Ch 7 Eczema

Question 1

Pathogenesis

Answer 1

• Activation of keratinocyte leading to release of IL-1 and IL-8
• IFNY increases local infiltrate
• Hyperproliferation ensues with acanthosis

Question 2

Histology

Answer 2

• Epidermal disruption and spongiosis
• Acanthosis maybe para
• Dilation and infiltration of lymphs

Question 3

Appearance

Answer 3

• Itch
• No sharp margin
• Scale
• Epithelial disription with weeping and crusting

Question 4

Contact Locations

Answer 4

• Eyes, Ears, Anal/wounds (Graviational stasis), Hands

- Assymetry and clears

Question 5

Exogenous

Answer 5

-Lanolin, Abx

Question 6

Tx

Answer 6

• Acute: steroids and wet dressing
• Subacute: Steroids, Abx
• Chronic: Steroids, Tacro/Picro, Abx
• Flares: Cyclosporin, AZT (TMPT), MM

Question 7

Irritant Vs Allergic

Answer 7

Allergic is type 4
Atopic is type 1
Irritant is neither and doesn’t get patch tested
Allergens are generally haptens

Question 8

Metals

Answer 8

Chrome: Builders and Cement
Nickle
Cobalt: Seen simliiar to nickel

Question 9

Cosmetics

Answer 9

Fragrance
Lanolin
Balsam of peru
PPD: hair dressers
Coelestyl Alcohol

Question 10

Preservatives

Answer 10

Formaldehyde
Quat 15
Parabens
Choldoresol: antiseptic

Question 11

Meds

Answer 11

Neomycin

Question 12

Rubber

Answer 12

Mercapto

Vulcanization

Question 13

Plants

Answer 13

Primin

Question 14

Resins

Answer 14

Colophony
Epoxy
Paratert

Question 15

Atopic Genes and Pathogenesis

Answer 15

Fillagrin
-Most commonly from mother
-IL-4/IL-13
-SPINK5
TH2 predominant

Question 16

Patterns through life

Answer 16

• Infant: Weepy and Face
• Child: Lichenification wrists/ankles
• Adult: Same with white dermatographism

Question 17

Diagnosis of Atopic

Answer 17

Itchy skin + 3 of

• History of itchy skin at sites
• Presence of eczema at sites
• Personal Allergy/Asthma
• Atopy by age 2
• Chornic dry skin for 1+yr

Question 18

Prick

Answer 18

Will show elevated IgE which is supportive but not diagnostic

Question 19

Tx

Answer 19

Steroids and emolients are mainstay
Ointments>Creams
Abx
UV
Cyclosporin
AZT (TPMT), MM

Question 20

Other Types

Answer 20

• Seborrheic
• Nummular
• Pompholyx
• Graviational
• Asteatotic
• Diaper
• Lichen Simplex
• Juvenile Plantar

Question 21

Seborrheic

Answer 21

• Armpits, Ears, Hair, Chest

- Ketocolanazole

Question 22

Nummular

Answer 22

• Be sure to appropriately differentiate with itch and ill defined borders
• Usually males and usually limbs
• Recur at previous sites
• Topical steroid and antibiotic

Question 23

Pompholyx

Answer 23

• Larger bullae on hand
• Related to heat and emotion
• Can recur
• May lead to lymphangitis and infection
• Could be due to tinea id reaction

Question 24

Stasis

Answer 24

• Need to repair edema first

- Site of contact allergy commonly (Neomycin)

Question 25

Asteatotic

Answer 25

• Fissuring in elderly with chronically chapped skin

- May be caused by malnutirtion or hypo thyroidism

Question 26

Lichen Simplex

Answer 26

-Thickened and fissured epidermis
Hands and genitals
-Must break itch scratch cycle

Question 27

Juvenile Plantar

Answer 27

Fisurred and desquamating skin

Caused by socks

Question 28

Diaper

Answer 28

Spares folds

Can lead to candidal super infection