Derm - Eczema

Question 1

What is eczema?

Answer 1

Chronic atopic condition caused by defects in skin leading to inflammation

Question 2

How does eczema vary?

Answer 2

Some patients have very occasional mild patches that respond well to emollients

vs

Large areas of skin that are severely affected and require strong topical steroids

Question 3

How does eczema present?

Answer 3

Usually presents in infancy
- Dry
- Red
- Itchy
- Sore
- Flexor surfaces
- Face and neck

Question 4

Where does eczema typically affect?

Answer 4

Flexor surfaces
(Inside of elbows and knees)
Face and neck

Question 5

What is the pathophysiology of eczema?

Answer 5

Defects in barrier that skin provides, tiny gapes in barrier provide an entrance for irritants, microbes and allergens causing an immune response leading to inflammation

Question 6

How is eczema managed generally?

Answer 6

Maintenance and management of flairs

Question 7

How is eczema maintained?

Answer 7

Maintenance
- Create artificial barrier over skin using emollients
- As thick and greasy as tolerated as often as possible
- Emollients particularly after washing and before bed
- Avoid hot baths, scratching or scrubbing skin
- Specific soap substitutes

Question 8

How are flares of eczema managed?

Answer 8

Thicker emolients
Topical steroids
Wet wraps
Treating complications

Very rarely IV antibiotics or oral steroids for severe flares

Question 9

What are wet wraps?

Answer 9

Covering affected areas in thick emollient and applying a wrap to keep moisture locked in

Question 10

What are some specialist treatments available for severe eczema?

Answer 10

Zinc impregnated bandages
Topic tacrolimus
Phototherapy
Systemic immunosuppressants e.g corticosteroids, methotrexate and azathioprine

Question 11

What are some examples of thin creams?

Answer 11

E45
Diprobase
Oilatum
Aveeno
Cetraben
Epaderm

Question 12

What are some examples of thick, greasy emollients?

Answer 12

All ointments
50:50 ointment
Hydromol
Diprobase
Cetraben
Epaderm

Question 13

What is the general rule for topical steroid use?

Answer 13

Use the weakest steroid for the shortest period to get skin under control

Thicker the skin, the stronger the steroid required

Question 14

What do steroids do?

Answer 14

Settle immune activity in skin
Reduce inflammation

Question 15

What adverse effects can topical steroid use lead to?

Answer 15

Thinning of the skin
Making skin more prone to flares
Bruising
Tearing
Stretch marks
Telangiectasia

Question 16

What can steroid use potentially lead to?

Answer 16

Systemic absorption

Question 17

What is the steroid ladder from weakest to most potent?

Answer 17

Mild- Hydrocortisone
Moderate- Eumovate
Potent- Betnovate
Very potent- Dermovate

Question 18

Why are opportunistic bacterial skin infections common?

Answer 18

Breakdown in skin’s protective barrier allows entry point for infective organism

Question 19

What is the most common opportunistic organism?

Answer 19

Staphylococcus aureus

Question 20

How is staphylococcus aureus skin infection treated?

Answer 20

Oral antibiotics
Flucloxacillin

More severe may need admission and IV antibiotics

Question 21

What viral skin infection can occur in eczema?

Answer 21

Eczema herpticum

Question 22

What is eczema herpticum?

Answer 22

AKA Kaposi varicelliform eruption

Viral skin infection caused by HSV and VZV

Question 23

What is the most common causative organism of eczema herpticum?

Answer 23

Herpes simplex virus 1

May be associated with a cold sore, usually occurs in eczema or dermatitis

Question 24

How does eczema herpticum present?

Answer 24

Patient who suffers with eczema
Widespread, painful vesicular rash
Fever
Lethargy
Irritability
Reduced oral intake
Lymphadenopathy

Question 25

What is the rash like in eczema herpticum?

Answer 25

Widespread

Can affect any area

Erythematous, painful and itchy

Vesicles containing pus

Question 26

What happens to the vesicles?

Answer 26

Appear as lots of individual spots containing fluid

After bursting, they leave a small punched-out ulcer with a red base

Question 27

How is diagnosis of eczema herpticum confirmed?

Answer 27

Viral swabs of vesicles

Question 28

How is eczema herpeticum managed?

Answer 28

Treatment started based on clinical appearance usually

Acyclovir
Oral in mild or moderate cases
IV in severe cases

Question 29

What are the complications of eczema herpticum?

Answer 29

Can be life-threatening if not treated adequately especially in immunocompromised

Bacterial superinfection can occur, leading to more severe illness