Atopic Dermatitis (Eczema) Flashcards
what is atopic eczema
pruritic papulovesicular skin reaction to endogenous and exogenous agents;
inflammatory skin condition characterised by dry, itchy skin
acute vs chronic eczema
acute is described as a flare-up. chronic is chronic inflammation
aetiology (endogenous)
atopic, seborrhoeic, pompholyx, varicose, lichen simplex
what is pompholyx eczema
type of eczema that affects the hands and feet
why may atopic eczema present with varicose veins
increased venous pressure in lower limbs
exogenous causes of eczema
irritants, contact dermatitis, atopic
what is contact dermatitis due to
delayed type 4 hypersensitivity reaction to an allergen
epidemiology of contact dermatitis
prevalence is 4%
epidemiology of atopic dermatitis
onset in first year of life, childhood incidence is 10-20%
presenting symptoms
itching, heat, tenderness, redness, weeping, crusting, ask about occupational exposure to irritants and ask about personal/.family history of ATOPY
signs of atopic eczema on physical examination (acute)
poorly demarcated erythematous oedematous dry scaling patches,
papules,
vesicles with exudation and crusting,
excoriation marks
signs of chronic atopic eczema
thickened epidermis, skin lichenification,
fissures,
changes in pigmentation
what is lichenification
where the skin becomes thicker and leathery
why does skin lichenification happen
the skin is itchy and as the skin is rubbed and itched over a long time, the cells grow
types of eczema
atopic- mainly affects face and flexures
seborrhoeic- yellow greasy scales on erythematous plaques. commonly on eyebrows, scalp etc
pompholyx- hands and feet (palms and soles). vesiculobullous eruption
varicose, nummular (coin shaped, on legs and trunk) and asteatotic (dry, crazy pairing pattern)
investigations for contact dermatitis
skin patch testing
what does a skin patch test involve
a disc containing allergens is diluted and applied on the skin for 48 hrs. It is positive if it causes a red raised lesion
investigations for atopic eczema
lab levels; IgE levels
risk factors for developing atopic eczema
filaggrin gene mutation, age below 5 years.
family Hx of eczema,
allergic rhinitis,
family Hx of atopy (e.g. asthma)
treatment (1st line)
emollients: these improve the skin barrier and rehydrate the skin
what else might be used in the management/ treatment
corticosteroids and antibiotic therapy
systemic immunosupressants
when may UV light therapy be used
resistance to topical corticosteroids
prognosis
Many patients with milder disease can be maintained on emollient treatment with intermittent use of other topical agents during flares. Patients with more severe disease often require combination treatment that includes ultraviolet light therapy and systemic immunosuppressants.
largest (most common) complication
psychological stress
