Eczema Flashcards
(78 cards)
1
Q
What is eczema?
A
A group of skin conditions characterized by dry skin that is red and scaly.
Usually refers to atopic dermatitis, but includes other forms.
2
Q
What are the different forms of eczema?
A
- Allergic contact dermatitis
- Irritant dermatitis
- Stasis dermatitis
- Dishydrotic/pompholyx dermatitis
- Discoid/nummular dermatitis
- Seborrhoeic dermatitis
Each form has distinct triggers and characteristics.
3
Q
What is the prevalence of atopic dermatitis in children and adults?
A
1:5 children, 1:10 adults.
Indicates a significant burden of the condition.
4
Q
What percentage of children and adults experience interrupted sleep due to eczema?
A
86% of kids, 84% of adults.
Sleep disruption can impact overall health and quality of life.
5
Q
What percentage of adults report depression related to eczema in the last two years?
A
43%.
Highlights the psychological impact of the condition.
6
Q
How does eczema present in infants and toddlers?
A
- More often acute
- Mainly located on face and extensor surfaces of limbs
- Trunk may be affected but nappy area usually spared
Clinical presentation varies by age group.
7
Q
What skin manifestations are seen in children and adolescents with eczema?
A
Polymorphous manifestations of different types of skin lesions, particularly in flexural folds.
Flexural folds are areas like the elbows and knees.
8
Q
What are the characteristics of eczema in adults?
A
- Lichenified and excoriated plaques in flexures
- Involvement of head, neck, upper trunk, shoulders, and scalp
- May present with hand eczema or prurigo-like lesions
Adults often have different patterns compared to younger age groups.
9
Q
What are some differential diagnoses for eczema in infants and toddlers?
A
- Atopic dermatitis
- Seborrhoeic dermatitis
- Ichthyosis vulgaris
- Scabies
- Psoriasis
- Phenylketonuria
- Ectodermal dysplasia
- Syndromic ichthyoses
- Coeliac disease
Important to differentiate from other skin conditions.
10
Q
What conditions should be considered for children and adolescents with eczema?
A
- Tinea mannum or tinea pedis
- Impetigo
- Pityriasis rosea
Conditions may overlap with eczema symptoms.
11
Q
What are the DDx of eczema in adults?
A
- Atopic dermatitis
- Allergic contact dermatitis
- Seborrhoeic dermatitis
- Asteatotic dermatitis
- Psoriasis
- Pityriasis rosea
- Cutaneous T-cell lymphoma
- Pityriasis rubra pilaris
Adult presentations can be more complex.
12
Q
What types of atopic dermatitis exist?
A
- Non-lesional
- Acute
- Sub-acute
- Chronic
Each type has distinct clinical features.
13
Q
What are the typical characteristics of chronic atopic dermatitis?
A
Dry, often lichenified patches.
Chronic forms can lead to significant skin changes.
14
Q
What are the characteristics of eczema in darker skin types?
A
- Perifollicular/extensor distribution
- Absence of erythema
- Lichenification
- Hypo/hyperpigmentation
Darker skin types may show different symptoms than lighter skin types.
15
Q
What are the essential features that must be present for a diagnosis of eczema?
A
- Pruritis
- Eczema (acute, subacute, chronic)
- Chronic or relapsing Hx
Typical morphology and age-related patterns are also considered.
16
Q
What are the important features that support the diagnosis of eczema?
A
- Early age of onset
- Atopy (personal and/or FHx, raised IgE levels)
- Xerosis
Atopy refers to the genetic tendency to develop allergic diseases.
17
Q
What are the associated features that suggest a diagnosis of eczema but are too non-specific?
A
- Atypical vascular responses (facial pallor, white dermatographism)
- Keratosis pilaris
- Pityriasis alba
- Hyperlinear palms
- Ichthyosis
- Ocular or periorbital changes
- Perioral or periauricular lesions
- Perifollicular accentuation or lichenification, prurigo lesions
These features are commonly seen but not definitive for eczema.
18
Q
What conditions must be excluded for a diagnosis of eczema?
A
- Scabies
- Seborrhoeic dermatitis
- Contact dermatitis (irritant or allergic)
- Ichthyoses
- Cutaneous T-cell lymphoma
- Psoriasis
- Photosensitivity dermatoses
- Immune deficiency diseases
- Erythema of other causes
Exclusionary conditions are critical to confirm a diagnosis of eczema.
19
Q
What are the characteristics of normal skin allowing it to function as a barrier maintaining skin integrity?
A
- Provides a defensive barrier against irritants, allergens, and pathogens
- Tightly packed keratinocytes form a natural barrier
- Natural immunological defense mechanisms keep allergens contained
Healthy skin functions as a barrier to maintain overall skin integrity.
20
Q
What characterizes dermatitis?
A
- Itchy, inflamed skin
- Loss of water and lipids
- Keratinocytes are less tightly held together
This results in easier penetration of irritants and more rapid dehydration.
21
Q
What are some complications associated with eczema?
A
- Other atopic conditions (allergic rhinitis, asthma)
- Increased risk of allergic contact dermatitis and food allergy
- Impact on growth and development
- Mental health problems
- Sleep disturbance
- Superinfection
Complications can significantly affect quality of life and overall health.
22
Q
What are the key components of the presenting complaint in a dermatological assessment?
A
- Age of onset
- Description of rash
- Symptoms
- Distribution
- Relapsing/remitting or persistent
- Worst affected areas
- Provoking or aggravating factors
- Topical CS use
- Parent understanding of treatment escalation
CS refers to corticosteroids
23
Q
What should be included in the past medical history (PMHx) during a dermatological assessment?
A
- Birth/feeding history
- Any other atopic symptoms
- Hospital admissions
- Other diagnoses
Atopic symptoms may include eczema, asthma, or allergic rhinitis.
24
Q
What should be documented regarding current medication (Rx) use in a dermatological assessment?
A
- Any regular medication use, including antihistamines
- Any recent courses of antibiotics, antivirals, or oral steroids prescribed by the GP
- Current skin regimen
GP refers to general practitioner.
25
What allergy-related information should be gathered during a dermatological assessment?
* Medication allergies (unlikely cause)
* Any concerns around food allergies (including inappropriate dietary exclusions)
## Footnote
Dietary exclusions may affect nutritional status.
26
What aspects of family history (FHx) are relevant in a dermatological assessment?
Any first-degree relatives with atopic dermatitis or other atopic disease.
27
What social history (Hx) factors should be considered in a dermatological assessment?
* Attendance at crèche/playschool/school/work
* Sleep disturbance
* Sleeping arrangements
* Sleeping environment
* Any pets
28
What specific characteristics should be examined in rashes during a dermatological exam?
* Distribution
* Colour
* Surface texture
## Footnote
These characteristics help determine the cause and appropriate treatment.
29
What are the signs indicating a rash that requires urgent identification and treatment?
A rash that appears suddenly, spreads rapidly, and extends all over the body.
30
What should be ensured during a dermatological examination?
* Conducive environment
* Examine all of the skin
* Observe distribution
* Check morphology
* Check for suspicion of superinfection
* Use Woods light to assist diagnosis
## Footnote
Woods light can help identify specific skin conditions.
31
What are the key features of atopic dermatitis?
* Erythematous, xerotic, and scaly skin
* Acute eczema may be oozing, exudative, and crusted
* Blistering or small intact vesicles may be present
* Chronic patches become raised and lichenified
* Evidence of excoriation is common
* Skin may become fissured
32
What are the two proposed models contributing to the pathogenesis of atopic dermatitis?
* 'Outside-In' model
* 'Inside-Out' model
## Footnote
Both models suggest different mechanisms that contribute to the condition.
33
What are the major criteria according to the Hanifin and Rajka criteria for diagnosing atopic dermatitis?
* Pruritis
* Dermatitis affecting flexural surfaces in adults or face and extensor surfaces in infants
* Chronic or relapsing dermatitis
* Personal or family history of cutaneous or respiratory allergy
## Footnote
At least three major criteria must be present for diagnosis.
34
What are the minor criteria according to the Hanifin and Rajka criteria for atopic dermatitis?
* Facial features
* Triggers
* Complications
* Other factors like early age onset, xerosis, ichthyosis
## Footnote
At least three minor criteria must be present for diagnosis.
35
What is the 'atopic march' in relation to atopic dermatitis?
Approximately 75% of children with atopic dermatitis will develop allergic rhinitis and around 50% will develop asthma.
36
What is the 'hygiene hypothesis'?
A theory suggesting that a lack of early childhood exposure to infectious agents increases susceptibility to allergic diseases.
37
What are the key management strategies for atopic dermatitis?
* Irritant and allergen avoidance
* Emollient care
* Topical corticosteroids
38
What irritants and allergens should be avoided in managing atopic dermatitis?
* Soap
* Foaming shower gels
* Wet wipes
* Hot baths
* Scented moisturizers and lotions
39
What is the recommended care for emollients in managing atopic dermatitis?
* Emollient bath with a liquid moisturizer or soap substitute if showering
* Daily during flares
* 1-2 times a week for maintenance
* Apply greasy emollient cream or ointment all over the skin after bathing and as often as needed (at least twice a day, preferably 3-4 times)
40
What are the general principles for using topical corticosteroids?
* Use 'enough' of a 'strong enough' steroid for 'long enough'
* Wean in frequency of application rather than a sharp stop
* Face, neck, and flexures - Mild
* Thicker skin, trunk, and limbs - Moderate or Potent
* Acral skin or under specialist care - Very potent
## Footnote
The choice of steroid strength depends on the area of application.
41
What types of topical corticosteroids are preferred for dry skin conditions?
Ointments are preferred due to fewer preservatives and better absorption.
42
What type of topical corticosteroids are more suitable for moist areas?
Creams are more suitable for moist areas.
43
What type of topical corticosteroids are better for hair but may sting due to alcohol?
Lotions are better for hair but may sting.
44
What is contact dermatitis?
A skin condition characterized by inflammation due to exposure to irritants or allergens
## Footnote
Contact dermatitis can be classified into allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD)
45
What history is important in the examination of contact dermatitis?
History of atopy, onset, exposure to irritants and potential allergens, improvement away from work, distribution of affected skin
## Footnote
Atypical distribution of eczematous rash may indicate a diagnosis
46
What are the key factors to assess in the history of contact dermatitis?
* History of atopy
* Onset of symptoms
* Exposure to irritants
* Potential allergens
* Improvement away from work
* Distribution of affected skin
## Footnote
Specific areas to note include hands, web spaces, eyelids, and perioral region
47
What is a recommended diagnostic procedure for contact dermatitis?
Consider patch testing to appropriate allergens to rule out allergic contact dermatitis (ACD)
## Footnote
Patch testing helps identify specific allergens causing the dermatitis
48
What is the primary management strategy for allergic contact dermatitis (ACD)?
* Complete avoidance of the allergen
* Topical corticosteroids
* Emollient care
## Footnote
May require a change of occupation if allergen cannot be avoided
49
What treatments are commonly used for irritant contact dermatitis (ICD)?
* Topical corticosteroids
* Emollient care
* Systemic medications if necessary
## Footnote
Fastidious emollient care is especially important if hands are affected
50
What challenges are associated with managing contact dermatitis?
Avoiding allergens can be difficult due to inadequate product labeling and ongoing care requirements
## Footnote
Decisions regarding occupational changes are significant and not taken lightly
51
What impact does a change of occupation have on individuals with contact dermatitis?
It is a significant disruption to life
## Footnote
This underscores the importance of effective management and allergen avoidance strategies
52
What is seborrheic dermatitis?
A chronic inflammatory skin condition characterized by 'oily' skin or 'seborrhea'
## Footnote
It commonly presents with greasy scales and can affect various areas of the body.
53
What family history is associated with seborrheic dermatitis?
Family history of seborrheic dermatitis or psoriasis
## Footnote
Genetic predisposition may play a role in the development of this condition.
54
Name two conditions that may indicate underlying immunosuppression contributing to seborrheic dermatitis.
* HIV
* Lymphoma
## Footnote
Immunosuppression can exacerbate symptoms of seborrheic dermatitis.
55
List some factors that can trigger seborrheic dermatitis.
* Neurological or psychiatric conditions
* Psychotropic medications
* Down's syndrome
* Stress
## Footnote
These factors may contribute to flare-ups of the condition.
56
What is the recommended shampoo treatment for seborrheic dermatitis?
Medicated shampoo containing ketoconazole or selenium sulfide twice weekly for a month
## Footnote
It's important to leave the foam in contact with affected areas for up to 5 minutes before rinsing.
57
What topical treatment can be used if seborrheic dermatitis is inflamed?
1% hydrocortisone with miconazole for 1-3 weeks
## Footnote
This combination helps reduce inflammation and fungal presence.
58
What are keratolytics, and when are they used?
Agents like salicylic acid or urea used as needed (PRN)
## Footnote
They help in exfoliating and managing scaling associated with seborrheic dermatitis.
59
Describe the typical clinical diagnosis of seborrheic dermatitis in adults.
Characterized by expected distribution and 'greasy scale' appearance affecting the scalp, face, nasolabial folds, post-auricular area, eyebrows, and upper trunk
## Footnote
Patches are often salmon-pink and ill-defined.
60
What is 'cradle cap' in infants related to seborrheic dermatitis?
Greasy scalp scale that may also affect armpit and groin folds
## Footnote
It presents as flaky salmon-pink patches.
61
What maintenance treatments are recommended for seborrheic dermatitis?
* Medicated shampoo 1-2 times per week
* Short courses of mild topical corticosteroids or antifungals
* Topical calcineurin inhibitors (tacrolimus 0.1%)
## Footnote
These are often necessary to manage flares and maintain skin health.
62
True or False: Seborrheic dermatitis can cause social embarrassment or psychological stress.
True
## Footnote
The visibility and chronic nature of the condition can impact emotional well-being.
63
When should a referral be considered for seborrheic dermatitis?
If recalcitrant to basic treatments, consider underlying immunosuppression
## Footnote
Conditions like HIV or lymphoma may require specialized care.
64
What is eczema herpeticum?
An acute eruption of painful, monomorphic clustered vesicles associated with fever and malaise
65
Where is eczema herpeticum often seen?
On the face and neck
66
Can eczema herpeticum occur on normal skin?
Yes, it can occur in normal skin or sites actively or previously affected by atopic dermatitis
67
How long does it typically take for new patches of eczema herpeticum to form and spread?
7-10 days
68
What is the preferred method for diagnosing eczema herpeticum?
Typical clinical appearance, but lab confirmation is preferable
69
What type of test is used for lab confirmation of eczema herpeticum?
Viral swab from the base of fresh vesicle sent for HSV 1 and 2 polymerase chain reaction
70
What is the management approach for early-onset eczema herpeticum in a well patient?
Oral aciclovir or valaciclovir for 10-14 days or until lesions heal
71
What should be done if the patient with eczema herpeticum is systemically unwell?
Hospital admission for IV aciclovir is required
72
How is secondary bacterial skin infection in eczema herpeticum treated?
With systemic antibiotics
73
Is it reasonable to commence a topical corticosteroid regimen for underlying eczema after starting antiviral treatment?
Yes, it is reasonable to commence once systemic antivirals are instituted
74
What should be done if there is involvement of eczema herpeticum on or near the eyes?
Seek urgent ophthalmology review
75
Can eczema herpeticum recur?
Yes, antiviral prophylaxis is considered in some cases
76
What is important to surveil for in the ongoing management of atopic dermatitis?
Superinfection, bacterial or viral
77
What can result from untreated eye involvement in eczema herpeticum?
Scarring or visual impairment
78
Where should clinical concerns for eczema herpeticum be reviewed?
In a specialist center for confirmation and assessment
