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Eczema Flashcards

(43 cards)

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1
Q

What are these: atopic & infantile seborrheic eczema, irritant & allergic contact dermatitis?

A

These are the 4x main types of eczema / dermatitis in paediatrics

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2
Q

who does irritant contact dermatitis occur in? (epidemiology)

A

anyone exposed to sufficient amount of offending agent; more common in those with atopic eczema (diminished skin barrier)

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3
Q

What is the aetiology/cause of irritant contact dermatitis?

A

irritating substance –> contact –> causes skin inflammation

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4
Q

What is this

rough, dry skin & white scaling with variable erythema caused by low relative humidity (dry) & aggravated by soaps and bathing?

A

asteatotic eczema

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5
Q

What are asteatotic eczema and nappy rash clinical features of?

A

irritant contact dermatitis!

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6
Q

How is the diagnosis of irritant contact dermatitis made?

A

clinical dx

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7
Q

What is the Rx of irritant contact dermatitis?

A
  • emmolients
  • topical corticosteroids
  • avoidance of irritant
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8
Q

What is the difference between eczema and dermatitis?

A

both are generic terms for skin inflammation

eczema = endogenous

dermatitis = exogenous

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9
Q

what are these types of:

atopic, venous / gravitational, asteatotic, seborrhoeic, discoid, pompholys, pityriasis alba?

A

Eczemas!

e.g. endogenous

  • *Atopic Eczema
  • Venous/ gravitational Eczema
  • Asteatotic eczema
  • Seborrhoeic dermatitis
  • Discoid
  • Pompholyx
  • Pityriasis alba
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10
Q

What are these types of:

irritant contact, allergic contact, photodermis, eczema herpeticum

A

= dermatitis types!

e.g. exogenous

  • Irritant contact
  • Allergic contact
  • Photodermatitis
  • Eczema herpeticum (vesicles, punched out haemorrhagic lesions, caused in HSV infectino)
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11
Q

What is the aetiology of allergic contact dermatitis e.g. cause?

A

abnormal immunological response –> inflammation caused by Type 4 cell mediated hypersensitivity to an allergen

~10% of childhood dermatitis

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12
Q

what are nickel, lanolin and urushiol in relation to allergic contact dermatitis?

A

they can be allergens –> Type 4 cell mediated hypersensitivity

in allergic contact dermatitis

lanolin = sheep wool wax

urushiol = a chemical in some plants

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13
Q

Where does the lesion from allergic contact dermatitis occur?

A

typically restricted to area of contact

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14
Q

What types of lesion can occur from allergic contact dermatitis & their differences?

A
  • Allergic contact dermatitis –> acute & subacute
    • Acute = really itchy dermatitis –> vesicle and blister formation
      • From potent sensitizers e.g. poison ivy
    • Subacute –> linchenification (leathery from itching) and scaling
      • from less potent sensitisors e.g. nickel
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15
Q

How do you diagnose allergic contact dermatitis?

A
  • Use HISTORY to identify possible allergen
  • PATCH TESTING
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16
Q

How do you manage allergic contact dermatitis?

A
  • emmolients
  • topical corticosteroids
  • avoidance of the allergen
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17
Q

What is an allergen vs irritant?

A

irritant is non-allergic

allergy = involves a damaging hypersensitivity immune response by the body to a substance (types 1-4)

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18
Q

What is a type 1 allergic reaction?

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A

Immediate Hypersensitivity (Anaphylactic Reaction)

These allergic reactions are systemic or localized, as in allergic dermatitis (e.g., hives, wheal and erythema reactions)

antigen + membrane IgE of mast cell/basophil

= H2, platelet activating factor, PG and leukotrienes released

19
Q

What is a type 2 allergic reaction?

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A

Cytotoxic Reaction (Antibody-dependent)

Ab –> ag to induce cell lysis

IgG and IgM mediated e.g. Rh incompatibility

20
Q

What is a type 3 hypersensitivity reaction?

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A

immune complex reaction

IgG and IgM bind Ag –> PMN releasing tissue damaging enzymes

–> e.g. SLE & chonic infectious diseases e.g. leprosy

21
Q

What is a type 4 hypersensitivity reaction?

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A

Cell-mediated (delayed hypersensitivity)

reaction initated by T lymphocytes + Ag –> mediated by effector T cells (CD4+ and CD8+) –> 48-72hrs later = cytokines

22
Q

Which is the most common eczema/dematitis?

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A

Atopic eczema

~15% children

23
Q

aczema / atopic dermatitis is caused by food allergy

true or false

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A

False

NB: if there is a true food allargy e.g. egg allergy –> immediate peri-oral syx on contact with egg, it is not uncommon for eczema to FLARE up (e.g. its pre-existing eczema) several hours after the allergic reaction

24
Q

what gene mutations is eczema associated with?

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A

filaggrin gene mutations

[encodes protein that facilitated terminal differentiation of the epidermis and formation of the skin barrier]

25
What is eczema?
* _chronic skin condition_ * assoc. w/**filaggrin** gene mutations * ==\> causes *poor barrier function* of the skin * ==\> _allows IgE sensitisation_ to air allergens (aero-allergens) * via the THINNER, PERMEABLE epidermis
26
What 4 factors can aggrevate eczema & cause a "flare-up"?
1. infections 2. chemical irritation 3. allergy - particularly aero-allergens 4. other
27
What is included in the "other" category for eczema aggravating factors?
* **hot or cold temperatures** * heat * humidity * **sweat** / perspiration from exercising * **food** * **stress** * **hormones**
28
Sort of infections can cause eczema exacerbations?
* general infection * or skin infection often induced by scratching * certain bacteria e.g. staph aureus * viruses or certain fungi
29
What sort of chemical irritants can cause eczema exacerbation?
* soap, detergents * disinfectants (chlorine), * contact with: chemicals, fumes on job * juices from: * fresh fruits * meats * vegetables
30
What kind of allergens can cause eczema flares?
* house dust mites * animal dander e.g. pets - cats, dogs * pollens (seasonal) * moulds * dandruff
31
What is the cause of atopic eczema?
multifactorial: * epidermal barrier impairment * _genetic_ component - filaggrin gene * & parts of _immune_ system dysfunctional * _& environmental_ factors e.g. exposure to allergens in utero or in childhood
32
What are the clinical features of atopic eczema?
* 1st 6 months of life * dry itchy rash --\> excoriation (abrasion) & linchenfication (leathery-thickening) * Fhx or Hx of atopy or eczema
33
Some age groups get atopic eczema most commonly in different parts. 1) extensors, face & trunk 2) flexors which groups get (1) or (2)?
_older children_ get eczema on _flexors_ _infants_ get eczema on _extensors, face, trunk_
34
What are the complications of eczema and why?
Bacterial infection from the chronic epidermal barrier impairment (filaggrin etc) --\> *staph aureus* infection (lives on skin) viral infection - due to altered T cell function...
35
What viral infections can you get due to eczema and what conditions do they cause?
Pox virus --\> molluscum contagiosum Herpes Simplex --\> eczema herpeticum (can be FATAL)
36
What is this?
molluscum contagiosum | (pox virus)
37
What is this?
Eczema herpeticum (HSV infection, can be fatal via organ failure if virus spreads to brain, lungs & liver)
38
How do you diagnose atopic eczema?
* clinical (ask Hx of triggers too) * plama IgE levels often raised
39
Why must allergy (oral etc) testing in eczema be based on the clinical history?
if not targeted based on clinical hx: * you get false positive specific IgE results * as this is common in eczema & asthma * this simply reflects **exposure** and **IgE sensitisation** *in an atopic individual* * TF does not necesserily predict clinical allergy
40
How many children go onto have eczema in adolescence?
1/3rd * 2/3rds of children with eczema will recover by adolescence
41
What are the general measures of management for eczema?
1. short nails, 2. avoid known exacerbating agents, * oil/soap substitute 3. frequent **emollients** +/- **bandages** (with **zinc/tar paste/diluted steroids**)
42
What are the topical therapies given for eczema flares?
* topical corticosteroids * NB: ointment is more effective than cream but messier
43
What are the oral therapies for eczema flares?
* _antihistamines_ (symptomatic relief) * _Infection Rx:_ * abx e.g. flucloxacillin for 2o bacterial infection * antivirals e.g. aciclovir for 2o herpes * _?exclusion diet -_ * food allergies may EXACERBATE/flare eczema so investigate and trial an exclusion diet (not cause it, exacerbate)

Paediatrics (16 decks)

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