4. Endogenous Eczema Flashcards
= Atopic dermatitis is the most common skin disease in Australian pre-school children
- Soap
= Eczema is characterised by inflammation of the skin
= The rash is intensely itchy
= Childhood onset
Epidemiology of Atopic Dermatitis (Eczema)?
Pathogenesis & Exacerbating Factors of Atopic Dermatitis (Eczema)?
Clinical Features of Atopic Dermatitis (Eczema)?
What is the goal of treatment in the management of atopic dermatitis?
- List 6 Triggers of Eczema?
The goal of treatment is disease control, not cure.
1. Wool clothes, blankets, toys
2. Synthetic fabrics such as lycra
3. Soap, shampoo, and bubble bath
4. Hot baths and very hot weather
5. Dry, windy, cold weather
6. Sand at the beach and in sandpits
Management of Atopic Dermatitis (Eczema)
- Emollients & Bathing?
Management of Atopic Dermatitis (Eczema)
- Wet wraps?
Management of Atopic Dermatitis (Eczema)
- 6 adverse effects of topical corticosteroids?
- What is a corticosteroid phobia?
- 3 Principles of corticosteroid use in the management of atopic dermatitis?
Topical Corticosteroids - Principles of Use
1. Use the appropriate strength of topical steroid for the skin site being treated.
2. Use the appropriate strength of topical steroid for the severity of the disease.
3. Withdraw the medication during remissions, even for a few days.
How does the strength of topical corticosteroids vary on the area of skin being treated?
- Thin skin - face, genital areas, flexures
- Moderate - trunk & limbs
- Thick skin - Palms, soles, elbows, & knees
2 Pharmacological treatments for atopic dermatitis (eczema)?
- 5 Principles of managing infected eczema?
Management of Infection
1. Take a dry swab from crusted or weeping areas.
2. The most common pathogen is S.aureus
3. Treat with antibiotics according to sensitivities.
4. For recurrent or chronic infections, add very dilute cholrine bleach to bathwater.
5. For nasal carriers of Staph, intranasal mupirocin ointment may be used.
5 Indications for referral for Atopic Dermatitis?
Case Study 1 - History
James is an 18 month old boy who presents to you with persistent rash which has not resolved on treatment with sorbolene cream and 1% hydrocortisone. He is otherwise healthy. The rash is itchy and sometimes wakes him at night. You suspect atopic eczema.
Case Study 1 - History
James is an 18 month old boy who presents to you with persistent rash which has not resolved on treatment with sorbolene cream and 1% hydrocortisone. He is otherwise healthy. The rash is itchy and sometimes wakes him at night. You suspect atopic eczema.
Case Study 1 - History
James is an 18 month old boy who presents to you with persistent rash which has not resolved on treatment with sorbolene cream and 1% hydrocortisone. He is otherwise healthy. The rash is itchy and sometimes wakes him at night. You suspect atopic eczema.
= All of them
Your management should include:
- Cease using any emollient
- Take a bacterial swab from her skin
- Use ointments rather than creams
- More potent topical steroids
- Wet dressings
- Decrease dust exposure in her environment
All but ‘Cease using any emollient’
How would you describe this rash:
- patchy
- poor defined
- involves flexor surfaces
- excoriated
- lichenified
= all but lichenified
Case Study 3 - 3 Year old girl with an itchy rash on the flexor surfaces, poorly defined, excoriated, patchy. You diagnose atopic eczema. She goes to preschool 2 days a week. She is otherwise healthy.
- Apply a moderate topical steroid twice a day until the rash has cleared completely.
- At preschool, avoid the sandpit.
- If she has a more severe flare, a potent corticosteroid could be used.
- Do not use soap and shampoo in the bath.
What are the 2 forms of Seborrheic dermatitis (SD)?
- 6 Clinical Features of Infantile seborrheic dermatitis?
- Management of Infantile seborrheic dermatitis?
Adult & Infantile
Management of Infantile seborrheic dermatitis
1. Gentle bathing, emollients, and weak topical corticosteroids, with the addition of antifungal or antibiotic agents if necessary.
2. Treat scalp with a weak keratolytic agent such as 2% salicyclic acid in aqueous cream
7 Clinical features of Adult seborrheic dermatitis?
Management of of Adult seborrheic dermatitis?
Management of Adult seborrheic dermatitis
Treat Scalp involvement with:
- Antidandruff shampoos containing selenium sulfide, ketoconazole, miconazole, or zinc pyrithione, which control Malassezia
- Tar-containing shampoos
- Combination of these
On non-scalp areas, use topical corticosteroids and consider adding topical antifungal agents for Malassezia.
Weak tar creams may help.
Nummular (Discoid) Eczema
- 5 Clinical features?
Nummular (Discoid) Eczema
- 2 Differential Diagnoses?
- Management?
Stasis Dermatitis
- 6 Clinical Features?
- Management?
Management
- To manage dryness, avoid soap, apply greasy moisturiser at least twice a day, and reduce duration and temperature of baths.
- To treat inflammation, use a weak to moderate topical steroid.
- For acute attacks, give short bursts of potent topical steroid, wet wraps, and antibiotics.
- To manage underlying venous insufficiency, use a compression bandaging or stockings, and elevate the foot of the bed at night.
When an adult has atopic dermatitis, it is likely that:
- The rash is limited to a small area of the body.
- It will be a lifelong tendency.
- It is aggravated by their work environment.
Regarding the prognosis of atopic dermatitis, which of the following statements are true?
Which of the following statements are true?
= seborrheic dermatitis
