Eczema and Itchy Skin

Question 1

What is the definition of eczema?

Answer 1

basically synonymous with “Atopic Dermatitis”

a red, itchy, scaly/flaky, sometimes oozing rash that can affect kids and adults

usually chronic, but frequently kids grow out of it

Question 2

What are the histologic findings of eczema?

Answer 2

inflammatory dermis - lymphocytic perivascular infiltrates

abnormal maturation

acanthotic epidermis

Question 3

What is the distribution of eczema at various ages?

Answer 3

baby - cheeks, trunks, extremities (extensors)

child - antecubital and popliteal fossae (flexors)

teen/adult - neck, flexors, hands and feet

Question 4

What are some theories for the cause of eczema?

Answer 4

genetics

pollution

hygiene hypothesis - our society is not too clean, overreaction of immune system

Question 5

What are some possible causes of eczema?

Answer 5

xerosis

internal or metabolic problems

acute virus infection

contactants

antigen - antibody reaction

acute bacterial infection

sweat retention and scratching

itchy skin

psyche

Question 6

ichthyosis vulgaris

Answer 6

hyperlinear palms, dry pretibial palms

form of very dry skin, can predispose people to eczema

Question 7

What is the role of filaggrin?

Answer 7

filament-aggregating protein

binds to keratin fibers and helps hold cells together and prevents water loss

provides mechanical strength and plays a role in calcium management

degrades to Natural Moisturizing Factor (NMF)

breaks down into organic acids for pH (acid mantle)

Question 8

What happens when filaggrin is mutated?

Answer 8

ichthyosis vulgaris (IV)

8% of eczema patients have features of IV

between 15-56% of eczema patients carry one or more filaggrin null mutations

about 13% of eczema may be due to filaggrin mutations on a population scale

Question 9

What are the areas that should be treated for an eczema patient?

Answer 9

anti-inflammatory

anti-pruritic (itching)

antibiotics

moisturization

Question 10

What are the anti-inflammtory treatments for eczema?

Answer 10

topical steroids are the mainstay of treatment

ointments are generally preferred

Question 11

Stoughton Scale

Answer 11

vascoconstrivtor assay, ranks potency from 1-5

correlates well with clinical effectiveness

Question 12

What are the risks of topical steroids?

Answer 12

atrophy, striae, dyspigmentation, hypertrichosis

hard to damage in < 2 weeks

the risks must be weighted against the benefits

Question 13

What is the maintenance therapy of eczema?

Answer 13

maintenance tacrolimus twice weekly when eczema clears

effective in reducing the number and frequency of disease exacerbations and improving health-related QoL

Question 14

What happens when kartinocytes differeniate in the presence of IL-4 and IL-13?

Answer 14

significantly reduced filaggrin gene expression

Question 15

What is the role of moisturizer in eczema treatment?

Answer 15

correlates with decreased eczema

may be able to preventeczema

Question 16

What are the common antibiotics used to treat eczema?

Answer 16

oral - cephalexin and diclox

muciprocin

bleach

Question 17

What is the role of dilute bleach baths in the treatment of eczema?

Answer 17

study shows that it decreased the clinical severity of eczema significantly at 1 and 3 month visits

may play a role in suppressing bacterial infections

Question 18

What are commonly used antipruritics?

Answer 18

sarna sensitive (1% Pramoxine)

aveeno anti-itch (3% Calamine, 1% Pramoxine HCl, 0.47% Camphor)

hydroxyne or cetirizine

doxepin (TCA)

Question 19

What is allerci contact dermatitis?

Answer 19

type IV (delayed type) T-cell-mediated inflammatory reaction characterized by erythema, scaling, xerosis, and vesiculation, occurring at the site of challenge with a contact allergen in sensitized individuals

takes hours to days to appear and lasts for days to weeks (unlike type I hypersensitivity)

Question 20

What is the treatment for contact dermatitis?

Answer 20

avoiding allergen is key, but first must find it first

can otherwise be treated just like eczema

patch testing - take a tiny bit of chemicals, in a few days take the chamber off

Question 21

What is urticaria?

Answer 21

appears shortly after exposure to offending agent and resolves rapidly after cessation - evanescent!

hallmark - changing within 24 hours, dermatographism

may have cyclical, annular gyrate forms

Question 22

What is the treatment for urticaria?

Answer 22

stop offending agent

monitor for signs of anaphylaxis

epinephrine if indicated

antihistamines

systemic corticosteroids if severe