Derm - Eczema Flashcards
What is eczema?
Chronic atopic condition caused by defects in skin leading to inflammation
How does eczema vary?
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
How does eczema present?
Usually presents in infancy
- Dry
- Red
- Itchy
- Sore
- Flexor surfaces
- Face and neck
Where does eczema typically affect?
Flexor surfaces
(Inside of elbows and knees)
Face and neck
What is the pathophysiology of eczema?
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
How is eczema managed generally?
Maintenance and management of flairs
How is eczema maintained?
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
How are flares of eczema managed?
Thicker emolients
Topical steroids
Wet wraps
Treating complications
Very rarely IV antibiotics or oral steroids for severe flares
What are wet wraps?
Covering affected areas in thick emollient and applying a wrap to keep moisture locked in
What are some specialist treatments available for severe eczema?
Zinc impregnated bandages
Topic tacrolimus
Phototherapy
Systemic immunosuppressants e.g corticosteroids, methotrexate and azathioprine
What are some examples of thin creams?
E45
Diprobase
Oilatum
Aveeno
Cetraben
Epaderm
What are some examples of thick, greasy emollients?
All ointments
50:50 ointment
Hydromol
Diprobase
Cetraben
Epaderm
What is the general rule for topical steroid use?
Use the weakest steroid for the shortest period to get skin under control
Thicker the skin, the stronger the steroid required
What do steroids do?
Settle immune activity in skin
Reduce inflammation
What adverse effects can topical steroid use lead to?
Thinning of the skin
Making skin more prone to flares
Bruising
Tearing
Stretch marks
Telangiectasia
What can steroid use potentially lead to?
Systemic absorption
What is the steroid ladder from weakest to most potent?
Mild- Hydrocortisone
Moderate- Eumovate
Potent- Betnovate
Very potent- Dermovate
Why are opportunistic bacterial skin infections common?
Breakdown in skin’s protective barrier allows entry point for infective organism
What is the most common opportunistic organism?
Staphylococcus aureus
How is staphylococcus aureus skin infection treated?
Oral antibiotics
Flucloxacillin
More severe may need admission and IV antibiotics
What viral skin infection can occur in eczema?
Eczema herpticum
What is eczema herpticum?
AKA Kaposi varicelliform eruption
Viral skin infection caused by HSV and VZV
What is the most common causative organism of eczema herpticum?
Herpes simplex virus 1
May be associated with a cold sore, usually occurs in eczema or dermatitis
How does eczema herpticum present?
Patient who suffers with eczema
Widespread, painful vesicular rash
Fever
Lethargy
Irritability
Reduced oral intake
Lymphadenopathy
What is the rash like in eczema herpticum?
Widespread
Can affect any area
Erythematous, painful and itchy
Vesicles containing pus
What happens to the vesicles?
Appear as lots of individual spots containing fluid
After bursting, they leave a small punched-out ulcer with a red base
How is diagnosis of eczema herpticum confirmed?
Viral swabs of vesicles
How is eczema herpeticum managed?
Treatment started based on clinical appearance usually
Acyclovir
Oral in mild or moderate cases
IV in severe cases
What are the complications of eczema herpticum?
Can be life-threatening if not treated adequately especially in immunocompromised
Bacterial superinfection can occur, leading to more severe illness
