Eczema

Question 1

clinical features

Answer 1

erythema
papules, vesicles, blisters, exudate
dryness, scaling
fissures, bleeding
itching, pain
excoriation, lichenification (chronic)
crusting and pustules (secondary infection

Question 2

pathogenesis

Answer 2

dermal vasodilatation, exudate, inflammatory mediators: erythema, oedema, pain, heat, itch
spongiosis (separated keratinocytes): vesicles, exudate

Question 3

acute/subacute/chronic

Answer 3

acute: classic signs
subacute: less spongiosis (fewer vesicles); cell malfunction - acathosis, hyperkeratosis (scaling)
chronic: lichenification, dry, scaly, fissured

Question 4

classification

Answer 4

endogenous: atopic, discoid, seborrhoeic, pomphlyx, varicose, asteatotic
exogenous: allergic, irritant, infective

Question 5

atopic eczema - BG

Answer 5

FHx, asthma, hayfever
10-20% prevalence
onset

Question 6

atopic eczema - factors

Answer 6

irritants, illness, stress, skin infection, weather, allergy

Question 7

atopic eczema - features

Answer 7

d: begins on face/extensors, flexures later; can be widespread

M: erythema, itch, vesicles, papules, weeping, inflammation, dryness, fissures, scaling, excoriation, lichenification

nail pitting and ridging

Question 8

discoid eczema

Answer 8

any age, any site
disc-like, circ’d, plaques, scaling throughout (no central clearing like tinea)
often infected (potent steroids Rx)

Question 9

seborrhoeic eczema

Answer 9

middle-aged adults
worse with alcohol/smoking

D: seborrhoeic sites (face/scalp/trunk)
M: erythema, dry, scaling, ‘dandruff’, yellow scalp scales

Question 10

varicose eczema

Answer 10

asteototic (dry) + varicose veins

plaques: itchy red, crusted/blistered, dry/scaly, fissured
haemosiderin
atrophie blanche (red spots)
LDS: indurated, red, champagne bottle

Question 11

irritant contact dermatitis

Answer 11

specific locations

• lip: licking
• dorsum of hands/finger webs
• chemicals
• friction, cold, water

dose-response: threshold

Question 12

allergic contact dermatitis

Answer 12

TIV hypersensitvity
asymmetrical, contact sites
delayed and persists (days)
patch tests (back discs, 48/72h)
e.g. nickel, dye, perfume, deodorants, latex, plasters, clothes/shoes

Question 13

hand dermatitis

Answer 13

multifactorial
variable: pompholyx, fissures
chronic relapsing

Rx: education/care, emollients, steroids, KMnO4 (vesicles), retinoids (Chronic)

Question 14

management - principles

Answer 14

education, avoid triggers and aqueous cream
emollients + soap substitutes

KMnO4/aluminium acetate: dry blisters
wet wraps: anti-itch and steroid-sparing

mild steroids for face; 5-7d use
moderate/potent for body

other options: ineffective or SE

Question 15

emollients

Answer 15

replace lipid layer

rehydrate

Question 16

second line

Answer 16

topical calcineurin inhibitors (‘limus’): steroid sparing, no thinning, good for face
ABx (fluclox/erythro): infection
phototherapy: systemic Rx
PO steroids
topical immunosuppressants (MTX, ciclo, azathio): long/severe/non-responsive

Question 17

complications

Answer 17

secondary infection: staph/strep, fungal, HSV

eczema herpeticum: crusted papules, punctate erosion, systemic

Question 18

pompholytic eczema

Answer 18

F>M; hyperhidrosis/weather/irritants/atopy

hands (cheiro) and feet (pedo) vesicles, blisters, intense itch/burn
red, dry, fissured, nail changes (paronychia - swelling, pitting, ridging)

Question 19

steroid SEs

Answer 19

worse: face/axillae/upper thighs; young/elderly

thin skin, striae, telangiectasia, perioral dermatitis
glaucoma, cataracts, DM, osteoporosis
adrenal suppression, immunosuppression
rebound