Atopic Eczema Flashcards
What becomes in inflamed in eczema?
What else happens?
Inflammation of the epidermis
Acute flareups characterised by weeping lesions
Different types
Atopic
Venous
Exogenous
Irritant contact
Basic features
SCAM
How are the border described?
S - anywhere
C - red
A - dry, flaky, itchy which may lead to excoriation
M - patch
Poorly defined border unless due to external cause e.g. stoma bag
Complications:
What is lichenification
What happens if it becomes infected with staph aureus?
Chronic scratching which leads to thickening of the epidermis and visible skin markings
Golden crust and weeping skin
Atopic eczema
Pathophysiology
Triggers?
Due to epidermal barrier dysfunciton and/or immune dysregulation
Irritants - soaps Infection Extreme temperatrues Animal hair Stress Food or inhaled allergens
Atopic eczema:
Risk factors
PMH of atopy, asthma or hay fever
FH of eczema or atopy
Atopic eczema:
Clinical features by age:
- infants
- children
- adults
Severity and what you’d see:
- Mild
- Moderate
- Severe
Mainly face
Flexor surfaces, wrists and ankles
Hands
Occasional itch
Some redness
Frequent itch
Redness
Excoriations
Thickening
Constant itch Redness Some bleeding Oozing Cracking Pigment change
Atopic eczema:
Management of atopic eczema:
General measures
What can be used for flare ups?
Oral therapies - 3
Avoid exacerbating factors
Emollients +/- bandages and bath oil/soap substitute
Topical steroid for flare ups (fucibet)
Topical immunimodulators
Antihistamines for symptomatic relief
Antibiotics for secondary bac infection
Antivirals for secondary viral infection
Atopic eczema:
Complications
Secondary bacterial infection (crusted weepy lesions)
Secondary viral infections
Discoid eczema
What does it look like?
Where is it seen most?
What can it be mistaken for?
Management?
Well-delineated round/oval lesions
Limbs
Psoriasis
Same as atopic - emollients and mild topical steroids
Seborrheic eczema
What is it?
Where does it affect infants?
Risk factors
Signs
Management
Scaly rash which may be an inflammatory response to a yeasts
Cradle cap
HIV
Parkinsons Disease
Affects areas rich in sebaceous glands e.g. face, scalp and axilla
Topical ketoconazole and topical steroids
Asteatotic eczema:
How is it distinguished from others?
What is its characteristic look?
Where?
Who?
Rx? - 3
You have severe dryness - cracked skin
Crazy paving appearance
Lower legs
Elderly
Reduce exposure to heat
Emollients
Mild topical steroids
Venous eczema
Pathophysiology
Signs on lower legs
What is lipodermatosclerosis
Management
Insufficient venous return from lower legs
Leakage of blood contents
Haemosiderin deposits and skin stretching
Inflammatory processes
Eczema
Hyperpigmentation
Varicose veins
Venous ulcers
Hard, tight skin
Reduce swelling - avoid prolonged standing, elevate feet, compression stockings
Topical steroids
Eczema Herpeticum
Pathogen
What do you get on skin? - think herpes
Where
Systemic symptoms
Investigations
Management
what should definitely not be given?
HSV 1,2
Itchy, painful blisters
Face and neck but can be disseminated
Fever
Lymphadenopathy
Swabs
FBC - low WBC
CRP
Aciclovir PO or IV if to unwell
NO TOPICAL STEROIDS
Irritant contact eczema
What is it?
Where
Causes
Management
Reaction to substances that can irritate anyone, often due to prolonged contact
Finger webs
Wetting washing Detergents or soaps Friction Nappy rash Chemical burns
Avoid trigger
