Eczema and dermatitis Flashcards Preview

Medical dermatology Dan > Eczema and dermatitis > Flashcards

Flashcards in Eczema and dermatitis Deck (305):
1

T/F
Exogenous eczema means spongiotic dermatoses caused by things contacting the skin

True
mainly treat by removing the trigger

2

What are the causes of exogenous eczemas?

Irritant contact dermatitis
Allergic contact dermatitis
Photoallergic contact dermatitis
Phototoxic contact dermatitis inc phytophotodermatitis
Eczematous PMLE
Dermatophytide (Id reaction)
Infectious eczema e.g. Discoid
Post-traumatic eczema

3

T/F
phototoxic drug reactions are a type of Exogenous eczema

False
phototoxic drug reactions are sunburn like rather than eczematous if due to systemic drugs
Phototoxic contact dermatitis is an exogenous eczema

4

T/F
generalized endogenous eczema is a valid diagnosis in elderly people

True
If doesnt fit a recognised type and no exogenous cause found

5

T/F
All eczematous dermatoses have acute, subacute and chronic lesions

False
eczema does but many other have single charcteristic appearances which are often acute
e.g. pompholyx, phytophotodermatitis

6

T/F
Autoeczematization means the same as dermatophytide or 'Id' reaction

False
Autoeczematization is secondary dissemination of eczema
‘Id reaction’ or ‘dermatophytide’ etc is used if the primary site is infection rather than eczema

7

Whic type of eczema most commonly causes autoeczematization?

stasis dermatitis
Also, regardless of cause, more likely if primary eczema site is on feet or legs

8

T/F
Typical for hand eczemas to spread to feet and vice versa

True
(autoeczematization)

9

T/F
Autoeczematization only occurs in long established eczemas

False
Eczema may have been present for any duration of time before spread

10

T/F
Dissemination (autoeczematization) often follows a local flare

True

11

How does autoeczematization present?

Often the eruption is symmetrical and striking
Starts as oedematous papules or papulovesicles or sometimes macules or wheals – soon become eczematous lesions
Can become generalized, can become erythroderma

12

T/F
Autoeczematization responds to Rx of the primary site but worsens if primary site worsens

True

13

What is meant by ‘conditioned hyperirritability’?

Skin away from the eczema site is more prone to flare up from irritants than normal skin
o Can be the cause for high proportion of irritant reactions to patch tests and the ‘angry back’ syndrome
o Unclear if this is the real cause of autoeczematisation reactions

14

T/F
Eczematous (spongiotic) drug reactions are a type of Exogenous eczema

False
Classified as endogenous as not due to something contacting the skin

15

What are the clinical appearances of eczematous drug eruptions?

Localized eczema
Generalized eczema (AD-like)
seb derm-like
Erythroderma
Pompholyx (esp IVIg)
Baboon syndrome subtype of ‘systemic contact-type dermatitis (medicamentosa)’

16

T/F
SDRIFE is the same thing as Baboon syndrome as a presentation of systemic contact dermatitis

False
Look the same and both called Baboon syndrome but Symmetrical Drug-Related Intertriginous and Flexural Exanthema (SDRIFE) is a clinical pattern of drug reaction caused by a normal oral drug exposure not oral ingestion of a contact allergen

17

T/F
Phenytoin is a classic cause of a widespread eczematous eruption which can involve flexures resembling atopic dermatitis

False
this is Carbamazepine

18

T/F
IVIg can cause cheiropompholyx

True

19

What is systemic contact-type dermatitis (medicamentosa)?

AKA ‘systemically reactivated contact dermatitis’ or ‘systemic contact dermatitis’
whereby a rash is precipitated by ingestion of a drug or compound to which the patient has a contact allergy due to prior physical contact of the same or a related compound
Can present as Baboon syndrome or another clinical pattern

20

What are the causes of systemic contact dermatitis?

Many
People sensitive to balsam of Peru can get rcns to ingested Cinnamon, vanilla, cloves or inhalation of tincture of benzoin
Pts sensitized to nickel, chromium, parabens, propylene glycol or sorbic acid can get rcns when these are ingested

21

Which allergens are associated with the Baboon syndrome presentation of systemic conatct dermatitis?

Nickel, chromium, balsam of Peru

22

T/F
systemic contact dermatitis often first or most severely affects site of prior ACD

True

23

T/F
systemic contact dermatitis is often symmetrical

True

24

T/F
Contact sensitization to neomycin can result in systemic contact dermatitis when gentamicin is given

True
also if given systemic neomycin

25

T/F
Contact sensitization to thiurams can result in systemic contact dermatitis when aminophylline is given

False
when disulfiram is given

26

T/F
Contact sensitization to ethylenediamine can result in systemic contact dermatitis when aminophylline is given

True
also when cetirizine or hydroxyzine given

27

T/F
Sorbic acid is found in foods such as strawberries, sweets, margarine and cheeses

True
can cause systemic contact dermatitis if contact allergy to sorbic acid

28

T/F
marinated fish products, jams and jellies, pickles and preserves contain parabens

True
can cause systemic contact dermatitis if contact allergy to parabens

29

T/F
Contact sensitization to propylene glycol can result in systemic contact dermatitis when antihypertensives are given

False
antihistamines

30

What are the top causes of eyelid dermatitis?

Atopic
Seborrhoeic
ACD esp nail varnish/acrylics, fragrance, make up, rubber, eye drops

31

T/F
Eczema craquele only occurs on the legs

False
Mainly on legs esp shins but can be arms and hands, lower flanks or posterior axillary line
can generalize

32

What are ‘parchment pulps’

dry and cracked fingertip pulps – maintain a depression after pressing

33

T/F
Discoid eczema can complicate Eczema craquele

True

34

T/F
Eczema craquele is not itchy

False
very itchy esp at night

35

What is the treatment of Eczema craquele?

soap free wash
BD greasy emollient (paraffin, petrolatum, lanolin, ceramide or urea)
may need weak-mod TCS to settle any inflammation
May need to reduce heat and increase humidity at home
Avoid long or hot baths

36

T/F
Chronic superficial scaly dermatitis is a prelymphomatous eruption

False
Thought to be abortive type of CTCL esp if clonal lymphocytic infiltrate

37

Whta is the difference if any between Chronic superficial scaly dermatitis and prelymphomatous eruption

Prelymphomatous eruption can look very similar but has finer scale, more angulated patches and is more itchy
Also histo shows spongiosis and minimal infiltrate in benign Chronic superficial scaly dermatitis but is more towards MF in prelymphoma eruption

If develop atrophy or reticulate pigmentation reclassify as ‘prelymphomatous poikiloderma’

38

T/F
Chronic superficial scaly dermatitis is the same as Small plaque parapsoriasis and digitate dermatosis

True
Digitate dermatosis is a variant which presents as elongated finger-like patches symmetrically distributed on flanks

39

T/F
Patches of Chronic superficial scaly dermatitis measure less than 5cm in diameter

True
except in digitate dermatosis

40

What is the natural history of Chronic superficial scaly dermatitis?
what is the treatment?

Persist for years or decades
Resistant to sustained remission
Risk of progression to MF is from zero to
May transform to prelymphomatous eruption with an increased risk of progression to MF
treat with emollients, TCS, UVB

41

T/F
symmetrical rash on borders of fingers is a characteristic dermatophytide reaction to tinea pedis

True

42

T/F
dermatophytide persists even when the fungus is treated

False
resolves

43

T/F
dermatophytide can cause other reactions than eczema at distant sites

True - but v rare
Pit rosea
EN
EAC
urticaria
erythroderma

44

T/F
Patients with discoid eczema often have some more typical eczema elsewhere

True

45

T/F
Patients with discoid eczema always have a history of atopic dermatitis

False
often do but not always

46

T/F
Discoid eczema is rarely itchy

False
very itchy

47

T/F
Discoid eczema can look annular

True

48

T/F
Discoid eczema can resemble HSV

True
can be group of vsicles on erythematous base

49

T/F
Discoid eczema of the hands affects the palms resembling pompholyx

False
discoid hand eczema affects dorsa and fingers

50

T/F
Discoid eczema is symmetrical

True
Often unilateral initially and then develop mirror image lesions on other side after some time

51

T/F
Discoid eczema may be triggered by staph aureus colonization of eczema

True

52

T/F
Discoid eczema can koebnerize

True

53

What are some triggers for discoid eczema?

staph aureus colonization of eczema
depilating creams
aloe vera
mercury
systemic drugs - methyldopa, gold
think of 'Gold coins'

54

T/F
Discoid eczema affects children or older adults

True
kids often have AD

55

T/F
Discoid eczema is prone to superinfection and is often resistant to treatment

True

56

Discoid eczema treatment ladder?

General measures
Rule out drug trigger
BetC or BOZ+C good
Betnovate in coal tar also useful for chronic treatment
Infective flares may need antibiotics – erythro recommended in Rook
Patch test in resistant cases
For resistant cases – oral pred, other immunosuppressents UVB, PUVA

57

What is Sulzberger-Garbe disease?

= Exudative discoid and lichenoid chronic dermatosis or Oid-Oid disease
Variant of discoid eczema
Widespread eruption
Mainly affects adult jewish men age 40-60
Unknown aetiology
Discoid lesions with both exudative and lichenified (not lichenoid) phases which occur alternately or together
Can be accompanying scattered round urticated lesions
Very itchy
Penile and scrotal lesions are common and pathognomonic; also most persistent
Can blood eosinophilia or gynaecomastia
Treatment resistant
Can use oral pred or AZA
Runs chronic course for months or years then resolves

58

T/F
Sulzberger-Garbe disease is discoid and lichenoid

False
discoid and lichenified not lichenoid

59

T/F
Penile and scrotal lesions are common and pathognomonic of Sulzberger-Garbe disease

True

60

T/F
Blasckitis is a rare, spontaneously reslving eczematous eruption in a blasckoid distribution in adults

True

61

T/F
Hand dermatitis is twice as common in men

False
twice as common in women

62

T/F
Hand dermatitis affects 2-5% population at any one time

True

63

T/F
AI Progesterone dermatitis can present as Hand dermatitis

True
Including pompholyx

64

T/F
10% of adults with eczema have some component of hand dermatitis

False
60%

65

T/F
Atopic hand eczema has the worst prognosis of all hand eczema types

True

66

What are the aetiological types of hand dermatitis?

Usually multifactorial
Endogenous causes;
o Idiopathic
o Dyshidrotic – exacerbated by excess sweating
o Progesterone dermatitis
o Atopic
Exogenous causes
o Irritant contact
Chemical – soaps, detergents, solvents
Physical - friction, minor trauma, cold air, dry
environment
o Allergic contact
Delayed hypersensitivity (type 4) – e.g. chromium,
rubber, epoxy glues
Immediate hypersensitivity (type 1) - latex, seafood
o Ingested allergens - systemic contact dermatitis
o Infection - exacerbates
o Secondary dissemination – autoeczematisation or Id reaction

67

T/F
Most cases of hand dermatitis have arecognisable morphological type

False
Most hand dermatitis is patchy and vesiculosquamous
1/3 has a recognisable morphological variant

68

What are the morphological types of hand dermatitis?

Apron eczema
Chronic acral dermatitis
Discoid eczema
Fingertip eczema
‘gut’ eczema
Hyperkeratotic palmar eczema
Pompholyx
Ring eczema
Keratolysis exfoliativa (Recurrent focal palmar peeling)
Wear & tear dermatitis
Contact urticaria
Others

69

T/F
Apron eczema type of hand dermatitis is usually due to ACD

False
Can be irritant, allergic or endogenous

70

T/F
Chronic acral dermatitis involves High IgE but no Hx of atopy

True

71

T/F
Chronic acral dermatitis responds well to TCS

False
poor response to TCS
responds to pred

72

T/F
Chronic acral dermatitis Is a hyperkeratotic papulovesicular eczema of hands and feet

True

73

T/F
Fingertip eczema involving most fingers on dominant hand is usually due to allergic contact dermatitis

False
this pattern is usually cumulative irritant dermatitis - soaps and trauma

74

T/F
Fingertip eczema involving first 3 digits on either hand is usually occupational

True
Can be irritant or allergic
Often dominant hand but may be non-dominant if due to foods e.g. onion, garlic
Patch test often positive

75

T/F
Gut eczema starts in web spaces and spreads down sides of fingers

True
Due to contact with entrails in slaughterhouses esp pigs

76

T/F
Hyperkeratotic palmar eczema mainly affetcts young men

False
middle aged or older men are main sufferers

77

T/F
Hyperkeratotic palmar eczema can look alot like psoriasis

True

78

T/F
Hyperkeratotic palmar eczema is often resistant to treatment

True
TCS
Crude coal tar
Salicylic acid
PUVA
Grenz rays

79

T/F
Keratolysis exfoliativa can be precursor of pompholyx

True

80

T/F
In ring eczema the pt usually patch tests positive to metals in the ring

False
Usually negative
?due to build up of soap etc under ring and microtrauma

81

T/F
Asteatotic hand eczema is usually due to a genetic defect

False
= wear and tear eczema
Combination irritant dermatitis, asteatosis and microtrauma
Often seen in cleaners and housewives
Can be co-exisiting fingertip or ring eczemas
Skin is dry and red with superficial white cracks criss-crossing surface

82

T/F
Asteatotic hand eczema is the dame as dyshidrotic hand eczema

False
Asteatotic is very dry, wear and tear eczema
Dyshidrotic eczema is pompholyx

83

T/F
dyshidrotic hand eczema is due ti abnormality of the eccribe sweat glands

False
although 'dyshydrotic' means abnormal sweat there is no proven connection with sweat gland activity

84

T/F
Pompholyx accounts for 5-20% of hand eczema cases

True

85

T/F
Pompholyx is an endogenous eczema and is idiopathic

False
Its a clinical pattern of eczema but aetiology can vary
May be endogenous or exogenous

86

What are the causes of pompholyx?

Atopy 50%
ACD esp to PPD, benzoisothiazolinones, dichromates, perfume/fragrance, balsam of Peru
Autoimmune progesterone dermatitis
Autoecematization of a primary ACD of the feet
Id rcn - dermatophytide or bacteride
Drug eruption – aspirin, OCP, IVIg
Systemic contact-type dermatitis esp to neomycin ingestion in pts with leg ulcers previously treated with topical neomycin

87

T/F
Cigarette smoking increases risk of Pompholyx

True

88

T/F
Pompholyx is primarily a bullous disease

False
vesicular but can get bullae as skin is thick allowing vesicles to enlarge

89

T/F
Pompholyx classically is crops of vesicles on an erythematous base

False
erythema usually not a feature

90

T/F
In Pompholyx 50% of cases involve hand and feet

False
80% palms only
10% soles only
10% both
nearly always symmetrical; if asymmetrical think of contact derm

91

T/F
Pompholyx classically desquamates then resolves in 2-3 weeks and recurs at varying intervals

True
Some people prefer the term chronic vesicular dermatitis if it continues and doesn’t resolve and recur periodically

92

T/F
Pompholyx is always confined to the palmar or plantar surfaces

False
can spread to dorsa of hands and fingers and can involve nails;
Dystrophy, transverse pitting and ridging, thickening or discolouration

93

What is the prognosis of pompholyx?

1/3 don’t recur
1/3 recur
1/3 chronic course

94

What is the approach to investigation of pompholyx?

Careful Hx for contact allergens, food, medicaments and regularity of flares
Examine feet/legs for tinea and elsewhere for bacterial and dermatophyte infections
Should patch test all cases

95

T/F
Chronic continuous cases of Pompholyx can become hyperkeratotic

True
coal tar + steroid good

96

What is the approach to treatment of pompholyx?

General hand dermatitis measures
In acute phase;
o Rest hands and/or feet from use
o Soak 3-4x per day in Condys crystals
o Aspirate large bullae
o Zinc cream
Then start potent TCS in subacute phase
Consider need for oral pred
Low dose MTX or XRT for refractory cases
antibiotics if infected
coal tar + TCS if hyperkeratotic

97

T/F
Dermatophyte, Psoriasis and autoimmune blistering disease should be considered in the differentials for Pompholyx

True
BP, linear IgA disease, Pemph gestationis, paraneoplastic pemphigus, anti-p200 pemphigoid

98

T/F
Smokers have worse occupational hand eczema than non-smokers

True

99

T/F
Smokers hand eczema readily responds to treatment

False
more likely to be resistant

100

T/F
Smokers miss more work time due to hand dermatitis and are more likely to become unemployed

True

101

T/F
Men are more likely to suffer occupational consequences of hand eczema than women

False
women more likely

102

Which factors predict poor prognosis in hand dermatitis

atopic dermatitis
widespread eczema
severe disease at presentation
frequnt flares

103

T/F
acrylates and epoxy resins can penetrate vinyl and rubber gloves

True

104

What is Rx ladder for hand dermatitis?

Full exam and work up - exclude DDs
Usually patch test
Rest hands
stop smoking
Avoid soap and irritants and friction
Condys soaks
Emollient++
Gloves for hand work
potent TCS +/- occlusion
Topical tacrolimus
Resistant patches may need ILCS
Tar on non responding chronic cases e.g. 5% crude coal tar
Sal acid if hyperkeratotic
PUVA – systemic or topical
UVB
Superficial Xrays – pt can safely have 3 course of 3Gy of superficial Xrays in their lifetime
Alitretinoin - not in Aus
Acitretin sometimes useful
CsA
Can use Zinc paste or Friars balsam to seal fissures
Treat infected flares with antibiotics
For resistant cases consider metal in diet causing systemic contact dermatitis – can use oral chelating agent

105

T/F
In hairdressers, localized interdigital dermatitis is a precursor for hand dermatitis

True

106

T/F
hand dermatitis can resolve quickly if an avoidable causative contact allergen is identified

True

107

T/F
Infective eczema clears when the triggering infection is treated

True

108

T/F
Raised CRP can help differentiate infected from colonized eczema

True

109

T/F
neuts, microvesicles and subcorneal pustules can be a feature of infective eczema

True

110

T/F
Infective eczema caused by staph or strep is associated with HTLV-1

True
this is a particualr type mainly seen in afro-caribean kids

111

T/F
Juvenile plantar dermatosis affects girls more than boys

False
boys more
esp age 3-13

112

T/F
Juvenile plantar dermatosis is more common in kids with atopy

False
but in atopic kids the hands may be affected

113

T/F
Juvenile plantar dermatosis affects the weigh beairng parts of the feet

True

114

T/F
Histo of Juvenile plantar dermatosis shows a severe spongiotic dermatitis

False
usually mild
may show blocked sweat ducts

115

What are the main DDs of Juvenile plantar dermatosis?

ACD
moccasin tinea pedis

116

What are the treatments for Juvenile plantar dermatosis?

Usually clears spontaneously
Wear cotton socks and leather shoes, avoid non-porous footwear
WSP, tar, urea, Lassar’s paste (sal acid in zinc paste)

117

T/F
Juvenile plantar dermatosis can persist into adulthood

True
but rare

118

What is dermatogenic enteropathy?

malabsorption due to severe eczematous inflammatory skin disease

119

What are the causes of photosensitive eczemas?

Hot (sun) CHIP
Carcinoid syndrome
Hartnup disease
Isoniazid
Pellagra

120

What is Meyerson’s naevus / Meyerson’s phenomenon

Halo of dermatitis around a naevus or other benign lesion
• Resolves spontaneously in few months
• Naevus remains

121

T/F
Pityriasis alba always presents with other features of atopic dermatitis

False

122

T/F
Pityriasis alba clears in 3-4 months

False
Often last many months, on face often over a year

123

T/F
Erythema and scale may be features of Pityriasis alba

True
often precede hypopigmentation and may persist

124

What are the associations of Seborrhoeic dermatitis?

Parkinsons
HIV (1/3 of HIV pts)
mood disorders
NB Can improve with levadopa Rx in Parkinson’s

125

T/F
Sebum excretion is increased in seb derm

False
normal in males and reduced in females

126

T/F
Seborrhoeic dermatitis can extend beyond scalp margins onto forehead

True
= ‘corona seborrhoeica’

127

T/F
Seborrhoeic dermatitis Can cause otitis externa or blepharitis

True

128

T/F
Seborrhoeic dermatitis can form annular lesions

True
Petaloid seb derm - small annular areas close to each other

129

T/F
Severe persistant scalp seb derm can cause non-scarring alopecia

True

130

T/F
Seborrhoeic dermatitis cannot generalise

False
Some get a generalised erythrosquamous eruption which is typically pityriasiform but more extensive than pit rosea
can cause erythroderma

131

T/F
Seborrhoeic dermatitis at genital sites can be same as elsewhere, red with minimal scale or more psoriasiform

True

132

T/F
Seborrhoeic dermatitis always worsens in sun

False
often flares it initially then later sun may help

133

T/F
Seborrhoeic dermatitis and rosacea together is common

True

134

T/F
Seborrhoeic dermatitis in HIV has more follicular involvement and more plasma cells + more malassezia

True

135

T/F
What are main histo features of Seborrhoeic dermatitis?

SNP - sullivan Nics pathology
Spongiosis - mild
may be Neuts in horn
Parakeratosis ‘lipping’ the edges of follicles
Little or no parakeratosis in between follicles

136

T/F
Washing with soap is recommended in seb derm

True
malassezia live on sebum (lipids) - soap best to get rid of this

137

What is treatment ladder for seb derm?

Pt education - chronicity
Wash BD with soap and water
Azole antifungals +/- weak-mod TCS
weak tar or sulphur can help;
- 2% LPC cream
- 3% sulphur +/- 3% salacid cream
TCNI if requiring frequent TCS
oral terbinafine or itraconazole if resistant
Pred low dose if severe/generalized
Scalp;
Azole (ketoconazole 2%), selenium sulphide, zinc pyrithione or tar shampoos
5% sal acid for severe scalp involvement

138

What organism is responsible for Pityrosporum folliculitis?

malassezia Spp.
In yeast form only - no hyphae
Usually M. furfur but also globosa

139

In whom is Pityrosporum folliculitis most common?
What are risk factors?

women slightly more than men
Down's syndrome
Immunosuppressed, diabtes
after antobiotics esp doxy
pts with acne
pregnancy, OCP
stress

140

T/F
Pityrosporum folliculitis affects the upper trunk with itchy follicular papules and pustules which look like acne except no comedones, cysts or scars

True

141

What are DDs of Pityrosporum folliculitis?

steroid folliculitis
acne

142

T/F
Pityrosporum folliculitis usually responds to azole creams

True - but often recurs
apply twice a week for 4 wks. Wash off after 15 mins
rare cases need oral itraconazole 200mg/day for 1 week
Nb Dont use terbinafine or griseo - not effective
regular azole cream, shampoo etc may allow longer remission

143

T/F
Venous eczema only occurs if there is increased venous pressure

True

144

T/F
Lateral malleolus is the classic starting point of Venous eczema

False
medial malleolus

145

T/F
Venous eczema can have a sudden onset

True

146

T/F
Venous eczema only affects the legs

False
can occur in fatty pannus of obese abdomen or around AV fistula site
Other leg can develop autoeczematisation even if not involved primarily
Can be generalized eczematisation, can be erythroderma

147

T/F
Venous eczema has highe rate of secondary infection and medicament ACD

True

148

T/F
For infected stasis eczema topical antiseptics +/- systemic antibitoics are preferred to topical antibiotics

True

149

What are the features of post thrombotic limb/ deep venous insufficiency ?

varicose veins, dilated superficial veins, (woody) oedema, purpura, haemosiderin, ulceration, telys, atrophie blanche, lipodermatosclerosis

150

What is Prurigo Pigmentosa?

Rare eruption of Itchy red papules on trunk and neck, can be vesicles
Affects adult females in spring and summer esp in japan; rare in western world
Lesions coalesce and turn into reticular erythema and then hyperpigmentation
Unknown cause. Pts may have diabetes or anorexia
Can have blood eosinophilia
Treat with minocycline 200mg/day or erythromycin

151

T/F
The incidence of atopic dermatitis in the western world is about 2%

False
10%

152

T/F
Elevated IgE is found in nearly all cases of atopic dermatitis

F
80% of atopics have high IgE, 20% normal
50% of infants with eczema have normal IgE but only 5% of adults
15% of normal people have high IgE

153

T/F
Sensitvity to M furfur may play a role in atopic dermatitis restricted to the face

True
Look for Malassezia specific IgE on RAST/positive skin prick to Malasseza components – if so, try oral anti-fungal (itraconazole)

154

T/F
Spongiosis is an important feature of chrinic atopic dermatitis

False
spong more in acute
Psoriasiform hyperplasia is most important finding in subacute and chronic eczema

155

T/F
The dirty neck seen in atopics is due to melanin incontinence

True
reticulate pigmentation due to longstanding eczema

156

What is Hertoghe sign?

thin/absent lateral eyebrows in stopic dermatitis

157

T/F
Most cases of infantile atopic dermatitis are present at birth

False
onset is rarely prior to age 2 months

158

T/F
Involvement of the napkin area is common in atopic dermatitis

False
rare

159

T/F
In infants the face is often first site involved in atopic dermatitis

True

160

T/F
Follicular lichenified papules can be seen as a feature of atopic dermatitis in asian and dark skinned children

True

161

T/F
In adults genital and nipple pruritus can be a feature of atopic dermatitis

True

162

T/F
Hand involvement is rare in children with atopic dermatitis

False
A patchy, vesicular and somewhat licheniifed eczema of the hands is a common manifestation of atopic dermatitis in childhood

163

T/F
In atopics the risk of anaphylactic drug reactions is increased

True

164

T/F
In atopics the risk of non-type 1 drug reactions is increased

False

165

T/F
Dennie-Morgan infraorbital folds are specific for atopic dermatitis

False
non specific

166

T/F
The incidence of cataracts is increased in atopic dermatitis

True
Uncommon overall but up to 10% of severe AD pts

167

T/F
In up to 80-90% of individuals the onset of atopic dermatitis is prior to 5 years of age

True

168

T/F
Atopic dermatitis shows little tendency to improve during childhood

False
improves during childhood but may relapse at adolesence
50-80% clearance within 20 years

169

T/F
The recommended concentration of topical tacrolimus for children is 0.1%

False
0.03% for children if over age 2 years
Use 0.1% for adults
Pimecrolimus (1%) for children over 3 months

170

T/F
Breast feeding reduces the risk of atopic dermatitis

True
Or possibly true - evidence that it may do
Also;
Early avoidance (first 6 mths) of food (milk, soy, peanuts, wheat, fish) and aero allergens may prevent developing allergy
Extensively hydrolysed cows milk formula rather than cows milk or soy formulas
Pro or pre -biotics for preg mum or child up to age 4 may also help reduce AD development

171

T/F
Non atopics make IgG to housedustmite but atopics make IgE

True

172

T/F
If pt has eczema alone IgE may not be that high but usually very high if asthma and/or hayfever

True
Raised IgE is a marker of atopy

173

T/F
Many AD pts have IgE mediated allergy to components of their own sweat

True

174

What are intrinsic and extrinsic eczema?

Eczema with raised serum IgE has been called extrinsic atopic dermatitis whereas eczema with normal IgE sometimes called intrinsic eczema/AD
not recommended terminology

175

T/F
The skin of pts with eczema has reduced defense against staph, malasezzia and herpes virus

True
may be due to imbalance in favour of Th2 T-helper profile
alos at increased risk of; HPV warts, vaccinia, coxsackie A, molluscum and fungal infection

176

T/F
eczema pts are prone to vasoconstriction of small skin vesssels resulting in cold extremeties and white dermatographism

True

177

T/F
Sedating anthistamines mainly help eczema by reducing pruritus

False
mainly by sedation
But mast cells and histamine do play a role in eczema

178

T/F
The itch of atopic derm responds quickly to cyclosporin

True

179

T/F
Targeting the histamine HR4 receptor in addition to the HR1 receptor and targeting IL-31 may be future strategies to reduce histamine-related itch in AD

True

180

T/F
Low but not high vitamin D increases suceptibility to eczema

False
both low and high vitamin D increases suceptibility to eczema

181

T/F
Normal skin has a slightly basic pH

False
slightly acidic (pH 5) due to natural moisturizing factor
eczema skin is more basic than normal skin - pH 6

182

T/F
Both soap and bleach are alkali and hence can worsen eczema

True
avoid soap and keep bleach baths short

183

T/F
AD skin has reduced ceramides

True
esp ceramides 1 and 3

184

What are the patho-aetiological factors in eczema?

B-SIMVA (BJD paper 2014)
Barrier dysfunction
Staph colonization
Immune dysregulation
Mast cell histamine release
Vitamin D derangement
Abnormal vascular responses

185

What is the sequence of the atopic march?

Eczema - peaks age 1-2
Asthma - peaks age 5-6
Hayfever - peaks early in second decade

NB food alergy peaks age 1-2 and often resolves before age 5

186

T/F
There is evidence that aggressive control of eczema may somewhat mitigate the progress of the atopic march

True

187

T/F
anaphylactic drug reactions are more common in atopics

True

188

T/F
Protein contact urticaria is rare in atopic dermatitis pts

False
quite common

189

T/F
one quarter of infants with seb derm go on to develop eczema

True

190

T/F
Hand dermatitis affects >50% of adults with AD

True
60%

191

T/F
AIDS can trigger eczema 'recall' in soemone who previously outgrew their AD

True

192

T/F
50% of eczema pts have icthyosis vulgaris and 15% of icthyosis vulgaris pts have eczema

False
other way around

193

T/F
Adult AD pts are at increased risk of fractures

True

194

T/F
AD causes increased skin cancer risk

False
no increase in skin or internal cancers

195

What are the associations of atopic dermatitis?

Atopy - asthma, food allergy, hayfever
Alopecia areata
Hand dermatitis (inc w/ age)
Icthyosis vulgaris
Keratosis Pilaris
Eye problems - cataract, keratoconus
Fractures (adults only)
Contact urticaria
In kids - depression, anxiety, ADHD

196

T/F
atopic derm pts ofetn get keratosis pilaris in the absence of icthyosis vulgaris

True
40% of AD pts get KP
kids get it on cheeks

197

What are the diagnostic criteria for atopic dermatitis?

Modified UK criteria;
'Itch Only Involves His Visibly Dry Areas'
Itchy rash + at least 3 out of 5 of;
Onset before age 2
Involves skin flexures or cheeks if under 10 yrs on History
Visible involvement of flexures or cheeks/forehead/extensors if under 4
Dry skin in last year
Asthma or hayfever or atopy in Pt or 1st degree relative before age 4

198

T/F
AD typically starts after 2 months and before one year

True
60% in first one year, 90% before age 5

199

What are triggers of eczema flare ups?

Infection
stress/habitual scratching
Sweating (thermal or emotional)
Wool (and sometimes other) fabrics
Water/ chlorinated water
Dry weather
Sand
Can flare pre-menstrually
In pregnancy – 50% flare, 25% no change, 25% improve

200

T/F
AD often flares in pregnancy

True
50% flare, 25% no change, 25% improve

201

T/F
Thick scaly scalp/cradle cap after 2 months of age is AD rather than seb derm

True

202

T/F
Infantile AD often involves nappy area

False
usually spared

203

T/F
Asian and black infants may retain extensor distribution eczema until older than caucasian kids

True

204

In addition to eczema kids often have pit alba, lip-licking eczema /upper lip cheilitis, hand dermatitis and juvenile plantar dermatosis

True

205

AD pts may have Icthyosis, KP and hyperlinear palms but not necessarily have icthyosis vulgaris

True
can all occur in AD alone

206

Asian and black kids often get micropapular eczema variant with hypo or hyper pigmentation – lesions are often folliculocentric – look like goosebumps

True
AKA Patchy pityriasiform lichenoid eruption or follicular atopic dermatitis

207

What is ‘atopic red face’?

Adult AD pts with primary facial dermatitis often severe around eyelids

208

What is Hertoghe sign?

thin/absent lateral eyebrows in eczema

209

What is dirty neck?

reticulate pigmentation due to longstanding eczema

210

How may eyes/eye region be affected in eczema?

Conjunctivitis, keratoconus
‘atopic red face’
eyelid only eczema - ichenification is characteristic
Orbital darkening/Panda eyes – grey-brown-violet skin around eyes. Often pale elsewhere
Dennie-Morgan infraorbital folds
Blepharitis

211

What are Dennie-Morgan infraorbital folds?

Start at or near inner canthus, extend ½ to 2/3 width of eye
single or double

212

T/F
nails are usually spared in adult hand dermatitis

True
kids more vesicular and more likely nail involvement – coarse pits and ridges

213

T/F
Half of pts with atopic hand eczema also have foot involvement

True

214

How do your test an eczematous child for potential immunodeficiency?

Immunoglobulin levels and subclasses, total IgE level, FBC, complement profile & function, Tcell, Bcell and phagocyte cell numbers and function tests. Consider also HIV and/or HTLV-1 testing

215

T/F
both RAST and skin prick tests have low specificity and positive predictive value (about 50%) but high sensitivty/negative predictive value (>95%)

True
good rule out tests

216

T/F
severity scoring systems are useful in rotione eczema practice

False
JAAD says not useful
NICE says classify as mild/mod/severe
e.g.
Diepgen
SCORAD – Scoring atopic dermatitis
EASI – Eczema area scoring index
Rajka & Langeland score
Nottingham score

217

T/F
Children with eczema often clear by teens

True
50% clear by teens
many clear by school age
Overall;
50% clear in about 10 years and 85% clear in up to 20 years

218

What are the features of Atopic keratoconjunctivitis?

JAAD paper on this 2014
Chronic (not seasonal) itching, watering, burning pain, blurred vision
Most severe ocular complication – can cause blindness
Suspect esp if eyelid/periorbital eczema, look for red eyes
Urgent ophthal referral - see within days

219

What are the eye complications of eczema?

Blepharitis - common if eyelid AD
Cataracts
Atopic keratoconjunctivitis
Vernal keratoconjunctivitis (cobblestone papillae on upper palpebral conjunctivae)
Keratoconus (conical cornea) – rare, can be assoc w/ AD
Retinal detachment (rare)

220

T/F
stress-responders are pts whose eczema flares when they are stressed

True
'no-stress responders’ have no association between stress and disease course

221

What are the complications of eczema?

Psychological - family dysfunction, school/work problems, relationship problems, social stigma, mental health problesm
Financial - v costly
QoL - impaired for pt and caregivers
Skin - infection, lichenification, prurigo nods, dyspigmentation, erythroderma, hand dermatitis, topical or systemic steroid AEs
Eyes - several
Systemic - sleep disturbance, irritability, poor concentration, growth delay
Other drug AEs including those from alternative medicines

222

T/F
Psychoneuroimmunology is the interaction between nervous and immune systems by hormones, neuropeptides and neurotransmitters

True
a brain-skin connection underlies many inflammatory dermatosis

223

T/F
Stress responses can stimulate mast cell activation

True

224

T/F
AD patients may have a blunted production of cortisol so that CRH release is not switched off by negative feedback

True

225

T/F
Stress causes increase endogenous glucocorticoids and reduced lipid synthesis and impairs skin barrier function leading to flares of AD or other skin disease

True

226

T/F
high perceived stress levels have no effect on barrier recovery rates

False
cause delayed barrier recovery rates

227

T/F
>90% of AD pts experienced itch at least once a day

True
70% do 5x per day
may experience their itch as heat or pain

228

T/F
In AD levels of depression, anxiety and suicidal ideation correlate with disease severity

False
levels are higher than normal but dont corelate with severity

229

T/F
The impact of AD on health related QoL is same as arthritis, diabetes, heart disease, depression or if severe the same as CF or renal disease

True

230

T/F
adults with AD have lower libido

True

231

T/F
It is important to to assess pts mental state and QoL during the consultation for AD

True

232

What info is important to provide at first diagnosis of atopic dermatitis?

Explain diagnosis - written info
Must explain chronicity - need to manage; cant cure
Prognosis - tends to improve
Associations esp atopic march
Usually not diet related but may have food allergies also
advise on triggers and irritants
Establish short and long term goals of treatment
provide written management plan inc managing flares
info on dose and frequency of Rx, how to step up or down
advise on recognistion of infection
where to find further info/ get support

233

What is Therapeutic Patient Education (TPE)?

Educational strategy for pts/carers
Delivered by MDT
For pts with little social support or failed treatment
Tailored to pts educational and cultural background
4 steps;
- Understand pts current knowledge, beliefs etc
- Determine educational objectives with the pt
- Help pt/carer to acquire knowledge and skills – wide range of tools/resources used
- Assess the TPE process
Good evidence for improved disease control and QoL esp for interventions lasting >30 mins

234

T/F
Demonstrating how to apply topicals and wet wraps improves compliance and disease control

True

235

How do you do ‘soak and smear’?
(AJD, 2015)

Apply compress of lukewarm tap or bathwater to area for 10-20 mins then apply TCS

236

T/F
‘soak and smear’ is a useful alternative to wet dressings

True

237

T/F
In eczema pts after a bath topical steroid or emollient should be applied within 10 minutes of drying

False
within 30 minutes max but ideal is within 3-5 minutes

238

T/F
using TCS in evening with emollient in morning can as effective as BD steroid

True

239

Which steroids are more suitable for children under age 1?

Usually moderate and/or mild potency but may need potent
Elocon and advantan/AFO have increased cutaneous metabolism so less systemic bioavailability so better for kids (as have high rates of systemic absorption)

240

T/F
cling film occlusion is a useful technique in eczema

False
use wet dressings for occlusion NOT cling film

241

T/F
can leave wet wraps on for 24 hrs

True
Fine if tolerated
Usually used for up to 12 hrs
often left on overnight

242

What are the side effects of topical steroids?

Irritation and stinging (esp creams & gels or if contain alcohol or propylene glycol)
Skin atrophy, with striae, visible veins and easy bruising
Erythema and telangiectasia
Periorificial dermatitis/ steroid acne
Masking of infection esp tinea
If applied to eyelids; glaucoma, cataracts
Systemic steroid effects and HPA axis suppression

243

What is TCS withdrawal?
(JAAD Hajar et al 2015)

Skin eruption which can occur after using TCS daily. Usually mod or strong potency, rare in mild TCS
Occurs on ceasing TCS or during TCS use and required increase use/strength to prevent it
Well demarcated erythema with burning/stinging
Half of pts get papules/nodules/pustules
2 broad subtypes - about half of all pts in each subtype;
- Papulopustular subtype – erythema, papules, pustules – often TCS used for cosmetic reason or acneiform disorder
- Erythematoedematous subtype – burning erythema and oedema – often TCS used for eczema or seb derm
May be itch, pain, hot flushes and exacerbations with sunlight or heat

244

T/F
Most pts with steroid addiction/withdrawal have positive patch tests to a topical they are using

False
15% do
may be the TCS or another topical

245

How do you manage TCS withdrawal?

stop steroids
supportive cares – cold compresses, consider antibiotics if papular
Consider APT
consider a weaker TCS which the pt has not had a positive patch test to in order to wean off

246

T/F
topical calcineurin inhibitors increase risk of skin cancer

False
No proven risk of lymphoma or skin cancer

247

How do you prepare a bleach bath?

White King bleach 4%, 12mls in 10L warm water (not hot)
- fill bath with 10L bucket first time and mark level
bath for up to 15 mins
Can add 100g pool salt per 10L and/or 1-2 capfuls of oil per bath
RCH Melbourne advise; daily for one month; 3x/wk for 1 month; weekly for 1 month

248

Are topical antimicorbials useful in eczema?

Fucidic acid and bactroban not of use except nasal bactroban for eradication (Rook)
Mupirocin can be used alone in localized infections (BJD, 2014)
Clioquinol useful - can use with TCS; Hydroform or compounded

249

T/F
You should rinse off the bleach after a bleach bath

False
do not rinse

250

What are some trigers to avoid in eczema?

Mechanical – rough textiles, wood
Physical – car exhaust, tobacco smoke
Biological – pets, HDM, pollen, microbes
Chemical – acids, alcohol, solvents, bleaches, some foods/additives, vasoactive amines

251

T/F
emollients alone can settle acute eczema

False
Emollients can irritate acutely inflamed skin and increase risk of infections - settle acute flare before suing emollient

252

T/F
Potent or superpotent TCS cream is mainstay for (wet) acute eczema flares

True
Some pts w/ very acutely inflamed lesions will not tolerate TCS alone and need wet wrap therapy with potent TCS cream for several days

253

What is 'proactive' or 'hot spot' Rx? why is it used?

Apply TCS or TCI twice a week to previously affected areas and emollient only to non-affected areas
– results in reduced flare incidence and duration and improved QoL

254

T/F
tachyphylaxis occurs with antihistamines

True
take a break every 2 weeks

255

T/F
CsA is better tolerated in kids than adults

True
‘Drug of choice for refractory AD’ (BJD)
In kids kids check BP and U&E every 2 weeks for first 3/12 then monthly

256

T/F
A 3-6 month course of CsA is often sufficient to gain control in kids with eczema

True
Start at 3-5mg/kg/day (often 5) and wean down to lowest effective dose if acute, otherwise can start low and work dose up

257

T/F
CsA is 1st line for long term systemic in AD

False
AZA 1st line if long term systemic needed
Usually in kids about 2.5 mg/kg/day but up to 4 (higher than adults)

258

T/F
AZA causes photosensitivty

False
but increases risk of skin cancer so avoid sun

259

T/F
nbUVB in eczema uses same protocol as in psoriasis

True

260

Eczema is a stronger risk factor for food allergy than asthma

False
other way around

261

T/F
Food can aggravate eczema in 10-35% of young children

True
Food allergy may result from and aggravate eczema rather than ‘causing’ it

262

Which 6 foods account for >90% of childhood food allergies which can aggravate eczema?

Eggs (most often reported to flare AD)
Milk
Peanuts
Soy
Wheat
Fish

263

T/F
Milk and soy allergies tend to persist

False
(tree) nuts, fish and shellfish allergies tend to persist
other resolve in childhood

264

When to test for food allergy in AD?

US JAAD guidelines – can consider limited food allergy testing to 6 highest risk foods if pt is under 5 and has mod-severe eczema and
o Fails to clear despite optimized topical therapy; Or;
o Reliable Hx of immediate allergic reaction after ingesting a specific food; Or;
o Both of above

265

T/F
In AD with food allergies if cows milk an issue try extensively hydrolysed formula or amino acid formula rather than soy as can also be allergic to soy

True

266

T/F
Strong evidence that breast feeding prevents eczema

False

267

What is the most important inhaled allergen for eczema?

Housedustmite antigen

268

T/F
TCS are the most common contact allergens in atopic dermatitis allergic contact dermatitis

False
Most common are;
Nickel, neomycin, fragrance, formaldehyde and other preservatives, lanolin and rubber chemicals

269

What is protein contact dermatitis?
what are the causes?

= contact urticaria
Allergy to contact with plant or animal proteins
causes initial urticaria within 30mins then a dermatitis like eczema which can be acute or chronic
E.g. fruit/veg, grain, latex, meats, fish, mites, insects, nuts, spices/herbs, animal dander/hair/saliva/urine

270

T/F
probiotics help restore a normal skin microbiome in eczema

False
no evidence of benefit
It is unclear if gut microbiome impacts on skin microbiome

271

T/F
Evening primrose oil helps reduce itch in eczema

False
no evidence of benefit

272

T/F
consultations with dermo for eczema usually meet patients expectations

False
data from UK;
Only 19% of initial eczema consultations w/ dermatologist met pt expectations in UK
Only 50% of pts satisfied with the treatment given

273

Why do eczema pts get por outcomes/ treatment failure?

AJD review paper Sokolova, 2015 (NSW);
- Treatment regimes too complex and time consuming
- Lack of understanding of what different topical are and when and how to use them
- Health related QoL is impaired for both eczema kids and caregivers – negatively impacts on adherence
- Patient/carer dissatisfaction – less likely to adhere if not involved in decision making
- White coat compliance
- Long follow up results in lower rates of compliance
- Corticosteroid phobia – >80% of parents worried about effects of steroids
- Use of complementary and alternative medicines

274

What steps should you take if eczema pt fails to respond?

Take Hx of triggers/ change in behaviours
Check compliance and assess for steroid phobia
assess for infection (and infestation)
Consider an alternative or additional diagnosis;
Irritant CD
ACD
Protein contact dermatitis
Photo allergic contact, phytophoto, photo-drug etc
Other – lupus, DH, MF, nutritional deficiency, immune deficiency
Drug eruption
Consider investigation - food diary, APT, RAST, skin prick
Finally consider escalating Rx

275

What is ‘white coat compliance’ ?

medications (esp TCS) are used most around the time of clinic visits but rapidly drop off after opd until shortly before

276

T/F
Fibulin is the major gene mutation in eczema

False
FLG gene which codes for fillagrin
Different populations display different mutations at different frequencies = ‘ethnospecific profiles’

277

T/F
Bathing without subsequent emollient leads to dry skin

True

278

T/F
HPA axis suppression is highly unlikely in kids with eczema even with long use of TCS

False
HPA axis suppression can occur quickly in children even with low or moderate strength TCS
Try to keep courses to under 3 weeks
acute flares need Rx for 1-2 weeks

279

What methods can be used to improve treatment adherence in AD?

Optimize relationship between Dr and patient/caregiver
Education – can’t have too much! E.g. handouts, demonstration, nurse-led training sessions, videos, workshops
Particular education about TCSs
Written eczema action plan
Encouragement strategies – sticker charts for kids, texts for teens etc
Early and frequent follow up
Emphasize improved QoL for whole family if better disease control is gained

280

What are the 5 Pillars of AD management?

Eczema is a 'Cycle RACE'
1. Tackling itch-scratch cycle
2. Rebuilding and maintaining optimal barrier function
3. Avoidance/modification of environmental triggers
4. Clearance of inflammatory skin disorders
5. Education and empowerment of Pt/caregiver

281

T/F
Moisturizers act as topical steroid sparers reducing need for TCS

True

282

T/F
Moisturizer and emollient mean the same thing

False
Moisturizers have varyng amounts of these properties;
Occlusive (prevent water loss)
Humectant (trap moisture in SC)
Emollient (lubricate)

283

How much moisturizer should be used in AD?

100-200g/wk in kids
200-300g/wk in adults

284

T/F
prescription emollient devices (PEDs) containing ceramides or filaggrin breakdown products are more effective than other moisturizers

False
no evidence for this

285

What is a fingertip unit?

‘amount of topical expressed from tube with a 5mm diameter nozzle from distal skin crease to tip of index finger of an adult’
covers the surface area of a hand (2 palms)
is about 0.5g

286

How many FTUs are needed for the bosy in adults?

Entire body: about 40 units (20g)
One hand: apply one fingertip unit
One arm: apply three fingertip units
One foot: apply two fingertip units
One leg: apply six fingertip units
Face and neck: apply 2.5 fingertip units
Trunk, front & back: 14 fingertip units

287

T/F
Infected skin is a contraindication to TCS

False
No contraindication to TCS in infection but must treat infection

288

When are wet dressings most useful?
when are they not advisable?

Should be used during acute flares in mod-severe eczema with or without TCS
Avoid or use with caution if any infection present

289

T/F
50% of adult pts with eczema carry staph

False
90% carry staph
In 90% of affected areas and 75% of uninvolved areas

290

T/F
there is controversy about the use of topical antibiotics and antimicrobials in eczema

True
AsiaPacific committee doesn’t support topical antiseptics (bleach baths, triclosan, benzalkonium chloride, chlorhex) due to risk of irritation and removal of normal skin commensals
JAAD supports bleach bath w/ intrnasal bactroban as eradication for pts with recurrent clinical staph infections
Rook says never use bactroban except nasally
BJD paper says bactroban can be used alone in localized infections

291

T/F
Phototherapy can be used in children over 12 years

True
not for kids under 12

292

T/F
Oral steroids are never useful in AD

False
Short term oral steroids may be useful – up to 6 wks for acute flares
Don’t use IV or IM steroids

293

What strategies may help Primary prevention of eczema in a baby?

early avoidance of food and aero allergens may prevent developing allergy ie) in first 6 months of life
Early life exposure to endotoxins, farm animals and dogs may be protective
Breast feeding recommended and may reduce AD, also extensively hydrolysed cows milk formula rather than cows milk or soy formulas
Weak evidence that maternal avoidance of milk, eggs and other dietary allergens in pregnancy and lactation can reduce risk of eczema
Pro or pre -biotics for preg mum or child up to age 4 may also help reduce AD development
Early use of emollient can be protective

294

T/F
Eczema herpeticum (Kaposi’s varicelliform eruption) is a more widespread skin involvement than would be seen on normal skin infected with same virus (usually HSV1)

True
Most Herpes infections in eczema pts are localized and not more severe than in normal pts so should not be called KVE but often still called ‘eczema herpeticum’

295

T/F
Eczema herpeticum can be caused by primary or recurrent herpes infection

True
Primary infection more likely to cause malaise, fever and low lymphocyte count

296

What are the risk factors for Eczema herpeticum?

Age – most common in teens and 20s
Early age of onset of AD
High IgE
Severe eczema and asthma
Not linked to TCS or topical calcineurin inhibitors

297

T/F
Eczema herpeticum causes scarring

False

298

What are complications of Eczema herpeticum?

Rare progression to systemic infection – can be fatal
herpes keratitis - must get ophthal consult if close to eyes
meningoencephalitis

299

T/F
In Eczema herpeticum early initiation of antivirals reduces length of hospital admission

True

300

T/F
In Eczema herpeticum should use antivirals early and for at least 7 days

True
IV if severe
also swab for baceria
most dermos give course of Abs empirically

301

T/F
should stop TCS in cases of Eczema herpeticum

False
can continue if on Rx for HSV and also for bacteria

302

Whats the incubation period for HSV/Eczema herpeticum?

about 10 days (5-20)

303

T/F
Immiquimod should be avoided in eczema pts with molluscum

False
can use all treatments
some may be iritating so try to keep off eczema skin

304

T/F
Malasezzia hypersensitivity can be a cause of treatment failure esp in pts with severe facial AD

True
Test w/ skin prick to malasezzia extracts
Rx w/ 2 weeks of oral itraconazole

305

Treatment ladder for atopic dermatitis

General measures - trigger avoidance, education, soap free wash
Emollient - TDS, cream if acute, ung if subacute/chronic
Anti-infectives as required
TCS - BD or OD, up to 3 weeks; stenght depends on pt age and body site; formulation on acuteness; advantan and mometasone safer for infants
soak and smear
wet dressings (both emollient or TCS)
TCNI - short course or as proactive Rx; esp if steroid AEs
+/- sedating antihistamines prn short course
Phototherapy - 2nd line if >12 years
Systemics;
pred - for up to 6 wks to gain control
CsA - for up to 3-6 months
AZA - 1st line for long term Rx - 1-2 yrs. 2.5-4mg/kg
MMF - 2nd line; 25-50mg/kg/day in kids >2yrs
MTX - 3rd line; 7.5-25mg weekly
Rarely needed;
monteleukas
oral/topical sodium cromoglycate
PDE4 inhibitors (Apremilast)
IVIg; 0.5g/kg daily for 4 days each month for min 3/12
IFN gamma - last line
Also consider and treat;
ACD, food allergy, protein contact dermatitis, inhlaed aeroallergens esp HDM
Rx associated depression, anxiety, ADHD
Education and engagement of caregivers is paramount