Eczema

Question 1

Presentation of eczema (acute)

Answer 1

• redness, swelling (ill defined)
• papules, vesicles
• exudation, crusting
• scaling (less than psoriasis)
• ITCHY ± associated excoriations

Question 2

Conservative Mx of (atopic) eczema

Answer 2

• explanation
• avoid irritants
• keep fingernails short

Question 3

Safety netting in eczema

Answer 3

they must report any severe weeping rash or widespread redness/peeling

Question 4

Mainstay Mx of eczema

Answer 4

Emollients and soap substitutes

• use liberally (3-4x/day) even when eczema less active
• can use wet wrapping (bandages on top of leave-on emollients)
• reduces need for steroids

Topical corticosteroids

• for exacerbations, only on active eczematous skin
• apply 1x/day, 30+ mins after emollient
• better to use properly during a flare, than sparingly all the time
• continue for 48h after flare has subsided
• mild-mod if mild-mod eczema (use lowest potency possible)
• potent if severe eczema, but moderate on delicate areas e.g. face (and flexures)
• should be limited to 4-6wks to gain control in chronic disease

Question 5

Further Mx of eczema after mainstay

Answer 5

• topical calcineurin inhibitors (e.g. tacrolimus) if not controlled with corticosteroids
• oral antihistamines for Sx relief
• Abx/antivirals if infection present
• if weeping: 0.01% potassium permanganate soaks

If severe/non-responsive:

• systemic e.g. azathioprine, ciclosporin, methotrexate, prednisolone
• phototherapy

Question 6

Secondary infections in eczema

Answer 6

• secondary bacterial infection (get skin swab)

- viral: molloscum contagiosum, viral warts, eczema herpeticum

Question 7

Where does seborrhoeic eczema appear?

Answer 7

• scalp, face, ears, eyebrows causing dandruff
• presternal interscapular
• armpits, groin, umbilicus

Question 8

What does crazy paving appearance of cracks in skin suggest?

Answer 8

asteatotic eczema, especially on shins

Question 9

What is lichen simplex?

Answer 9

plaques of lichenification due to repeated rubbing/scratching

Question 10

What is pompholyx?

Answer 10

itchy vesicular rash on hands and feet

triggers: ?heat ?fungus

Question 11

When to do patch testing?

Answer 11

Contact dermatitis (allergic/irritant)

Question 12

Emergencies caused by eczema

Answer 12

• bacterial infection
• eczema herpeticum
• erythroderma/exfoliative dermatitis

Question 13

Causes of erythroderma/exfoliative dermatitis

Answer 13

• eczema
• psoriasis
• drugs: sulfonamides, allopurinol, carbamazepine, gold
• T-cell lymphoma and leukaemia (consider if acute/sudden)

Question 14

1 example of a mild steroid

Answer 14

hydrocortisone (0.5%, 1%, 2.5%)

Question 15

2 examples of moderate steroids

Answer 15

Betamethasone valerate 0.025%

Clobetasone butyrate 0.05%

Question 16

1 example of a strong steroid

Answer 16

Betamethasone valerate 0.1%

Question 17

1 example of a very strong steroid

Answer 17

Clobetasol propionate 0.1%