Atopic Eczema

Question 1

What is atopic eczema?

Answer 1

The same as atopic dermatitis

Question 2

Factors contributing to atopic eczema?

Answer 2

Genetic and environmental triggers

Question 3

Symptoms of atopic eczema?

Answer 3

ITCH
Ill-defined erythema and scaling
Dry skin
Flexural distribution

Question 4

Acute changes in atopic eczema?

Answer 4

Papulovesicular, erythematous lesions, spongiosis, ooze, crusting & scaling

Question 5

Chronic changes in atopic eczema?

Answer 5

Lichenification
Excoriation
Elevated plaques
2nd Infection (crusting indicates S. Aureus)

Question 6

Treatment of atopic eczema?

Answer 6

• Lots of emollients (everyone)
• Anti-histamines (itch)
• Topical steroids (Flare/mild-severe)
• Treat infection
• Phototherapy- mainly UVB
• Systemic immunosuppressants
• Biologic agents
• Topical calcinurin inhibitors used as steroid sparing agents in patients on continual steroids
• Light therapy (UVB or PUVA) and systemic immunosuppression is for conditions which don’s respond to potent topical steroids

Question 7

What does atopic eczema have a strong association with?

Answer 7

Asthma
Allergic rhinitis
Food allergy

Question 8

Diagnosis criteria for atopic eczema?

Answer 8

ITCH 
\+ 3 or more of 
-Visual flexural rash*
-History of flexural rash* 
-Personal history of atopy (or 1st relative if <4)
-Dry skin 
-Onset <2 y/o

Cheeks & extensor surface in infants

Question 9

Genetic contributor to atopic dermatitis?

Answer 9

-Mutations in the fillagrin protein

Question 10

What is the purpose of the fillagrin protein?

Answer 10

Protein involved in maintaining the waterproof, protective nature of the keratin layer
-Mutation increases predisposition to all atopic disease

Question 11

Immunological influences in atopic dermatitis?

Answer 11

Overactive T cells

Question 12

Risk factors for atopic dermatitis?

Answer 12

Age <5 y/o

-Family or personal history of atopy

Question 13

Presentation of atopic dermatitis?

Answer 13

• Usually presents between 6months-5 years
• Associated with general dry skin
• Rash distribution differs in infants and children

Question 14

Rash distribution of atopic eczema in infants?

Answer 14

Face
Scalp (cradle scalp)
Extensor surfaces involved

Flexor surfaces and napkin area spared

Question 15

Rash distribution of atopic dermatitis in children and adults?

Answer 15

Flexor surfaces 
ESPECIALLY the wrist 
Cubital fossa 
Popliteal fossa 
Ankles

Question 16

Triggers of atopic eczema?

Answer 16

Stress
Non compliance with treatment
Allergens: pets, new products on skin, temperature

Question 17

Associated conditions with atopic eczema?

Answer 17

• Bacterial infections: usually staph A

- Viral infections: infection with herpes simplex is considered to be an emergency

Question 18

What is eczema infected with herpes simplex called?

Answer 18

Eczema herpeticum

Question 19

What does eczema herpeticum present with and what treatment is required?

Answer 19

Monomorphic punched out lesions and required admission for IV aciclovir

Question 20

What topical steroids to give for mild eczema?

Answer 20

Hydrocortisone

Eumovate

Question 21

Topical steroids for moderate atopic eczema?

Answer 21

Betnovate +/- tacrolimus

Question 22

Topical steroids for severe eczema?

Answer 22

SEVERE

-dermovate +/- UV light therapy +/-systemic immunosuppression

Question 23

Example of topical calcinurin inhibitors?

Answer 23

Tacrolimus