Eczema and related dermatitis

Question 1

aetiology of eczema

Answer 1

mutlifactorial both genetic and environmetal factors

-50% of severe cases have a mutationin the filaggrin gene

-this gene forms part of the strattum corneum which helps form the skin barrier

Question 2

how is eczema diagnosed 2

Answer 2

clinically
-although total and specific IgE may be raised and aid diagnosis

Question 3

diagnostic criteria for eczema 4

Answer 3

flexural rash

development before the age of 2 (seen in 80%)

FHx

dry skin

allergic sensitation (total and specific IgE)

Question 4

chief characterisitic of eczema 1

Answer 4

itch
-can be unbearable leeding to sleep loss,s tress and depression

Question 5

prinicples of eczema management

Answer 5

restoring the skin barrier

avoiding irritant and allergens

reducing inflammation

trying to reduce itch

Question 6

what can itching in eczema lead to 3

Answer 6

excoriation (which further disrupts the skin barrier)

infection

lichenifiication (thickening of the skin)

Question 7

barrier protection managemnt in eczema

Answer 7

bathe daily

use the greasiest emolloient tollerated (ointments)

-generally use a greasy emollient at night and cream during the day
-if greasy ointments are felt to be too messy for day time

Question 8

overview of priniciples of eczema managemnt 4

Answer 8

improving barrier

avoiding irritants and allergens

reducint in itch and scratchin

topical steroids

Question 9

prinicples of avoiding irritatns and allergens in eczema

Answer 9

these aggrevate eczema
-include soap perfumes and individualised allergens

heat and sweating aggrevates eczema so child and bedroom should be kept cool

Question 10

prinicples of reduction in itch and scratcing for eczema 4

Answer 10

dryness will contribute to itch so ensure well moisturied

sedative anti-histamines

cotton garmnets/scratch mits

keep nails schort

-scratching will cause release of histamiens and other chemicals into the skin which causes further ithcing (itch scratch cycle)

Question 11

when should topical steroids be used in eczema 2

for the following steroid potentencies give an example
mild
moderate
potent
very potent

Answer 11

short burts for active areas
-either flares only or additionally twice weekly if there are chronic pathces that do not clear

steroid potency
mild-hydrocortison (0.5-2.5%)

moderate betamethasone 0.025

potent Fluticasone 0.05

v potent clobetasol PROPIONATE 0.05

Question 12

topical steroid regime for body in eczema

Answer 12

medium potency for 7 day for flares
-then 2-3 times weekly in chronic areas

*-if not controlled increase strength to a potent steroid again for short burts for flates then twice weekly for chronic patches- (if over 1yo)

Question 13

what is safe topical steroid amounts for long term use in eczema

Answer 13

moderate and potetn topical steroids twice weekly

Question 14

topical steroid regime for eczema of the face

Answer 14

1% hydrocort safe for daily use
-except eyelids when use should be limited to 3 nights weekly

three day bursts of moderately potent steroids shouild be safe for occasionaly flares

Question 15

side effects of topical steroids in eczema 4

Answer 15

if used twice weekly moderate potency no side effects seen

fear of adverse affects has led to under use

others:
-systemic -cushings

-local- thinning, striae, telengectasia

-eyelids

-periorifical dermatitis

-steroid rosacea

-pustular psoriasis

Question 16

most common skin problem of infancy

Answer 16

irritant contact napkin dermatitis

Question 17

what causes irritant contact napkin dermatitis

Answer 17

moisture and friction disrups the skin barrier allowing penetration of irritants from urine and faeces

-contributed to by candida and bacterial overgrowth

Question 18

characteristic appearance of irritant contact napkin dermatitis 3

Answer 18

glazed eryhtmea that spares the skin folds

-can ulcerate if left untreated or when diarrhoea causes a sevee form

develops a wrinkled appearnace and scaling when it resolves

Question 19

treatment of mild irritant contact napkin dermatitis 2

Answer 19

frequent nappy changes w avoidiance of soap and wips

greasy emollients help repair skin barrier and a thick barrrier preparartion applied at each nappy change to prevenet prenetration of irritatns

Question 20

treatment of very inflamed irritant contact napkin dermatitis

Answer 20

topical steroid/antifungal cream to settle inflammation

try mild potency then moderate

use for 5-7days then repeat if flares <2x per mnth

if flares >2x mnth use twice weekly to chronic areas

Question 21

treatment of irritant contact napkin dermatitis if candidal infection develops

Answer 21

add topical antiyest - clotrimazole

CONTINUE USE OF STEROIDS

Question 22

appearnace of candida infected irritant contact napkin dermatitis

Answer 22

satellite papules and pusutles which spread to the flexures

Question 23

who gets vulvitis

Answer 23

young prepubertal girls

-represents localsied eczema

usually seen in atopic children (though may not have eczema elsewhere)

*-note prepubertal girls cannot develop candidiasis

Question 24

appearance of vulvitis

Answer 24

itch

eryhtmea

discharge

sting/buring passing urine

Question 25

managemnt of vulvitis

Answer 25

same as for napkin dermaitis + cotton underwear avoidance of tights

Question 26

define discoid eczema

Answer 26

localised form of eczema appears in well demarcated circular plaques -often crusted and weeping due to bacterial superinfection

Question 27

management of discoid eczema 2

Answer 27

emollient and bathing regimes as for atopic eczema - -potent steroid use is common -usually start with medium strenght dependent on severeity -use for 7-10 days to settle flairs

Question 28

management of discoid eczema 2

Answer 28

emollient and bathing regimes as for atopic eczema - -potent steroid use is common -usually start with medium strenght dependent on severeity -use for 7-10 days to settle flairsr

Question 29

managment of discoid eczema if crusted/ weeping

Answer 29

if crusted/weeping -topical steroid combinded with an antibacterial agent

Question 30

define lip lick dermatitis

Answer 30

peri-oral eczema caused by drying of the lips in atopic chldren -causes them to lick them which then irriatets skin-> eczema-> viscouc cycle usually worse in winter

Question 31

managemtn of lip lick dermatitis 3

Answer 31

greasy emollients if red-> topical steroid with an anti yeast -daktacort (weak steroid) for 7 days trimovate (moderate steroid) for 2 days for flares if requirng trimovate more than once per month-> consider tacrolimus

Question 32

appearance pityriasis alba

Answer 32

usually asain children hypopigmentation -usualy with dry rough skin on cheekcs of atopic children 4-12 years -seen mainly in non-caucasian skin genetrally patchy and poorly demarcated inconrast to vitligo

Question 33

Management of pityriasis alba 3

Answer 33

use of emollients topical streoids to areas of erythema and sunscreen to prevent surrouding skin tannign whichc makes it more obvious

Question 34

who gets juvenile plantar dermatosis

Answer 34

affects anterior planter surface of children (mainly boys) aged 4-7 flares intermittently continues until puberty then settles spontaneously main trigger is sweating -variety of factors contribute -wearing of sports shoes with rubebr soles and syntehtic nylon (football) socks or tights whichc cause occulsion and maceration

Question 35

risk factors for juvenile plantar dermatosis 2

Answer 35

repeated friction atopic dermatitis -worse in winter

Question 36

where on the foot is affeected by juvenile plantar dermatosis (more specific) -appearance 3

Answer 36

plantar surface of the anterior third of the foot and occasionally the first toe -plantar arch is always spared -erythema -hyperkeratosis -fissuring -characteristic glazed appearanc (itch is not a feature)

Question 37

investigations for juvenile plantar dermatosis

Answer 37

clinical diagnosis patch testing- though ont routinely recommened rubber allergy- may affect soles and palms but is usually itchy and generally causes blisters- JPD does not

Question 38

treatment for juvenile plantar dermatosis 5

Answer 38

avoid occlusive footwear and synthetic socks wear 2 pairs of cotton socks or thick toweling socks to imrpove aborption of sweat aluminium hydrochldoird powder may help reduce sweating urea based emollients may help hyperkeratosis and fissusing topical steroids for flares