Eczema

Question 1

signs of infected eczema

Answer 1

• weeping
• crusted
• pustules
• fever/malaise

Question 2

tool used to assess severity of eczema

Answer 2

Patient Orientated Eczema Measure

Question 3

where is commonly the first place for eczema to occur in children

Answer 3

cheeks

Question 4

symptoms of eczema

Answer 4

• dry skin
• itchy
• redness

Question 5

what is atopic eczema

Answer 5

common inflammatory skin condition

Question 6

exogenous types of eczema (4)

Answer 6

• atopic
• varicose
• seborrhoeic
• discoid

Question 7

4 closely linked conditions all of “atopic tendency”

Answer 7

• atopic eczema
• atopic dermatitis
• asthma
• hayfever

Question 8

triggers of atopic eczema

Answer 8

• soap + detergents
• overheating/rough clothing
• skin infection
• pollens
• food
• stress
• house dust mites

Question 9

Diagnosis of atopic eczema = child with itchy skin + 3 or more of following:

Answer 9

a) visible flexural dermatitis involving skin creases
b) personal hx flexural dermatitis
c) personal hx dry skin in last 12 months
d) personal hx of asthma/allergic rhinitis OR hx atopic disease in a 1st degree relative of children under age of 4 years
e) onset of signs + symptoms under age of 2 years

Question 10

what is pomphoplyx

Answer 10

acute presentation of eczema; tiny vesicles appear typically on lateral aspects of fingers + toes
- intensely itchy

Question 11

what is lichenification

Answer 11

increased skin markings seen in chronic eczema

Question 12

signs of atopic eczema infected with staph aureus/streptococcus

Answer 12

• weeping
• pustules
• crusting
• atopic eczema failing to respond to therapy
• rapidly worsening atopic eczema
• fever/malaise

Question 13

what is eczema herpeticum

Answer 13

HSV virus infecton of atopic eczema

Question 14

signs of eczema herpeticum

Answer 14

• areas or worsening/painful eczema
• clustered blisters (consistent with early stage cold sores)
• punched out erosions
• fever/lethargy/distress

Question 15

treatment of bacterial infected eczema

Answer 15

Fucidin H cream: applied topically every 12 hours

Question 16

what is Fusidin H cream

Answer 16

combination of abx + steroid to treat both secondary infection and underlying eczema

Question 17

describe the typical appearance of Eczema Herpeticum

Answer 17

punched out erosions

• circular
• depressed
• ulcerated
• 1-3 mm
• uniform
• grouped vesicles

Question 18

complications of systemic herpes simplex

Answer 18

• hepatitis
• pneumonitis
• acute renal failure
• encephalitis

Question 19

lack of what protein leads to skin breakdown

Answer 19

flaggrin

Question 20

allergens are taken up by dendritic cells… stimulating an inflammatory cascade; what cells is this cascade predominated by

Answer 20

Th2 cells

Question 21

treatment overview for atopic eczema (4)

Answer 21

• emollient therapy
• steroid creams
• immunomodulator cream/ointment
• know when to refer

Question 22

mechanism of benefits of emollient therapy

Answer 22

in eczema their is loss of the oily layer in skin –> water can escape from the skin –> crack in the skin –> things can enter and cause irritation –> therapy replaces this lost layer.

Question 23

oily + paraffin based

Answer 23

ointments

Question 24

soap substitutes

Answer 24

lotions

Question 25

emollient regime (3)

Answer 25

combination of - ointments - lotions - moisturiser

Question 26

frequency of emollient therapy

Answer 26

application of ointments _ creams 3x/day

Question 27

when to apply steroids

Answer 27

after allowing moisturised to dry into skin for 20 minutea

Question 28

strength of steroid determined by

Answer 28

site + severity + age

Question 29

an alternative to topical steroids ? and mechanism

Answer 29

Topical calcineurin inhibitos - Tacrolimas - Pimecrolimus suppress T lymphocytes --> suppressing synthesis of pro inflammatory cytokines

Question 30

indication for topical calcineurin inhibitors?

Answer 30

- 2nd line trx of moderate to severe atopic eczema that has not been controlled by topical steroids - risk of adverse effects of topical steroids e.g. skin atrophy

Question 31

steroid of choice for mild eczema flare up

Answer 31

HYDROCORTISONE

Question 32

steroid of choice for moderate eczema flare up

Answer 32

EUMOVATE

Question 33

steroid of choice for severe eczema flare up

Answer 33

BETNOVATE

Question 34

steroid of choice for very severe eczema flare up

Answer 34

DERMOVATE

Question 35

steroid ladder:

Answer 35

hydrocortisone --> euvomate --> betnovate --> dermovate

Question 36

define erythroderma

Answer 36

erythema affecting > 90% body

Question 37

what does the maintenance therapy aim to do?

Answer 37

create an artificial barrier over the skin to compensate for defective skin barrier (thick & greasy emollients)

Question 38

side effects of topical steroid therapy

Answer 38

- skin thinning - telengiectasia - systemic absorption

Question 39

why does bacterial infection happen?

Answer 39

opportunistic bacteria infect the skin through the entry points in the breakdown of skin

Question 40

features of the vesicles found in eczema herpeticum

Answer 40

the vesicles contain pus & can burst & leave small punched out lesions

Question 41

features of the punched out lesions in eczema herpeticum (3)

Answer 41

- circular - depressed - ulcerated

Question 42

4 year old with facial eczema - what steroid treatment would you recommend?

Answer 42

Mild steroid = 1% Hydrocortisone ointment | for a short duration e.g. 3-5 days