Dermatitis Flashcards
1
Q
What is dermatitis?
A
Dermatitis, also known as eczema, is a group of diseases that result in inflammation of the skin
2
Q
What is dermatitis characterised by?
A
- Itchiness
- Red skin
- Rash
3
Q
How much of the skin is affected in dermatitis?
A
Can range from a small amount to the whole body
4
Q
What are the types of dermatitis?
A
- Atopic dermatitis
- Allergic contact dermatitis
- Irritant contact dermatitis
- Stasis dermatitis
5
Q
What is atopic dermatitis?
A
An inflammation of the skin, that tends to flare up from time to time. It can range from mild to severe
6
Q
When does atopic dermatitis usually start?
A
In early childhood
7
Q
What proportion of children with atopic dermatitis grow out of it by their mid teens?
A
About 2/3
8
Q
What causes atopic dermatitis?
A
The exact cause is unknown, although there is some evidence of genetic, environmental, and immunologic factors
9
Q
What suggest a genetic component to atopic dermatitis?
A
- Most people with atopic dermatitis have a family history of atopy
- About 30% of people with atopic dermatitis have a mutation in the gene for the production of filaggrin
10
Q
What is the role of filaggrin?
A
It plays an important role in keeping the skin surface slightly acidic, hence giving it anti-microbial effects
11
Q
What environmental factors may be involved in atopic dermatitis?
A
- Hygiene hypothesis
- Sensitisation to foods
- Consumption of hard water
12
Q
What is the hygiene hypothesis?
A
A theory that children who are raised in a sanitary environment are more likely to develop allergies - there is some support for this theory with regard to atopic dermatitis
13
Q
What are the symptoms of atopic dermatitis?
A
- Dry skin
- Some areas of the skin become red and inflamed. The inflamed skin is itchy, and may become blistered and weepy
14
Q
What areas of skin are most commonly affected in atopic dermatitis?
A
The areas next to skin creases, such as the front of the elbows and wrists, backs of knees, and around the neck, however any area of skin might be affected
15
Q
What typically happens to inflamed areas of skin in atopic dermatitis?
A
They tend to flare up from time to time, and then settle down
16
Q
How do flare-ups of atopic dermatitis vary?
A
The severity and duration of flare-ups varies from person to person, and from time to time in the same person
17
Q
What might a flare-up cause in mild cases?
A
One or two small patches of inflammation
18
Q
What might a flare-up cause in severe cases?
A
Inflammation covering many areas of skin that lasts for several weeks or more
19
Q
On what basis is atopic dermatitis diagnosed?
A
Clinically
20
Q
What are the UK diagnostic criteria of atopic dermatitis?
A
The person must have itchy skin, or evidence of rubbing/scratching, plus 3 or more of;
- Involvement of skin creases
- History of asthma or allergic rhinitis
- Symptoms began before age 2 (if patient >4 years old)
- History of dry skin (within past year)
- Dermatitis visible on flexural surfaces (patient >4), or on cheeks, forehead, and extensor surfaces (patients <4)
21
Q
How often should you assess atopic dermatitis?
A
At every consultation
22
Q
Why is it important to assess atopic dermatitis at every consultation?
A
In order to determine the most approrpiate treatment
23
Q
How should assessment of severity of atopic dermatitis be done?
A
Examine all areas of affected skin, and ask about itching
24
Q
What can dermatitis be categorised as, based on severity?
A
- Clear
- Mild
- Moderate
- Severe
- Infected
25
What is classified as clear in atopic dermatitis?
Normal skin, no evidence of acute dermatitis
26
What is classified as mild in atopic dermatitis?
Areas of dry skin, and infrequent itching (with or without small areas of redness)
27
What is classified as moderate in atopic dermatitis?
Areas of dry skin, frequent itching, and redness
28
What is classified as severe in atopic dermatitis?
Widespread areas of dry skin, incessant itching, redness, may be extensive skin thickening, bleeding, oozing, cracking, and alteration of pigmentation
29
What is classified as infected in atopic dermatitis?
Weeping, crusted, pustules, fever, malaise
30
How is mild atopic dermatitis managed?
* Prescribe generous amounts of emollients, and advise frequent and liberal use
* Consider prescribing a mild topical corticosteroid (such as hydrocortisone 1%) for areas of red skin. Treatment should be continued for 48 hours after flare has been controlled
* Give appropriate information and advice
31
What information and advice should be given to patients with mild atopic dermatitis?
* How to maintain skin and reduce risk of flares
* Self care advice
* Avoid trigger factors a=
32
What are the potential trigger factors of atopic dermatitis?
* Soaps and detergents
* Animals
* Heat
* Synthetic fibres
* House-dust mits
* Stess and habit scratching
* Pregnancy and pre-menstural hormone changes
33
How is a current flare of moderate atopic dermatitis managed?
* Consider possibility of trigger factors or infection, which can precipitate or worsen a flare
* Prescribe a general amount of emollients, and advise frequent and liberal use
* If the skin is inflamed, prescribe a moderately potent topical corticosteroid, for example betamethasome valerate 0.025% to be used on inflamed areas. Treatment should be continued for 48 hours after falre has improved
* If severe itch or urticarial, consider prescribing one month trial of non-sedating antihistamine
34
What should preventative treatment be prescribed based on in moderate atopic dermatitis?
The usual severity of the condition between flares
35
What is the first line option in the prevention of future flares in moderate atopic dermatitis?
A maintenance regime of topical corticosteroids to control areas of skin prone to frequent flares (not recommended for face, genitals, or axilla)
36
What is the second line option in the prevention of future flares in moderate atopic dermatitis?
Topical calcinneurin inhibitors
37
What does optimal follow-up time depend on in moderate atopic dermatitis?
A number of factors, such as severity of condition, treatment the person is receiving, and their health/age
38
How often should emollient use be reviewed in moderate atopic dermatitis?
Annual basis
39
What is the purpose of annual review of emollient use in moderate atopic dermatitis?
Ensure optimal usage
40
How often should topical corticosteroid use be reviewed in moderate atopic dermatitis?
Regular review if there is heavy useage, *however this is unlikely to be necessary with moderate dermatitis*
41
How often should the use of non-sedating antihistamines be reviewed in moderate atopic dermatitis?
Every 3 months
42
How is severe atopic dermatitis management?
* Treatment largely the same as for moderate flare, except use a more potent topical corticosteroid on inflamed areas, such as betamethasone valerate 0.1%
* If itching is severe and affecting sleep, consider prescribing short course (maximum 2 weeks) of sedating antihistamine
* If there is severe, extensive dermatitis causing psychological distress, consider prescribing short course of oral corticosteroid
43
What needs to be done in all people who have had a severe and extensive flare requiring treatment with oral corticosteroids or oral antibiotics?
Need reviewing after course is finished, and consider the need for referral
44
How is currently infected dermatitis managed when there is extensive areas of infected eczema?
Swab the skin and prescribe an oral antibiotic
45
What is the first line oral antibiotic in the treatment of extensive infected dermatitis?
Flucloaxicillin
46
What oral antibiotic is prescribed in extensive infected dermatitis if flucoxacillin is contraindicated (e.g. penicillin allergy) or if there is known resistance?
Erythromycin
47
What oral antibiotic is prescribed in extensive infected dermatitis if the person has been unable to tolerate erythromycin?
Clarithromycin
48
What should be done in extensive infected dermatitis if the first line antibiotic is ineffective?
Prescribe an alternative
49
How is currently infected dermatitis that is localised managed?
Topical antibiotics
50
How long should topical antibiotics be used for in infected eczema?
No longer than 2 weeks
51
How are future occurences of infected dermatitis prevented?
* Prescribe new supplies of topical products for use after infection as cleared, and advise the person to discard old products
* Consider the use of topical antiseptic preparation as an adjunct to standard treatment to reduce bacterial load in areas prone to infection
52
What is contact dermatitis?
An inflammatory skin reaction in response to an external stimulus, acting as either an allergen or an irritant
53
What are the types of contact dermatitis?
* Allergic contact dermatitis
* Irritant contact dermatitis
54
What is allergic contact dermatitis?
A type IV delayed hypersensitivity reaction that occurs after sensitisation and subsequent re-exposure to an allergen
55
What is irritant contact dermatitis?
An inflammatory response that occurs after damage to the skin, usually by chemicals
56
Is irritant contact dermatitis an allergy?
No, *it can occur in any individual significantly exposed to an irritant*
57
Is irritant contact dermatitis acute or chronic?
Can be either
58
What can the insults causing contact dermatitis be classified into?
Chemical, biological, or physical
59
How can contact with allergens arise?
* Immersion
* Direct handling of contaminated substances
* From workbenches, tools, or clothing
* Splashing
* Dust from air
60
Give some common irritants
* Water, especially if hard, chalky, or heavily chlorinated
* Detergents and soaps
* Solvents and abrasives
* Machining oils
* Acids and alkalis, including cement
* Reducing agents and oxidising agents
* Powders, dust, and soil
* Some plants
61
Give some common allergens
* Cosmetics
* Metals, particularly nickel and coblat in jewellery and chromate in cement
* Topical medications
* Rubber additives
* Textiles
* Epoxy resin adhesives
* Plants
62
What symptoms do both irritant and allergic contact dermatitis present with?
* Redness
* Vesicles or papules on affected area
* Crusting and scaling of skin
Itching of affected area
* Pain or burning sensation from affected area
63
What features may arise in contact dermatitis with chronic exposure?
* Fissures
* Hyperpigmentation
64
What are the predominant featues of irritant contact dermatitis?
* Burning
* Stinging
* Soreness
65
What are the predominant features of allergic contact dermatitis?
* Redness
* Itching
* Scaling
66
Describe the onset of irritant contact dermatitis?
Within 48 hours, may be immediate
67
Describe the onset of allergic contact dermatitis?
Delayed onset
68
Describe the location of the rash in irritant contact dermatitis
Rash only in areas of skin exposed to irritant
69
Describe the location of the rash in allergic contact dermatitis
Rash may be in areas which have not been in contact with the allergen
70
Describe the resolution of the rash in irritant contact dermatitis?
Resolution occurs quickly after removal of irritant, typically within 4 days
71
Describe the resolution of allergic contact dermatitis
Resolution may take longer than irritant contact dermatitis, with or without treatment
72
What is irritant contact dermatitis commonly associated with?
Atopic eczema
73
What makes a diagnosis of irritant contact dermatitis more likely?
Exposure to friction, soap, detergents, solvents, or wet work
74
What is the clinical relevance of the presentation and pattern of skin change in contact dermatitis?
It may give some indication of the likely irritant
75
What area of the body is most commonly affected with direct contact?
Hands
76
Where might chemicals on clothing cause contact dermatitis?
* Axillae
* Groin
* Feet
77
Where are dust irritants most likely to cause contact dermatitis?
Areas where dust might collect, such as collar line, belt line, sock line, or in flexural areas
78
Where are irritants in vapour/mist most likely to affect?
The face and neck
79
What investigations are done into contact dermatitis?
In many cases, no investigations will be required, and diagnosis is made based on clinical findings and history.
Some patients may require referral to a specialist clinic for patch testing
80
What are the indications for referral to a specialist clinic for patch testing in contact dermatitis?
* Severe or recurrent distressing symptoms despite adequate treatment with topical corticosteroids
* Suspicion of contact dermatitis without clear history of exposure
81
What are the differential diagnoses of contact dermatitis?
* Atopic dermatitis
* Seborrhoiec dermatitis
* Ringworm
* Urticaria
* Psoriasis
* Acute infections, such as cellulitis, impetigo, shingles, and chickenpox
82
What is the most effective form of management of contact dermatitis?
Avoid the irritant producing the dermatitis, when it has been identified.
83
When might avoidance of the irritant producing the contact dermatitis be the only treatment required?
In milder cases of recent origin
84
How long will it take for dermatitis after removal of the irritant in milder cases of recent origin?
Approximately 3 weeks
85
When can simple emollients be used in the management of contact dermatitis?
When the skin barrier has not been breached
86
When will contact dermatitis require medication?
In more severe or chronic cases
87
What medication is used in contact dermatitis?
Topical corticosteroid cream, or a short course of oral corticosteroid for acute, severe episodes
88
What is the strength and period of use of corticosteroid cream in contact dermatitis adjusted based on?
The severity of the condition
89
What are the second line options for use in contact dermatitis?
* PUVA treatment
* Ciclosporin
* Azathioprine
## Footnote
*These are used for chronic, steroid-resistant dermatitis*
90
What are the complications of contact dermatitis?
Secondary bacterial infection
91
How does a secondary bacterial infection in contact dermatitis present?
As worsening of the skin condition, or as typical impetigo
