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Flashcards in Itchy Skin & Eczema Deck (38)
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1

What is Yamamoto's Sign?

Atopic Eczema (AE) that spares the tip of the nose and forehead.

2

What are the most common sites of involvement in childhood?

Felxures of the arms and legs.

3

As one gets older the face is more commonly affected.

Why is this?

It is thought to be due to Malassezia Furfur Overgrowth. (seborrheic eczema)

4

Genetically, what causes the dry skin of eczema sufferers?

Filaggrin (the skin barrier protein) isn't produced as well and therefore Skin barrier function is impaired.

5

What occurs due to the reduced skin barrier function?

Transepidermal water loss and dehydration of the skin.

6

In Type 5 and 6 Fitzpatrick patients, how can eczema present? (2 ways)

In a follicular pattern. (like turkey skin)

OR

as Pityriasis Alba-Hypopigmented patches typically on the face.

7

What is this?

What is it called if this is a chronic problem with the skin?

Lichenification of the skin (Acanthosis/Thickening of the epidermis of the skin)

 

Lichen Simplex Chronicus

8

What is the prognosis of childhood eczema?

50% of patients have outgrown it by the age of 5 years.

 

90% by the age of 14 years.

9

What is the differential diagnoses of Atopic Eczema (AE)?

  • Scabies
  • Contact dermatitis - unusual in children.
  • Impetigo
  • Cutaneous T Cell Lymphoma (CTCL Mycosis Fungoides) - eczematous looking patches but they don't itch.
  • Langerhans Cell Histiocytosis (LCH) - ecchymosis with yellow brown papules in intertiginous areas.

10

What are some complications of Atopic Eczema?

  • Secondary bacterial or viral infection.
  • Eczema Herpeticum
  • Molluscum Contagiosum

11

What is the commonest bacterial cause of infection Eczema?

Staph Aureus.

 

90% of patients will have Staph colonization.

12

If someone has a staph infection on eczema what does it look like?

Impeitginous (yellow crusts etc)

13

What is the management protocol for Eczema patients who continually get Staph Super Infections (PVL)?

  • Nasal Mupirin for 5 days TDS to each nostril.
  • Antibacterial soap Substitute (e.g. Benzylkonium Chloride)
  • Bleach Baths Twice Weekly
    • 150ml of Milton Sterilising Fluid - bath to 10cm depth once weekly.
      • Similar to swimming pool - which reduces infection rates.

14

Similar to Asthma, what is the approach to managing Eczema

  1. Relieve
  2. Prevent

Getting it Better and Keeping it Better

15

What are some lifestyle changes for preventing Eczema?

  • Avoid wool or man made fibers.
  • Avoid hot rooms at night.
  • Prescription undergarments - Dermasilk.

16

What are the 3 categories of topical therapy in Eczema?

  1. Emollients
  2. Soap Substitutes
  3. Anti-Inflammatories
    1. Steroids
    2. Non-Steroids - Calcineurin Inhibitors

17

Why should Sodium Lauryl Sulphate not be used in Eczema?

They activate proteases that encourage trans-epidermal waterloss by reducing the skin barrier function.

18

Are emollients used for relief or maintenance?

Maintenance

19

If a patient has weepy skin how would you manage it?

With Potassium permanganate soaks.

20

What soap substitutes are recommend for the bath?

Aqeous Cream or Unguentum Merck.

21

Why is avoiding soaps etc important in eczema?

It can lead to protease activation and thus reduce epidermal barrier function.

22

What is first line for acute flares of eczema?

Topical Steroids.

23

What are the instructions on using potassium Permanganate soaks?

  • Dilute to pale pink.
  • Use an old plastic bowl because it stains.
  • Apply on gauze and leave on for 20mins 3 times daily.

24

What is second line for flare ups of eczema?

Tacrolimus or Picrolimus

 

(But they can be used for maintenance aswell.)

25

What is a common side effect of Tacrolimus or Pimecrolimus?

It can initially sting but this settles with use.

26

How often per week are calcineurin inhibitors licensed for use as maintenance therapy?

3 times weekly

27

Why are Calcineurin Inhibitors useful when compared to steroids?

They can be used in facial eczema without thinning the skin.

28

How can steroids be used as maintenance?

Mometasone once weekly as maintenance

ONLY for body sites.

29

What are 3 useful behavioural therapies that can help with the itch of eczema?

  1. Biofeedback - scratch counters.
  2. Hypnosis (limited evidence)
  3. Acupuncture (less evidence)

30

What are some scoring systems that can be used to assess Eczema severity?

SCORAD

Real Life Severity Score

DLQI (Dermatology Life Quality Index)