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Dermatology > Eczema > Flashcards

Eczema Flashcards

1
Q

Another name for eczema

A

Atopic dermatitis

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2
Q

What kind of condition is eczema?

A

An inflammatory skin condition

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3
Q

Where does eczema commonly effect?

A

Flexural areas

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4
Q

Definition of atopic eczema (criteria)

A

An itchy skin condition in the last 12 months PLUS 3 of the following

  • onset before age 2
  • history of flexural involvement
  • history of general dry skin
  • history of other atopic disease
  • history in 1st degree relative if under 4 years
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5
Q

What is asked about in an atopic family history?

A

Atopic eczema
Asthma
Hay fever (allergic rhinitis)
Food allergy

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6
Q

Pathology of eczema

A

Spongiosis (intracellular oedema) within the epidermis
Acanthosis (thickening of the epidermis)
Inflammation - superficial perivascular lymphohistiocytic infiltrate
Accumulation of intra epidermal vesicles

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7
Q

Pathology of chronic spongiotic dermatitis

A

Vesiculation uncommon
Significant epidermal acanthosis - which may show psoriasiform pattern with hyperkeratosis, hypergranulosis and minimal parakeratosis
Fibrosis of papillary dermis may be present

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8
Q

What is epidermal acanthosis?

A

Thickening of epidermis

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9
Q

Presentation of eczema

A 
ITCHY
Erythema
Scale
Papules
Vesicles 
Exudate
Crusting
Excoriation
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10
Q

Distribution of eczema

A 
Flexures
Neck 
Eyelids
Face
Hands 
Feet
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11
Q

Where does eczema tend to spare?

A

Nappy area

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12
Q

Chronic changes of eczema

A

Lichenification
Plaques
Fissuring

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13
Q

Types of eczema

A 
Chronic 
Atopic 
Contact dermatitis
Lichen simplex
Photoallergic or photoaggravated eczema 
Discoid 
Venous
Serborrhoeic dermatitis 
Pompholyx 
Juvenile plantar dermatitis 
Asteatotic
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14
Q

Pathology of allergic contact dermatitis

A

Type 4 hypersensitivity
Delayed hypersensitivity
Antigen presenting cells take hapten / allergen to LN and present to naïve T cells
Clonal expansion of these T cells, released into blood stream
When these T cells next encounter hapten
Mast cell degranulation, vasodilation and neurophils

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15
Q

How long can allergic contact dermatitis take to develop a reaction?

A

48 - 72 hours

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16
Q

What is irritant contact dermatitis?

A

A form of contact dermatitis, in which the skin is injured by friction and environmental factors

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17
Q

How is skin injured in irritant contact dermatitis?

A 
Friction 
- micro trauma 
- cumulative 
Environmental factors
- cold
- over exposure to water
- chemicals such as acids, alkalis, detergents and solvents
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18
Q

What occupations tend to get irritant contact dermatitis?

A

Hairdressers
NHS staff
Cleaners

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19
Q

Who gets seborrheic eczema?

A

Infants < 6 months

Adults with chronic dermatitis

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20
Q

Where does seborrheic dermatitis affect in infants?

A

Scalp

Proximal flexures

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21
Q

Where does seborrhoeic dermatitis affect in adults?

A

Malasseia yeast increased in the scaly epidermis of dandruff and seborrheic dermatitis
Affects areas rich in supply of sebaceous glands
- scalp
- face
- upper trunk

22
Q

Presentation of seborrheic dermatitis in adults

A

Red, sharpley marginated lesions covered with greasy looking scales

23
Q

What can be a precursor for seborrheic eczema?

A

Dandruff

24
Q

Progression from dandruff to seborrhoiec eczema

A

Redness
Irritation
Increased scaling

25
Q

Treatment of seborrheoic eczema in adults that started with dandruff

A

Topical anti yeast (ketoconazole)

26
Q

If have severe seborrheic eczema, what test should be done?

A

HIV test

27
Q

What is discoid eczema?

A

Circular plaques of eczema

28
Q

Where may discoid eczema develop?

A

Sites of trauma

Irritation

29
Q

Where do you get pompholyx/vesicular eczema?

A

Palms and soles

30
Q

Who is pompholyx/vesicular eczema common in?

A

< 40 y/o

31
Q

Presentation of pompholyx/vesicular eczema

A

Sudden onset of crops of vesicles

Intensley itchy

32
Q

What can resolution of pompholyx/vesicular eczema include?

A

Desquamation

33
Q

Features of asteatotic eczema

A

Very dry skin

Cracked scaley appearance

34
Q

What is most commonly affected in asteatotic eczema?

A

Shins

35
Q

Causes of asteatotic eczema

A

Hot climate

Excessive washing / soaps

36
Q

Pathology of venous eczema

A

Stasis eczema or varicose eczema
Increased venous pressure
Oedema

37
Q

What areas are involved in venous eczema?

A

Ankle

Lower leg

38
Q

What can help to treat venous eczema?

A

Resolution of oedema

- compression stockings

39
Q

What is eczema herpeticum?

A

Disseminated viral infection with poorly controlled eczema

40
Q

Presentation of eczema herpeticum

A

Itchy clusters of blisters and erosions
Fever
Often unwell
Swollen lymph glands

41
Q

Causes of eczema herpeticum

A

Herpes simplex 1 and 2

42
Q

Treatment of eczema herpeticum

A

Admission
Anitvirals
Consider secondary bacterial infection

43
Q

Treatment of eczema

A 
Avoid causative/exacerbating factors
Emoillients (moisturisors)
Soap substitutes 
Intermittent topical steroids 
- hydrocortisone
- betamethasone
Antihistamines or antimicrobials 
Calcineurin inhibitors
- topical pimecrolimus
- tacrolimus
44
Q

Treatment of severe eczema

A 
UV light
Immunosuppression 
- azathioprine
- ciclosporin 
- methotrexate
- mycophenolate mofetil
45
Q

Two main types of contact dermatitis

A

Irritant contact dermatitis

Allergic contact dermatitis

46
Q

What is irritant contact dermatitis due to?

A

Weak acids or alkalis (e.g. detergents)

47
Q

Is irritant contact dermatitis common?

A

Yes

48
Q

Is irritant contact dermatitis an allergic reaction?

A

No

49
Q

Where is contact dermatitis often seen?

A

Hands

50
Q

Pathology of allergic contact dermatitis

A

Type IV hypersensitivity reaction

51
Q

Name a common cause of contact dermatitis

A

Cement

Dermatology (11 decks)

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