingers intensely itchy episodic can be due to allergy or endogenous stronger steroids needed as skin thicker

Question 40

Describe seborrhoeic eczema

Answer 40

due to sensitivity to yeast on skin not due to yeast in diet very common + made worse by stress severe in HIV causes dandruff, rash on eyebrows, nose, nasolabial folds + flexures treat with systemic or topical antifungals +/- corticosteroid creams

Question 41

Eczema general treatments

Answer 41

emollients if dry antiseptic soaks if oozing topical steroids depending on degree of inflammation antibiotic courses if infected or discoid antifungals if seborrhoeic antivirals if herpes bandaging if scratching elevation etc if stasis local PUVA (can reach dermis) oral alitretinoin (if on hands) oral azathioprine, ciclosporin

Question 42

What skin layer can UVA reach?

Answer 42

dermis

Question 43

What skin layer can UVB reach?

Answer 43

epidermis

Question 44

Eczema differential diagnoses

Answer 44

scabies (burrows between fingers, friends/family usually affected) fungal infection hands (often unilateral) psoriasis (can be itchy - different physical signs) drug eruption (take a good history to exclude) rarer diseases (eg. bullous pemphigoid, dermatitis, herpetiformis, mycosis fungoides)

Question 45

Describe fungal (tinea) hand infection

Answer 45

fine silver scale in the creases lack of cracking unilateral take fungal scrapings if unsure

Question 46

What nail changes can occur in psoriasis and discoid eczema?

Answer 46

pitting onycholysis