Derm - Eczema

Question 1

What are the major endogenous types of Eczema? [5]

Name types of exogenous eczema [3]

Answer 1

Endogenous:
Atopic
Seborrhoeic
Discoid
Pompholyx
Varicose

Exogenous:
Allergic contact dermatitis
Irritant contact dermatitis
Photosensitive/photoaggravated eczema

Question 2

Triggers of eczema flares in children [6]

Answer 2

• Infection
• Environment e.g. hot/cold
• Pets (if sensitized)
• Teething
• Stress
• Idiopathic

Question 3

In general how do you treat eczema? [5]

Answer 3

• Emollients
• Topical Steroids
• Calcineurin Inhibitors
• UVB Phototherapy
• Immunosuppresants

Question 4

How do we dose steroids?

Maximum length of time to be using steroids

Answer 4

The mildest form is Hydrocortisone.
Should be used in finger tip units for:
- 1/day for 1-2wks
- Then if it improves continue using on alt days for a few days
- If stubborn areas you can use twice weekly for those areas
- If flare restarts, then go back to daily applications
Max: use up to 3 weeks at a time

Question 5

Commonest type of eczema is atopic dermatitis. How does it occur? [4]
Name 2 risk factors

Answer 5

Overactive immune response + Abnormal fillagrin expression –> loss of skin barrier function

This allows loss of water + Penetrance of allergens/irritants leading to dry inflamed skin

RF: another atopic triad condition, FH of atopy

Question 6

Atopic dermatitis

Presentation in infancy [2], older children [1]

Answer 6

Infants start on face/neck and spread generally

Older kids show a flexural pattern

Question 7

Seborrhoeic dermatitis
Causative organism
Distribution [3]
Onset [1]
Progression [1]
Treatment [3]

Answer 7

Malezzia yeast
Scalp and face - cradle cap
Mainly in babies under 3m
Resolves by 12m but may signal increased risk of atopic eczema
For scalp: low conc sulphur, salicylic acid
Emollients and mild topical steroids
Antifungal creams (Canesten H) and shampoos

Question 8

Discoid eczema can occur as part of atopic eczema or as a separate entity. Describe how it appears on the skin [2]
What does pompholyx Eczema look like?

Answer 8

Discoid eczema: Scattered annular/circular itchy patches

Pomphylx: Intensely itchy vesicles on the hands and feet

Question 9

Describe urticaria [2]

How long before its classed as acute/chronic [2]

Answer 9

Wheals or hives with associated angioedema lasting for 24 hours
<6 weeks acute
>6 weeks chronic

Question 10

What happens in Varicose Eczema? [2 step process]

How do you treat varicose eczema? [3]

Answer 10

Venous insufficiency, varicose veins, oedema or chronic leg swelling –> dry/inflamed skin, ulceration and oedema
Treatment: emollients and topical steroids, compression stockings

Question 11

List some allergens causing Allergic Contact Dermatitis? [4]

What are the 3 common irritants in contact dermatitis

Answer 11

Milk, Soy, Peanuts, Eggs, Wheat
Dust Mite
Pet Dander
Pollen

Soap
Chemicals
Citrus/tomato

Question 12

When would you suspect an allergy in eczema? [4]

How do we test for allergy? [4]

Answer 12

• Immediate reaction to food
• GI problems, FTT
• Unresponsive to treatment
• Generalised itching, atopy

Blood test for specific IgE
Skin Prick & patch testing
Radioallergoabsorbent Test (RAST)
Dietary elimination for 8 weeks, keep food diary

Question 13

Nappy rash causes [5]

Indicate most common

Answer 13

Irritant dermatitis*
Candida dermatitis
Seborrhoeic dermatitis
Psoriasis
Atopic eczema

Question 14

Irritant dermatitis
Cause [1]
Sites [4]
Spared sites [1]
Rx [2]

Answer 14

Due to irritant effect of urinary ammonia and faeces
Sites: convex surface buttocks, perineal region, lower abdomen, thighs
Creases spared

Rx: emollients, topical CCS

Question 15

Candida rash [3]

Answer 15

Erythematous rash
Sites: flexures
Characteristic: creases