Eczema

Question 1

eczema is also known as?

Answer 1

atopic dermatits

Question 2

what is eczema?

Answer 2

inflammatory skin condition which often affects flexural areas

Question 3

percentage in children and percent who clear?

Answer 3

24% children

60% clear into adults

Question 4

eczema is irritated skin caused by?

Answer 4

barrier dysfunction + inflammation

Question 5

definition of atopic eczema?

Answer 5

an itchy skin condition in the last 12 months plus 3:

• onset before age 2
• history of flexural involvement
• history of generally dry skin
• history of other atopic disease

Question 6

genetics?

Answer 6

many genes implicated but key role for Filaggrin gene

Question 7

pathogenesis? (3)

Answer 7

epidermal barrier dysfunction

environmental factors

immune system dysregulation

Question 8

pathology? (3)

Answer 8

spongiosis within epidermis (intercellular oedema)

acanthosis (thickening of the epidermis)

inflammation (superficial perivascular lymphohistiocytic infiltrate)

Question 9

clinical features?

acute/chronic

Answer 9

ITCH
distribution (spares nappy)

acute: pruritus, erythema, scale, papules, vesicle, exudate, crusting
chronic: lichenification, plaques, fissuring

Question 10

allergic contact dermatitis?

Answer 10

Type 4 hypersensitivity

hapten/allergen presented and then T cell activates on next exposure

mast cell degranulation

Question 11

testing?

Answer 11

patch testing, allergens applied

apply monday
off wednesdayy
assess Friday

Question 12

seborrhoeic dermatitis?

infants

Answer 12

predilection for the scalp
<6months of age
clears within weeks of treatment

Question 13

seborrhoeic eczema?

adults

Answer 13

chronic dermatitis - dandruff precursor

malassezia yeast increased in the scaly epidermis

areas rich in supply of sebaceous glands

treat with anti-yeast

Question 14

discoid eczema?

Answer 14

circular plaques

may develop at sites of trauma/irritation

Question 15

pompholyx/vesicular eczema?

Answer 15

palms and soles
intensely itch
<40yrs
sudden onset of crops of vesicles
resolution can include desquamation

Question 16

asteatotic eczema?

Answer 16

very dry skin
cracked scaly appearance

most common shins
climate - heat
excessive washing/soaps

Question 17

eczema herpeticum?

Answer 17

disseminated viral infection
fever and often unwell
itchy clusters of blisters and erosions
swollen lymph glands
HSV1+2

admission and antivirals

Question 18

eczema treatment?

Answer 18

education
avoiding causative/exacerbating
emollients (moisturisers)
soap substitutes

intermittent topical steroids
antihistamines
calcineurin inhibitors (tacrolimus)

• UV light
• immunosuppression