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A - MSRA - Dermatology [3] > Dermatitis > Flashcards

Dermatitis Flashcards

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Dermatology Board Prep flashcards
1
Q

What is dermatitis?

A

Dermatitis, also known as eczema, is a group of diseases that result in inflammation of the skin

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2
Q

What is dermatitis characterised by?

A
  • Itchiness
  • Red skin
  • Rash
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3
Q

How much of the skin is affected in dermatitis?

A

Can range from a small amount to the whole body

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4
Q

What are the types of dermatitis?

A
  • Atopic dermatitis
  • Allergic contact dermatitis
  • Irritant contact dermatitis
  • Stasis dermatitis
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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

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6
Q

When does atopic dermatitis usually start?

A

In early childhood

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7
Q

What proportion of children with atopic dermatitis grow out of it by their mid teens?

A

About 2/3

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8
Q

What causes atopic dermatitis?

A

The exact cause is unknown, although there is some evidence of genetic, environmental, and immunologic factors

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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
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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

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11
Q

What environmental factors may be involved in atopic dermatitis?

A
  • Hygiene hypothesis
  • Sensitisation to foods
  • Consumption of hard water
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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

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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
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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

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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

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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

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17
Q

What might a flare-up cause in mild cases?

A

One or two small patches of inflammation

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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

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19
Q

On what basis is atopic dermatitis diagnosed?

A

Clinically

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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)
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21
Q

How often should you assess atopic dermatitis?

A

At every consultation

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22
Q

Why is it important to assess atopic dermatitis at every consultation?

A

In order to determine the most approrpiate treatment

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23
Q

How should assessment of severity of atopic dermatitis be done?

A

Examine all areas of affected skin, and ask about itching

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24
Q

What can dermatitis be categorised as, based on severity?

A
  • Clear
  • Mild
  • Moderate
  • Severe
  • Infected
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25
Q

What is classified as clear in atopic dermatitis?

A

Normal skin, no evidence of acute dermatitis

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26
Q

What is classified as mild in atopic dermatitis?

A

Areas of dry skin, and infrequent itching (with or without small areas of redness)

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27
Q

What is classified as moderate in atopic dermatitis?

A

Areas of dry skin, frequent itching, and redness

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28
Q

What is classified as severe in atopic dermatitis?

A

Widespread areas of dry skin, incessant itching, redness, may be extensive skin thickening, bleeding, oozing, cracking, and alteration of pigmentation

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29
Q

What is classified as infected in atopic dermatitis?

A

Weeping, crusted, pustules, fever, malaise

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30
Q

How is mild atopic dermatitis managed?

A
  • 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
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31
Q

What information and advice should be given to patients with mild atopic dermatitis?

A
  • How to maintain skin and reduce risk of flares
  • Self care advice
  • Avoid trigger factors a=
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32
Q

What are the potential trigger factors of atopic dermatitis?

A
  • Soaps and detergents
  • Animals
  • Heat
  • Synthetic fibres
  • House-dust mits
  • Stess and habit scratching
  • Pregnancy and pre-menstural hormone changes
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33
Q

How is a current flare of moderate atopic dermatitis managed?

A
  • 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
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34
Q

What should preventative treatment be prescribed based on in moderate atopic dermatitis?

A

The usual severity of the condition between flares

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35
Q

What is the first line option in the prevention of future flares in moderate atopic dermatitis?

A

A maintenance regime of topical corticosteroids to control areas of skin prone to frequent flares (not recommended for face, genitals, or axilla)

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36
Q

What is the second line option in the prevention of future flares in moderate atopic dermatitis?

A

Topical calcinneurin inhibitors

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37
Q

What does optimal follow-up time depend on in moderate atopic dermatitis?

A

A number of factors, such as severity of condition, treatment the person is receiving, and their health/age

38
Q

How often should emollient use be reviewed in moderate atopic dermatitis?

A

Annual basis

39
Q

What is the purpose of annual review of emollient use in moderate atopic dermatitis?

A

Ensure optimal usage

40
Q

How often should topical corticosteroid use be reviewed in moderate atopic dermatitis?

A

Regular review if there is heavy useage, however this is unlikely to be necessary with moderate dermatitis

41
Q

How often should the use of non-sedating antihistamines be reviewed in moderate atopic dermatitis?

A

Every 3 months

42
Q

How is severe atopic dermatitis management?

A
  • 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
Q

What needs to be done in all people who have had a severe and extensive flare requiring treatment with oral corticosteroids or oral antibiotics?

A

Need reviewing after course is finished, and consider the need for referral

44
Q

How is currently infected dermatitis managed when there is extensive areas of infected eczema?

A

Swab the skin and prescribe an oral antibiotic

45
Q

What is the first line oral antibiotic in the treatment of extensive infected dermatitis?

A

Flucloaxicillin

46
Q

What oral antibiotic is prescribed in extensive infected dermatitis if flucoxacillin is contraindicated (e.g. penicillin allergy) or if there is known resistance?

A

Erythromycin

47
Q

What oral antibiotic is prescribed in extensive infected dermatitis if the person has been unable to tolerate erythromycin?

A

Clarithromycin

48
Q

What should be done in extensive infected dermatitis if the first line antibiotic is ineffective?

A

Prescribe an alternative

49
Q

How is currently infected dermatitis that is localised managed?

A

Topical antibiotics

50
Q

How long should topical antibiotics be used for in infected eczema?

A

No longer than 2 weeks

51
Q

How are future occurences of infected dermatitis prevented?

A
  • 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
Q

What is contact dermatitis?

A

An inflammatory skin reaction in response to an external stimulus, acting as either an allergen or an irritant

53
Q

What are the types of contact dermatitis?

A
  • Allergic contact dermatitis
  • Irritant contact dermatitis
54
Q

What is allergic contact dermatitis?

A

A type IV delayed hypersensitivity reaction that occurs after sensitisation and subsequent re-exposure to an allergen

55
Q

What is irritant contact dermatitis?

A

An inflammatory response that occurs after damage to the skin, usually by chemicals

56
Q

Is irritant contact dermatitis an allergy?

A

No, it can occur in any individual significantly exposed to an irritant

57
Q

Is irritant contact dermatitis acute or chronic?

A

Can be either

58
Q

What can the insults causing contact dermatitis be classified into?

A

Chemical, biological, or physical

59
Q

How can contact with allergens arise?

A
  • Immersion
  • Direct handling of contaminated substances
  • From workbenches, tools, or clothing
  • Splashing
  • Dust from air
60
Q

Give some common irritants

A
  • 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
Q

Give some common allergens

A
  • Cosmetics
  • Metals, particularly nickel and coblat in jewellery and chromate in cement
  • Topical medications
  • Rubber additives
  • Textiles
  • Epoxy resin adhesives
  • Plants
62
Q

What symptoms do both irritant and allergic contact dermatitis present with?

A
  • Redness
  • Vesicles or papules on affected area
  • Crusting and scaling of skin
    Itching of affected area
  • Pain or burning sensation from affected area
63
Q

What features may arise in contact dermatitis with chronic exposure?

A
  • Fissures
  • Hyperpigmentation
64
Q

What are the predominant featues of irritant contact dermatitis?

A
  • Burning
  • Stinging
  • Soreness
65
Q

What are the predominant features of allergic contact dermatitis?

A
  • Redness
  • Itching
  • Scaling
66
Q

Describe the onset of irritant contact dermatitis?

A

Within 48 hours, may be immediate

67
Q

Describe the onset of allergic contact dermatitis?

A

Delayed onset

68
Q

Describe the location of the rash in irritant contact dermatitis

A

Rash only in areas of skin exposed to irritant

69
Q

Describe the location of the rash in allergic contact dermatitis

A

Rash may be in areas which have not been in contact with the allergen

70
Q

Describe the resolution of the rash in irritant contact dermatitis?

A

Resolution occurs quickly after removal of irritant, typically within 4 days

71
Q

Describe the resolution of allergic contact dermatitis

A

Resolution may take longer than irritant contact dermatitis, with or without treatment

72
Q

What is irritant contact dermatitis commonly associated with?

A

Atopic eczema

73
Q

What makes a diagnosis of irritant contact dermatitis more likely?

A

Exposure to friction, soap, detergents, solvents, or wet work

74
Q

What is the clinical relevance of the presentation and pattern of skin change in contact dermatitis?

A

It may give some indication of the likely irritant

75
Q

What area of the body is most commonly affected with direct contact?

A

Hands

76
Q

Where might chemicals on clothing cause contact dermatitis?

A
  • Axillae
  • Groin
  • Feet
77
Q

Where are dust irritants most likely to cause contact dermatitis?

A

Areas where dust might collect, such as collar line, belt line, sock line, or in flexural areas

78
Q

Where are irritants in vapour/mist most likely to affect?

A

The face and neck

79
Q

What investigations are done into contact dermatitis?

A

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
Q

What are the indications for referral to a specialist clinic for patch testing in contact dermatitis?

A
  • Severe or recurrent distressing symptoms despite adequate treatment with topical corticosteroids
  • Suspicion of contact dermatitis without clear history of exposure
81
Q

What are the differential diagnoses of contact dermatitis?

A
  • Atopic dermatitis
  • Seborrhoiec dermatitis
  • Ringworm
  • Urticaria
  • Psoriasis
  • Acute infections, such as cellulitis, impetigo, shingles, and chickenpox
82
Q

What is the most effective form of management of contact dermatitis?

A

Avoid the irritant producing the dermatitis, when it has been identified.

83
Q

When might avoidance of the irritant producing the contact dermatitis be the only treatment required?

A

In milder cases of recent origin

84
Q

How long will it take for dermatitis after removal of the irritant in milder cases of recent origin?

A

Approximately 3 weeks

85
Q

When can simple emollients be used in the management of contact dermatitis?

A

When the skin barrier has not been breached

86
Q

When will contact dermatitis require medication?

A

In more severe or chronic cases

87
Q

What medication is used in contact dermatitis?

A

Topical corticosteroid cream, or a short course of oral corticosteroid for acute, severe episodes

88
Q

What is the strength and period of use of corticosteroid cream in contact dermatitis adjusted based on?

A

The severity of the condition

89
Q

What are the second line options for use in contact dermatitis?

A
  • PUVA treatment
  • Ciclosporin
  • Azathioprine

These are used for chronic, steroid-resistant dermatitis

90
Q

What are the complications of contact dermatitis?

A

Secondary bacterial infection

91
Q

How does a secondary bacterial infection in contact dermatitis present?

A

As worsening of the skin condition, or as typical impetigo

A - MSRA - Dermatology [3] (28 decks)

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