Case 3 - Atopic Eczema & Impetigo PWQ

Question 1

Describe the aetiology and pathophysiology of atopic eczema

Answer 1

Atopic dermatitis is an inflammatory skin disease that presents as generalised skin dryness, itch and rash.

Results from a combination of environmental factors, such as irritants, and genetic factors, such as skin structural gene mutations, defect in skin cells and other factors.

Question 2

Describe the clinical presentations of atopic eczema

Answer 2

Acute dermatitis is red (erythematous), weeping/crusted (exudative) and may have blisters (vesicles or bullae). Long term acute dermatitis can lead to thickened (lichenified) and scaly skin.

Question 3

Describe impetigo

Answer 3

Impetigo is a common acute superficial bacterial skin infection, characterised by pustules and honey-coloured crusted erosions. Impetigo can occur in areas of previously healthy skin or at the site of minor trauma that disrupts the skin barrier (e.g. grazes, scratches or eczema).

Question 4

State which groups of people are prone to impetigo

Answer 4

Impetigo is most prevalent in young children (aged 2-6).

Question 5

Discuss the use of topical antibiotics for the treatment of impetigo

Answer 5

For treatment of first-line impetigo, management should be focused on good skin hygiene measures and a trial of topical antiseptics.

The use of topical antibiotics is only appropriate as a second-line option and when all primary options have failed.

If topical antibiotics are used, instruct patients to use them for no longer than 7 days and should be discarded immediately after.

Question 6

Provide examples of pharmacological options for atopic eczema

Answer 6

• Emollients
• Coal tar
• Antihistamines
• Topical steroids
• Systemic steroids
• Biological agents

Question 7

Provide examples of non-pharmacological options for atopic eczema

Answer 7

• Phototherapy
• Antiseptics
• Hygiene
• Moisturiser
• Wet compress

Question 8

Explain emollients, with reference to how they are used and factors to consider when choosing formulations

Answer 8

Emollients are topical moisturising agents used to alleviate itchiness and other discomforts associated with eczema.

Emollients fill cracks of dry skin and form an occlusive barrier, promoting moisture retention, maintaining skin integrity, and protecting the skin from irritants.

Formulations of emollients involve lotions, creams, gels and ointments.

Dose: Apply to damp skin 2-3 times a day.

Question 9

Consider the cultural and psychosocial impact impetigo has on children

Answer 9

• Young children suffer sleep disturbances leading to behavioural problems
• Interfere with activities such as sport
• School absences