Dermatitis and Eczema

Question 1

in cornification where is the nucleus lost from cells

Answer 1

at the granular layer

Question 2

what is seen histologically in eczema

Answer 2

spongiosis (oedema between keratinocytes)

inflammatory cell infiltrate (acute or chronic; lymphocytes and/or neutrophils)

Question 3

what is a common symptom in ALL types of eczema

Answer 3

itching

Question 4

what is eczema a form of

Answer 4

dermatitis

Question 5

describe the acute phase of eczema

Answer 5

papulovesicular erthematous (red) lesion, oedema (spongiosis), ooze or scaling and crusting

Question 6

describe the chronic phase of eczema

Answer 6

thickening (lichenification), elevated plaques, increased scaling

Question 7

what are the key words to remember for the presentation of eczema

Answer 7

itchy, ill defined, erythematous and scaley

Question 8

what is seen histologically in ALL types of dermatitis

Answer 8

spongiotic dermatitis

Question 9

what causes contact irritant dermatitis

Answer 9

trauma (eg soap, water)

Question 10

what causes atopic dermatitis

Answer 10

genetic and environmental factors resulting in inflammation

Question 11

what causes lichen simplex dermatitis

Answer 11

physical trauma to skin (e.g. scratching)

Question 12

what causes stasis dermatitis

Answer 12

physical trauma to skin (hydrostatic pressure - peripheral oedema)

Question 13

what extra feature is seen histologically in drug related dermatitis

Answer 13

eosinophils

Question 14

what extra feature is seen histologically in lichen simplex dermatitis

Answer 14

external trauma

Question 15

what extra feature is seen histologically in stasis dermatitis

Answer 15

extravasation of RBS’c (leakage into surrounding tissue)

Question 16

what are common causes of contact allergic dermatitis

Answer 16

nickle, chemicals, topical therapies, plants

Question 17

why can weeping occur in eczema

Answer 17

due to acute oedema of the skin, liquid weeps out

Question 18

what is the difference between a vesicle and a bullae

Answer 18

vesicle- small

bullae-big

Question 19

describe the immunopathology of contact allergic dermatitis

Answer 19

langerhans cells in epidermis processes antigen (increased immunogenicity) anf present it to Th cells in the dermis.

sensitised Th cells migrate into lymphatics and then to regional nodes where antigen presentation is amplified

on subsequent antigen challenge, sensitised T cells proliferate and migrate to infiltrate skin = dermatitis

Question 20

how long are skin patch batteries left in place and when are the reactions checked

Answer 20

left for 48 hours

checked after 96 hours

Question 21

what is the difference between irritant contact dermatitis and contact allergic dermatitis

Answer 21

irritant contact dermatitis is a non specific physical irritation rather than a specific allergic reaction

Question 22

what are features commonly seen in contact irritant dermatitis

Answer 22

erythema, scaling, fissuring, lichenification, nail dystrophy, crusting, erosions

Question 23

is nappy rash irritant or allergic contact dermatitis- how can you tell

Answer 23

irritant- to urine, as flexures usually spared

Question 24

what is and causes ‘lip-lick’ chilitis

Answer 24

lip irritant contact dermatitis to saliva

Question 25

what is the difference between atopic eczema and atopic dermatitis

Answer 25

none same thing

Question 26

why does atopic eczema have such a big impact on childrens QOL

Answer 26

pruritus= sleep disturbance= neurocognitive impairment affects whole family

Question 27

what mutation is associated with atopic eczema

Answer 27

filaggrin mutation

Question 28

what is seen on the palms of chldren with atopic eczema

Answer 28

extra linear palm

Question 29

what 'cycle' is seen in eczema

Answer 29

the itch- scratch cycle

Question 30

how does atopic eczema present

Answer 30

pruritus, ill-defined erythema and scaling, generalised dry skin, flexural distrubution

Question 31

what atopic diseases is atopic eczema associated with

Answer 31

asthma, allergic rhinitis (hay fever), food allergy,

Question 32

what ONLY happens in ATOPIC eczema

Answer 32

eczema beneath the earlobe- is pathognomonic

Question 33

how does eczema present in darker skin

Answer 33

papules, erythema (harder to see), extensive lichenification, prurigo-like nodules, hypertrophic scarring and keloid formation

Question 34

what are the chronic changes of atopic eczema

Answer 34

lichenification excoriation secondary infection

Question 35

what does (gold) crusting of eczema mean

Answer 35

secondary staph aureus infection

Question 36

what is eczema herpeticum

Answer 36

when eczema becomes infected with herpes simplex virus- systemic and potentially life threatening

Question 37

describe the presentation of eczema herpeticum

Answer 37

extremely painful, monomorphic punched out lesions

Question 38

how do you treat eczema herpeticum

Answer 38

anti viral e.g. acyclovir

Question 39

the uk diagnostic criteria for atopic eczema; WHAT plus 3 or more;

Answer 39

ITCHING + 3 or more; - visible flexural* rash - history of flexural* rash * (cheeks and extensor in infants) - personal history of atrophy (or 1st degree relative if <4yo) - generally dry skin - onset before age of 2

Question 40

how do you treat eczema

Answer 40

- lots of emollients - avoid irritants including shower gels and soaps - topical steroids - treat infection - phototherapy (mainly UVB) - systemic immunosuppressants (cyclosporin, methotrexate, azathioprine) - biologic agents

Question 41

what is the most important gene in skin barrier function

Answer 41

filaggrin

Question 42

what causes eczema

Answer 42

multifactoral; genes + environment + immunology

Question 43

describe discoid eczema

Answer 43

coin shaped lesions, patients often atopic too

Question 44

what is chronic actinic dermatitis

Answer 44

photosensitive eczema

Question 45

how does photosensitive eczema present

Answer 45

extensive lichenification and chronic erythema- cut off at collar

Question 46

what is the presentation of stasis eczema

Answer 46

eczema follows varicose veins

Question 47

how do you treat stasis eczema

Answer 47

treat hydrostatic pressure- compression stocking, surgery etc

Question 48

what is cradle cap

Answer 48

seborrhoeic dermatitis- can be atopic eczema often with co fungal or yeast infection

Question 49

what is pompholyx eczema

Answer 49

eczema where vesicles appear due to rapid onset of intercellular oedema

Question 50

what is lichen simplex

Answer 50

when normal skin has become thickened and scaley due to scratching

Question 51

how is lichen simplex treated

Answer 51

potent topical steroids