Atopic Eczema Flashcards

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1
Q

What is eczema and dermatitis?

A
  • Terms often used to describe the same condition
  • Non infectious, non contagious inflammation of the skin
  • characterized by
    1. certain clinical
  • erythema, scales & vesicles)
    2. and histopathological changes
  • spongiosis
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2
Q

What are the different phases of eczema?

A
  1. ACUTE:
    - redness swelling, papules blisters oozing, crusts
  2. SUBACUTE:
    - still red, drier, scalier, pigment changes
  3. CHRONIC:
    - lichenification, excoriations scaling, cracks
    Note: sometimes all phases are present at the same time
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3
Q

What is erythroderma?

A

Eczema affects the whole body

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4
Q

Classification of eczema?

A
  1. endogenous - atopic
  2. exogenic - conrtact
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5
Q

Endogenous eczema?

A
  1. Seborrhoic
  2. Discoid - Nummular
  3. Dyshidrotic
  4. Asteatotic
  5. Ichtyosis
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6
Q

Exogenic eczema?

A
  1. CONTACT
    * Toxic irritant
    * Allergic
    * Photosensitive
    * Vaseline dermatitis
  2. Lichen simplex chronicus
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7
Q

Taking a history of eczema?

A
  1. Elicit the nature, course, time of the eczema
  2. Enquire: atopic symptoms, general medical
    conditions, travelling, profession, operation
  3. Identify any factor in social or family history that
    may be relevant – e.g.psoriasis, eczema
  4. Record recent drugs and medications,
    including topical agents, herbals.
  5. Ask about use of cosmetics, sunexposure
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8
Q

Examining the skin inneczema?

A
  1. good light or use hand lens
  2. Gently palpate lesions to assess
    texture, consistency
  3. Observe distribution, individual lesion:
    * morphology & configuration
    * Localised, widespread, linear, symmetrical, peripheral-central,
    flexures - extensors, sunexposed areas, groin, axilla, colour ?
    * Nails, hair, mucous membranes, lymph nodes
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9
Q

What is atopic dermatitis?

A

distinctive pruritic eczematous condition of the skin
* Acute, subacute or chronic
* inflammation of dermis and epidermis
* Very heterogenous
* Pruritus, dry skin
* Symtoms may change often and fast
* May have long periods of remissions
* Always itchy = „the itch that rashes

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10
Q

Epidemiology of atopic dermatitis?

A
  1. genetically determined
  2. Often together with personal or family history
    of hay fever, asthma, rhinitis, AD
  3. Starts mostly in early childhood, 10-25% of
    infants, 1-3 % of adults
  4. Common disease in people under 25
  5. Underlies 80% of occupational dermatoses
  6. Often misdiagnosed, misunderstood and infeffectively treated
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11
Q

Etiology of atopic dermatitis?

A

Increasingly prevalent and common in industralized countries
- Theory suggests that our overall sterile modern lifestyle
- lack of exposure to parasites,
infections and bacteria creates an imbalance and immaturity for the immune system predisposing us to atopic disorders

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12
Q

Reduced risk for developing atopic dermatitis?

A
  1. High exposure of Endotoxins on farms
  2. Early attendance of Kindergardens
  3. Dog in the household at birth time
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13
Q

Higher risk for developing atopic dermatitis?

A

frequently use antibiotics

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14
Q

Features of atopic dermatitis?

A
  • Usually recurrent exacerbations
  • Duration of lesions: untreated = month to years
  • Itch is the most important clinical symptom, Disturbing
    quality and individual way of life in children and adults
  • Individual therapy and education
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15
Q

What is the atopic march?

A

the natural history of allergic diseases as they develop over the course of infancy and childhood
- food allergy > atopic eczema > allergic rhinitis > allergic asthma

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16
Q

What is the role of the epidermal barrier?

A

Tight junctions, desmosomes and adherens junctions form adhesions between the cells of the epidermis to help create a physical, permeability barrier.

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17
Q

Pathophysiology of acropic eczema?

A

Impairment of the physiology of the skin
1. Reduced activity of sebaceous glands
2. Reduced barrier function of skin

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18
Q

Epidermal barrier dysfunction and atopic dermatitis?

A
  1. Genetic mutations for Filaggrin (protein important for composition of the lipids of the skin)
  2. Genetic mutations for important Proteases have been described
  3. Secondary proteases: produced by inflammatory cells
  4. Exogen proteases:
    * Dust mites
    * Staphylococci
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19
Q

Influencing factors for developing atopic dermatitis?

A
  1. detergents
  2. allergens
  3. staph aureus
  4. Malassezia sp.
  5. hormones
  6. neuropeptides
20
Q

Diagnosis?

A

clinical findings

21
Q

Skin symptoms?

A
  1. ITCHING - Eczema is the itch that rashes“
  2. Vicious circle of itch:
    > Itch – scratch – rash - itch
  3. DRY SKIN:
    > Lichenification of the skin
22
Q

Consequences of the itch?

A
  • Causes rubbing, scratching, flare up
  • Interferes sleep, rest, concentration, growth
    and learning.
  • May dominate waking hours, torture,
    embarrassing
  • an individual want to itch, continuing the
    itch-scratch cycle
  • DON`T UNDERESTIMATE THE
    PSYCHOLOGICAL IMPACT OF PRURITUS IN A
    YOUNG PERSON!! And their family
23
Q

Major criteria for atopidc dermatitis?

A
  • Pruritus
  • Morphology and distribution
  • Flexural lichenification (adults)
  • Facial and extensor involvement (infancy)
  • Chronic relapsing course
  • Pos. Family - or own history of Atopy
  • requiring 3 of 4 basic features +
24
Q

Minor criteria for atopic dermatitis?

A

3 or more features
1. Xerosis (dryness)
2. Ichthyosis/palmar hyperlinearity/keratosis pilaris
3. Immediate (type I) skin test reactivity
4. Elevated serum IgE
5. Earyl age of onset
6. Tendency towards cutaneous infections (S.aureus and
Herpes simplex ) – “Defensin-Defect“
7. Tendency towards nonspeciific hand or foot dermatitis
8. Nipple eczema
9. Cheilitis
10. Recurrent conjunctivitis
11. Dennie-Morgan infraorbital fold

25
Q

Distribution of lesions in baby/infancy?

A
  1. Face, wrists,
  2. Extensor sites
26
Q

Distribution of lesions in childhod?

A

Antecubital, popliteal fossae, neck, abdomen

27
Q

Distribution of lesions in adults?

A
  1. flexures, front and sides of neck
  2. eyelids, forehead, face, wrists
  3. dorsa of feet and hands, often generalized
28
Q

Describe acute skin lesions?

A
  • Poorly defined erythematous
    patches possibly scaling
  • Skin appears puffy
  • Moist, crusted erosions
29
Q

Describe chronic skin lesions?

A
  1. Lichenification
  2. Follicular eczema
    - involvement of all hair follicles: discrete follicular papules
  3. Fissures - painful
30
Q

What is pityriasis alba?

A

Postinflammatory Residual Hypo- and
hyperpigmentation leads to Medical consultation

31
Q

Ddx for pityriasis alba?

A
  1. Vitiligo
  2. Leprosy
  3. Seborrhoic dermatitis
  4. Discoid Lupus eryth
  5. Contact dermatitis
  6. Psoriasis
32
Q

Ddx for atopid dermatitis?

A
  1. Other forms of Eczema
  2. Psoriasis
  3. Pellagra
  4. Infections and infestations
    * Scabies
    * HIV-associated Dermatoses
    * Dermatophytoses
  5. Malignancies/adults
    * Mycosis fungoides, Sezary Syndrome, KS
33
Q

Complications of AD?

A

Bacterial Infections
* Staphylococcal
* Streptococcal
Viral infections
* Mollusca contagiosa
* herpetic infection

34
Q

Microbial flora of AD?

A

Staphylococcus aureus
found in
* Lesional skin: >90%
* Uninvolved: >70%
* Nasal Passage: 79%

35
Q

Describe herpetic infection in AD?

A
  • Secondary infection to atopic dermatitis
  • Eczema herpeticatum – varicelliform eruption
  • Potentially life threatening
36
Q

AD exacerbation factors?

A

SKIN DEHYDRATATION/IRRITATION
* Frequent bathing and hand washing
* Direct wool contact (clothing, blankets)
* INFECTIONS
* Staphylococcal, streptococcal, fungal, viral
infections
* EMOTIONAL STRESS
* ALLERGIES
* Contact allergens, Food, Inhalants

37
Q

How does stress get into the skin?

A

Psychological stressors contribute to
the severity of chronic inflammatory diseases such as psoriasis or atopic dermatitis
- Dysregulation of the Hypothalamic–pituary-adrenal-Axis activity

38
Q

What is the atopy patch test?

A

Epicutaneous patch test with allergens known to elicit IgE-mediated
reactions, for the provocation of eczematous skin lesions due to these
allergens

39
Q

What is the skin prick test?

A
  • Method of choice to detect IgE-mediated
    immediate type hypersensitivities
    – should always be used prior to
    all other in-vivo/in-vitro tests.
40
Q

Allergens in AD?

A

Grass/ Tree pollens - proteins
* most common cause of hayfever
* wind pollinated: not colourful flowers
* House dust mites, - mite faeces
* Cockroaches - house dust
* Animal products: Cat, Dog, Cow, Horse, Birds
* Food
* Microfunghi- Mould spores

41
Q

Prick test procedure?

A

REGION:
* VOLAR FOREARM
» CLEAN SKIN –
» APPLY 1 DROP OF ALLERGEN SOLUTION
(50% Glycerolallergen extract)
» “PRICK” THE SKIN THROUGH THE DROPwith a lifting motion
» REMOVE DROP NOT BEFORE 3 MIN.
» READING AFTER 20 MINUTES

42
Q

What does a positive prick test mean?

A

ALWAYS INTERPRETE IN CONTEXT WITH HISTORY!
* HISTORY positive
» PROOF FOR ALLERGY
* HISTORY negative
» SENSITIZATION
* HISTORY QUESTIONABLE/UNCLEAR
» ALLERGY/ SENSITIZATION POSSIBLE?

43
Q

Use of the prick test?

A

CAN BE USED TO TEST NATIVE
ALLERGENS
* FOOD
* DRUGS
* USE DILUTIONS (start with 1: 1000 of
therapeutic dilution) !!!!!
* “everything”

44
Q

Management of AD?

A

Avoid irritants !!!!!!!!!!
soap, mineral oil, woolen clothes, heat, sweat, dry air
Keep fingernails short
Use Emollients: Lubrication of the skin
Aqueous cream or emulsifying ointment

45
Q
A