Atopic Eczema Flashcards
What is Atopic Eczema?
- A common inflammatory skin condition that presents in early life
How does Atopic Eczema typically present?
- Acute: Itchy papules and vesicles which are weepy
- Chronic: dry scaly itchy patches which are erythematous
- Common on the face and Flexor regions
- Chronic Scratching/ Rubbing = excoriations and Lichenification
- Eczema can lead to hyperpigmentation and hypopigmentation
- Nail pitting and ridging of the nails
What are some of the causes of Atopic Eczema?
- Family History of Atopy
- Exacerbating factors: infections, allergens (chemicals, food, dust, pet fur), sweating, heat, occupation and severe stress
- Genetic defect in the skin barrier function (loss of function variants of the protein filaggrin - allows access of antigens through the skin barrier)
What is Atopy?
- abnormally exaggerated IgE response to allergen exposure
- Type 4 hypersensitivity
- Sensitisation to allergens/ antigens detected by CD4+ type 2 helper cells
- Triad of Rhinitis (hayfever), Eczema, Asthma
What are the Differential Diagnosis for Atopic Eczema?
- Psoriasis
- Seborrhoeic Dermatitis
- Fungal infection
- Contact Dermatitis
- Scabies
How do you make a diagnosis of Eczema?
- An itchy skin condition plus 3 or more of:
1. Visible flexural eczema involving the skin creases
2. History of Flexural eczema
3. Personal History of Dry skin in the last 12 months
4. Personal history of asthma or allergic rhinitis
5. onset of signs and symptoms before the age of 2 years
What are the features of Mild Eczema?:
- Areas of dry skin
- infrequent itching
What are the features of Moderate Eczema?
- Areas of dry skin
- Frequent itching
- Redness
What are the features of Severe Eczema?
- Widespread dry skin
- incessant itching
- Bleeding
- Oozing
- Crackling
- Alteration of pigmentation of the skin
What is the conservative management of Eczema?
- Identifying Triggers ( perfumes, detergents, soaps, clothes, hormones and foods)
- Diaries can be used to demonstrate a relationship between triggers and flares
- Ensure nails are short and cut
What is the Medical Managment for Eczema?
Wet bandages can be used with emollients
1.Emollients (moisturising agents that come in the form of lotions, creams and ointments)
- They help to soothe, smooth and hydrate the skin in patients with dry and scaling disorders
- The effects are short-lived and therefore require regular application
- Can be used as bath/ soap substitutes
2. Steroids
3. Topical Calcineurin Inhibitors (Tacrolismus and Pimecrolismus) - Steroid Sparing
4. Phototherapy
5. Immunosuppresants (Azathioprine, Ciclosporin and Methotrexate)
6. Antihistamines (symptomatic relief
7. Antibiotics (Flucloxacillin
8. Antivirals (Aciclovir)
What are the Different types of Emollients and when are they used?
- Lotion (Dermol, E45): high water content, spread easily. Not effective at moisturising. Quick absorption time
- Creams (Diprobase, Epaderm): mixture of fat and water. Spread easily. Not as greasy
- Gels: high oil content. Light and non-greasy
- Sprays: (Emollin Spray) Useful for hard to reach areas. Small number of preparations
- Ointment: (Diprobase, Epaderm) Minimal water making them thick and greasy. Very effective at holding water and repairing skin
What are the Different Types of Steroids Used?
- Hydrocortisone
- Eumovate
- Betnovate
- Dermovate
What are the Complications of Atopic Eczema?
- Secondary Bacterial Infections - Staphylococcus Aureus (crusted weepy lesions)
- Secondary Viral Infections - Molluscum Contagiosum, Eczema Herpeticum (Herpes Simplex Virus) - life-threatening infection, punched out erosions and vesicles with immediate hospitalisation and specialist managment
How is dermatitis investigated?
- Skin Scraping
- Swin Swab - infection
- Patch testing - contact allergens
- Blood tests - IgE
