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Dermatology > Atopic Dermatitis > Flashcards

Atopic Dermatitis Flashcards

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Dermatology Board Prep flashcards
1
Q

What is another name for eczema?

A

Dermatitis

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2
Q

Describe the appearance of dermatitis (eczema)

A

It is characterised by itchy, dry patches of papules and vesicles on an erythematous base.

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3
Q

What is the most common type of eczema?

A

Atopic dermatitis

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4
Q

Is eczema well or poorly demarcated?

A

Poorly

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5
Q

What are the endogenous types of eczema?

A

Atopic
Seborrhoeic
Varicose - from venous stasis
Discoid

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6
Q

What are the exogenous types of eczema?

A 
Allergic contact (type IV sensitivity reaction)
Irritant contact
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7
Q

When does atopic eczema usually develop by?

A

Early childhood (before age of 5) and resolves during teenage years (but may recur)

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8
Q

As eczema is itchy, what marks can be seen on the skin?

A

Excoriation marks

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9
Q

What are the causes of eczema?

A

Multifactorial

Family history of atopy often present e.g atopic dermatitis, asthma, allergic rhinitis (the atopic triad)

Genetic defect in epidermis barrier function - defects in the filaggrin protein

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10
Q

In infants, where on the body is atopic dermatitis usually found?

A

Face

Extensor aspects of limbs

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11
Q

In children and adults where on the body is atopic dermatitis usually found?

A

Flexor aspects of limbs

Also around eyes and on neck
Can involve scalp and abdomen

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12
Q

What are some complications of eczema?

A

Secondary bacterial infection- crusted weepy lesions
Secondary viral infection- molliscum contagiosum, viral warts, eczema herpeticum
Linchenification

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13
Q

What general measures can be done to treat atopic dermatitis?

A

Explain : management involves control not cure. It can fluctuate in its course

Identify and avoid triggers
Avoid overheating
Dress in soft fabrics 
Manage stress 
Keep fingernails short 
Try and stop children from scratching
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14
Q

Atopic dermatitis can worsen with allergens such as…

A

Soaps, detergents, shower gels
Abrasive or synthetic fabrics e.g wool, nylon
Skin infections
Extremes in temperature
Inhaled allergens - dust mites, pollen, pet dander, mould
Stress
Hormonal changes in women

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15
Q

What type of hypersensitivity reaction is atopic dermatitis?

A

Type 1 - starts off with something in environment e.g flower pollen that travels through porous skin and picked up by an antigen presenting immune cell. Allergen presented to naive helper T cell activating it into a Th2 cell - stimulates a B cell to produce IgE antibody specific for that pollen.

IgE binds to other immune cells e.g mast cells, basophils = sensitisation

If second exposure to pollen, the allergen cross links the IgE on sensitised cells - degranulation and release of pro inflammatory molecules

Causes nearby vessels to dilate and attract more immune cells to area creating inflammation in skin tissue. More allergen can enter skin and water can escape (skin becomes dry).

Scratching further damages skin barrier - vicious cycle

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15
Q

When is the itchiness often worse?

A

At night - no distractions

16
Q

What topical measures can be used to treat atopic dermatitis?

A

Frequent emollient usage - best applied when skin moist, but applied at other times as well (ideally every 4 hours)
Topical steroids BD - weakest that controls disease effectively

Topical calcineurin inhibitors e.g tacrolimus if intolerant to / steroid therapy ineffective - does not thin skin like steroids, so useful on face

17
Q

How do topical calcineurin inhibitors work? E.g pimecrolimus and tacrolimus

A

They are immunomodulators - they decrease lymphocytic proliferation

18
Q

What oral treatment can be used to manage atopic dermatitis?

A

Oral antibiotics if signs of infection - 7 days of flucloxacillin
Antivirals if secondary viral infection
Antihistamines - ideally intermittently for exacerbations to reduce itch and scratch

Secondary care: immunosuppressive agents - cyclosporin, azathioprine, prednisolone

19
Q

What percentage of children with eczema also have food allergies?

A

30%

20
Q

Where is the incidence highest?

A

Developed countries in urbanised areas - affects 20-30% of children here

21
Q

What is another term for itch?

A

Pruritis - the main feature!

22
Q

Are bacterial infections a common complication?

A

Yes

23
Q

How would a bacterial infection present?

A

Crusting
Weeping
Surrounding erythema - may look like cellulitis

24
Q

How is it diagnosed?

A

Clinically
Difficult to distinguish from contact dermatitis

NICE criteria requires itching plus 3 of:
Itchy in skin folds in front of elbows and back of knees
History of asthma or hay fever
Generally dry skin
Visible patches of eczema in skin folds
Onset in first 2 years of life

25
Q

What differential diagnoses are there?

A 
Contact dermatitis
Seborrhoeic dermatitis 
Fungal skin infection 
Psoriasis 
Scabies
26
Q

What is the prognosis?

A

Usually improves throughout childhood

May be flare ups throughout childhood and adolescence

27
Q

What is lichenification?

A

When skin becomes thickened and leathery - due to epidermal hypertrophy usually due to excessive scratching and rubbing

28
Q

What is erythrodermic eczema?

A

Eczema involving more than 90% of body

29
Q

Are creams, lotions or ointments more potent?

A

Ointments

Creams are water based
Lotions have water and oil component
Ointments are oil based, so most potent

30
Q

Should emollients be used even when flare ups not present?

A

Yes

31
Q

Using emollients frequently and liberally will reduce the need of…

A

Steroids

32
Q

Should steroids be used at first sign of flare up or once established?

A

First sign

33
Q

Should steroids be applied before emollient?

A

Yes

34
Q

Why should steroids not be used around eyes?

A

Can cause cataracts

35
Q

What is an example of a mild corticosteroid?

A

1% hydrocortisone

36
Q

What is an example of moderate corticosteroid?

A

Betamethasone valerate 0.02%

37
Q

Can phototherapy be used?

A

Yes
Sunlight is beneficial
UVA/B effective for disease resistant to topical agents
Not for children - sun damage

Dermatology (35 decks)

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