Eczema Flashcards by Robbie Pollock

why learn about eczema?

It’s common - 24% of children will be diagnosed with eczema at some point in their childhood
It’s climbing - Prevalence is rising and Rates of hospital admission for children and adults is increasing
It’s chronic
It’s costly

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what is eczema also known as?

Also known as atopic dermatitis

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what is eczema?

Inflammatory skin condition

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where does eczema commonly affect?

Commonly affects flexural areas

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is there just one type of eczema?

Multiple types and a spectrum of severity

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what type of factors can cause eczema?

Wide range of external (exogenous) or internal (endogenous) factors can induce the condition

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what 2 things make up/are going on in eczema?

Barrier dysfunction + inflammation

(picture show triggers involved in eczema)

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what is the epidemiology of eczema?

Overall prevalence is 4% in Western countries
Most commonly appears in babies and children - By adult life 60% have cleared
Recent studies indicated rising numbers:
More so in “developed” regions
Social class effect?
Commoner in cooler climates?
Pollution? Other environmental factors?

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is prevelance increasing or decreasing?

increasing

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what is the definition of atopic eczema?

An itchy skin condition in the last 12 months

Plus 3 of the following:

Onset before age 2
History of flexural involvement
History of generally dry skin
History of other atopic disease - History in 1st degree relative if under 4 yrs

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what is the pathogenesis of eczema?

• Genetics:

Many genes implicated
Key role for Filaggrin gene
Atopic family history
atopic eczema, asthma hay fever (allergic rhinitis), food allergy
Epidermal barrier dysfunction
Environmental factors
Immune system dysregulation

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what is the pathology of eczema?

Spongiosis (intercellular oedema) within the epidermis
Acanthosis (thickening of the epidermis)
Inflammation - Superficial perivascular lymphohistiocytic infiltrate

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what does the epidermis and dermis contain?

Epidermis - outermost layer of skin

Dermis - contains blood vessels, lymph vessels, hair follicles and sweat glands

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what is one of the main clinical feautres in eczema?

Itch!!

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what does the distribution of eczema tend to be?

Flexures, Neck, Eyelids, Face, Hands and feet

Tends to spare nappy area

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what are acute changes seen in eczema?

Pruritus, Erythema, Scale, Papules, Vesicles

Exudate, crusting, excoriation

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what are chronic changes seen in eczema?

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Lichenification, Plaques, Fissuring

what are other types of exogenous (external) eczema?

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• Contact dermatitis:

Irritant
Allergic
Lichen simplex
Photoallergic or photoaggravated eczema

what are other types of endogenous (internal) eczema?

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Atopic
Discoid
Venous
Seborrhoeic dermatitis
Pompholyx
Juvenile plantar dermatitis

• Asteatotic

what type of reaction is allergic contact dermatitis?

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Type 4 Hypersensitivity (T cell mediated)
Delayed hypersensitivity – can take 48-72 hrs to develop reaction

what happens in allergic contact dermatitis?

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Antigen presenting cells take hapten/allergen to LN and present to naive T cells
Clonal expansion of these T cells, released into blood stream
When these T cells next encounter hapten - Mast cell degranulation, vasodilatation and neutrophils

in irritant contact dermatitis, the skin can be innjured by what?

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1) Friction – micro-trauma, cumulative
2) Environmental factors:
cold
over-exposure to water
chemicals such as acids, alkalis, detergents and solvents

Irritant contact dermatitis is a form of contact dermatitis, in which the skin is injured by friction, environmental factors such as cold, over-exposure to water, or chemicals such as acids, alkalis, detergents and solvents

Irritant contact dermatitis may occur in what occupations?

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Hairdressers

NHS staff

Cleaners

Dermatitis - under a ring on finger - soaps can accumulate - irritant

Nappy rash

what is patch testing and how is it carried out?

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Used in allergic contact dermatitis

Potential allergens applied (no needles involved!)
Baseline/standard series – applied to all patients
Applied Monday
Remove Wednesday
Re-assess Friday

what is Seborrhoeic dermatitis?

Seborrhoeic dermatitis is a common, chronic or relapsing form of eczema/dermatitis that mainly affects the sebaceous, gland-rich regions of the scalp, face, and trunk

how does Seborrhoeic dermatitis appear in infants?

* Distinctive pattern * Predilection for scalp, proximal flexures * \<6months age usually * Often clears within weeks of treatment

what are the clinical features of Seborrhoeic eczema in adults?

Chronic dermatitis Malassezia yeast increased in the scaly epidermis of dandruff and seborrehoic dermatitis Red, sharply marginated lesions covered with greasy looking scales Distinctive distribution – areas rich in supply of sebaceous glands (scalp, face, upper trunk)

what may be a precursor for Seborrhoeic eczema?

Dandruff can be a pre-cursor. May gradually progress through redness, irritation and increased scaling

what is the treatment of Seborrhoeic eczema?

* Treat with topical anti-yeast (ketoconazole) * If severe, consider HIV test

what is discoid eczema, what is its cause and where may it develop?

Circular plaques of eczema Cause often unknown May develop at sites of trauma/irritation

where does Pompholyx/vesicular eczema affect?

palms and soles

What does Pompholyx/vesicular eczema cause someone to be?

intensely itchy Sudden onset of crops of vesicles

Pompholyx/vesicular eczema tends to happen at what age?

More common under 40 years

What happens when Pompholyx/vesicular eczema gets better?

Resolution can include desquamation (skin peeling)

what is asteatotic eczema?

Very dry skin Cracked scaly appearance

where does asteatotic eczema affect and what causes it?

* Most commonly shins affected * Climate - heat * Excessive washing/soaps

what is venous eczema?

Due to circulatory changes * Stasis eczema or varicose eczema * Increased venous pressure * Oedema * Ankle and lower leg involved * Resolution of oedema can help – compression stockings

what causes Eczema herpeticum?

Disseminated viral infection

what are the clinical features of eczema herpeticum?

* Fever and often unwell * Itchy clusters of blisters and erosions * Herpes Simplex 1 and 2 * Swollen lymph glands

what is the management of Eczema herpeticum?

Consider admission, antivirals, consider secondary bacterial infection

what is the treatment of eczema?

* Patient education * Avoid Causative/exacerbating factors * Emollients (moisturisers) - Ointment - greasy but effective - Creams - lighter - Lotions - more watery * Soap substitutes * Intermittent topical steroids - Different potency: - hydrocortisone (low) - Betamethasone (potent) * Sometimes need antihistamines or antimicrobials * Calcineurin Inhibitors (inhibit the action of calcineurin. Calcineurin is an enzyme that activates T-cells of the immune system - topical treatment) - Topical Pimecrolimus and Tacrolimus

what is the treatment of severe eczema?

* Ultraviolet light * Immunosuppression - Azathioprine - Ciclosporin - Mycophenolate mofetil - Methotrexate

Eczema Flashcards

(42 cards)