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Dermatology > Eczema and Dermatitis > Flashcards

Eczema and Dermatitis Flashcards

1
Q

Which group is Atopic eczema most common in

A

Children

Most start in early infancy

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2
Q

What factors contribute to eczema

A

Genetic and environmental
Often involves mutation in the filaggrin gene, overproduction of cytokines or IgE
More common in Western and industrialised areas

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3
Q

What is the biggest trigger for an eczema breakout

A

Stress

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4
Q

What conditions is atopic eczema related to and why

A

Asthma (2+) and hay fever (7+)

Often people with eczema have overreacting Th2 cells that make them sensitive to other triggers

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5
Q

What would be seen under the microscope in skin with eczema/dermatitis

A

Spongiosis - oedema between keratinocytes
Varying degrees of acanthosis
Inflammatory cell infiltrate - superficial

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6
Q

What are the general signs of eczema/dermatitis

A 
Itch 
Ill defined rash 
Erythema 
Scaling
Clustered papulo-vesicles
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7
Q

How do you test for contact dermatitis

A

Patch testing
Use many patches with the most common allergens
May add extras based on history - e.g. patients own products
Assessed at day 3 and 5

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8
Q

Describe irritant dermatitis

A

Very common
Non-specific physical irritation rather than an allergy - direct irritation from a substance
e.g. excessive soap/water exposure
May be caused by occupation

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9
Q

How common is atopic eczema

A

Affects up to 25% of school aged children

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10
Q

What other atopic diseases is eczema associated with

A

asthma, allergic rhinitis (hayfever), food allergy etc

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11
Q

What is the normal distribution of atopic eczema

A

Flexural
In crook of elbow, behind knees etc

In infants it is often on their face and extensors!

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12
Q

What are some chronic changes that occur with atopic eczema

A

Lichenification
Excoriation
Secondary infection

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13
Q

What factors are thought to cause/impact eczema

A

Multiple genetic and environmental factors

  • skin barrier function
  • environment
  • immunology
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14
Q

Where does photosensitive eczema present

A

In sun exposed areas

E.g. hands, above collar

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15
Q

What is discoid eczema

A

The classic eczema erythema and lesions present as well defined circles/ovals
Very itchy
Will be scattered - often on legs
Patients are often atopic

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16
Q

What is stasis eczema

A

occurs secondary to increased hydrostatic pressure, oedema and red cells being pushied out of vessels
Dry skin forms over varicosed veins

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17
Q

What is the common name for seborrheoic dermatitis in infants

A

Cradle cap

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18
Q

What is pompholyx eczema

A

Subtype of eczema
Spongiotic vesicles form - itchy, watery blisters
Skin is itchy with burning sensation, then blisters form. Skin may then dry and peel
Commonly on hands and feet
May be due to irritants

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19
Q

A rash that is never itchy is unlikely to be dermatitis - true or false

A

True

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20
Q

Dermatitis and eczema are synonymous terms - true or false

A

True

They both indicate skin inflammation

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21
Q

Describe the acute phase of dermatitis

A

Fluid accumulation in epidermis - spongiosis

Vesicles and bullae may be seen

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22
Q

Describe the chronic phase of dermatitis

A

The affected area becomes drier and crustier

Thickened skin with prominent skin markings (lichenification)

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23
Q

What is contact dermatitis

A

Dermatitis secondary to external agents - exogenous

May be irritant ( non-immune mediated) or allergic.

24
Q

Which patients are at higher risk of developing contact allergy

A

Chronic skin conditions (particularly leg ulcers) necessitating prolonged exposure to topical treatments ( under occlusion in some cases)

Certain occupations due to repeated exposure to potential allergens - building trade, hairdressing etc

25
Q

The majority of contact dermatitis occurs where

A

On the hands

26
Q

How do you treat contact dermatitis

A 
Future avoidance of the allergen
Symptomatic treatment (emollients, steroids) of the dermatitis as required
27
Q

How can you differentiate between allergic contact dermatitis and irritant

A

Irritant reactions tend to be most prominent when the patch is removed, then fade quickly

Allergic reactions often worsen over the course of the patch testing visits

28
Q

How does irritant dermatitis typically appear

A

Erythema
Papules
Follicular pustules

29
Q

What can cause false negatives in patch testing

A

Insufficient penetration of the potential allergen through the skin - can cause delayed reaction
Too low an allergen concentration
Local or systemic treatment with immunosuppressants (e.g. potent topical steroids, oral steroids, UVB exposure)

30
Q

What is seborrhoeic dermatitis

A

Chronic or relapsing form of eczema/dermatitis that mainly affects the sebaceous gland-rich regions of the scalp, face, and trunk
Seen in babies

31
Q

Describe the appearance of seborrhoeic dermatitis

A

Ill-defined localised scaly patches or diffuse scale in the scalp - salmon-pink, thin, scaly, and ill-defined plaques
Minimal itch most of the time or not itchy

32
Q

At what time of year does seborrhoeic dermatitis typically flare up

A

In winter

Improves in summer following sun exposure

33
Q

Seborrhoeic eczema in babies can evolve into typical atopic eczema - true or false

A

True

Can also develop into psoriasis

34
Q

What are the diagnostic criteria for atopic eczema

A

Itching plus 3 or more
Visible flexural rash (or cheeks/extensors if an infant)
History of flexural rash
Personal history of atopy (or first degree relative)
Dry skin in past year
Onset before age 2 years

35
Q

what is the cardinal symptom of atopic eczema

A

Itching!

Sufferers will often scratch a lot which can make things worse

36
Q

What are some of the risks of persistent skin scratching

A 
Lichenification
Scarring
Pigmentary changes
Habit scratching
Infection
37
Q

What is the function of filaggrin

A

It is a protein found in keratohyalin granules in granular layer of epidermis
Helps in terminal differentiation of cells

38
Q

Mutations in filaggrin genes can lead to which conditions

A

Mutations cause ichthyosis vulgaris and predispose to atopy

39
Q

What factors can exacerbate eczema

A 
Scratching 
Allergens - activate inflammation
Diet - in infants 
Stress 
Infection 
Heat/cold 
Dryness
40
Q

What food allergies are most commonly linked to eczema in children

A

Egg & milk commonest
Typically in infants

Majority of eczema not related to food allergy

41
Q

What type of immune reaction is seen in eczema

A

Eczema is delayed type IV +/- type 1 reactions

42
Q

How do you treat eczema

A 
Liberal emollient use  - ointments, creams and shower emollients 
Topical steroids 
Calcineurin inhibitors 
Wet wraps and bandages 
Phototherapy 
Systemic agents - azith, metho
43
Q

What are the side effects of topical steroids

A 
Skin thinning
Increased skin infections
Telangiectasia & Steroid acne 
Striae - long-term or overuse
Minor systemic absorption
44
Q

How do topical steroids control eczema

A

Anti-inflammatory
Vasoconstrictive
Antiproliferative

45
Q

What type of steroid is hydrocortisone

A

Mild

46
Q

What type of steroid is betnovate

A

Potent

47
Q

What type of steroid is eumovate

A

moderate

48
Q

What type of steroid is dermovate

A

very potent

49
Q

What is third line topical treatment after emollients then steroids in eczema

A

Calcineurin inhibitors such as tacrolimus

Used in moderate cases

50
Q

How are antihistamines used in eczema treatment

A

Not great evidence but used if sleep disturbance or severe itching

Use sedating AH at night to help sleep
Non-sedating AH for day or school-age

51
Q

How do you treat infected eczema

A

Topial fucidin

Consider antiseptics

52
Q

How does eczema herpeticum present

A

Monomorphic rash Circular blisters or crusted erosions

May be umbilicated

53
Q

What is eczema herpeticum

A

Herpes simplex infection in existing eczema

54
Q

how do you treat eczema herpeticum

A

Emergency-needs same day referral

Immediate oral or systemic aciclovir

55
Q

The majority of eczema cases clear in childhood - true or false

A

True - for mild/moderate

Continuous reduction with age

Dermatology (14 decks)

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