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Year 2 Clinical > Dermatitis/Atopic Eczema > Flashcards

Dermatitis/Atopic Eczema Flashcards

1
Q

What is the preferred term:

Dermatitis or eczema?

A

Eczema - skin lesions with similar clinical and pathological features but different pathogenic mechanisms (i.e: this is an umbrella term)

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2
Q

Acute phase of eczema?

A

Papulovesicular rash

Erythematous lesions

Spongiosis (oedema)

Ooze or scale and crusting

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3
Q

Difference between scaling and crusting?

A

Scale - dead keratinocytes

Crust - dried tissue fluid or blood

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4
Q

Chronic phase of eczema?

A

Lichenification (thickening)

Elevated plaques

Increased scaling

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5
Q

4 main features of eczema?

A

Pruritic (if it is not itchy, it is not eczema)

ILL-DEFINED (unlike psoriasis)

Erythematous

Scaly

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6
Q

Describe atopic eczema

A

Genetic and environmental factors cause inflammation of the skin that is most common in childhood

Exhibits type I and IV hypersensitivity and, on histology, shows spongitoic dermatitis

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7
Q

Describe contact allergic dermatitis

A

Contact of allergen with the skin causes a delayed (type 4) hypersensitivity reaction; this leads to spongiotic dermatitis on histology

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8
Q

Describe contact irritant dermatitis

A

Non-specific reaction to trauma, e.g: soap, water, leads to spongiotic dermatitis, on histology

NON-ALLERGIC

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9
Q

Describe drug-related dermatitis

A

Can be a type I or IV hypersensitivity reaction

Histologically, there is spongiotic dermatitis and EOSINOPHILS (unique to drug-related dermatitis)

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10
Q

Describe photo-induced or photosensitive dermatitis

A

Reaction to UV light causes spongiotic dermatitis

Rash present on light-exposed regions and sparing under clothes

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11
Q

Describe lichen simplex

A

Physical trauma to skin, such as scratching, leads to thickening of skin, which leads to more itchiness

Histologically, there is spongiotic dermatitis and external trauma

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12
Q

Describe stasis dermatitis

A

Physical trauma to the skin under hydrostatic pressure, e.g: legs, lower back

Histologically, there is spongiotic dermatitis and extravasation of rbcs (leading to brown pigmentation of skin)

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13
Q

Give examples of allergens in contact allergic dermatitis?

A

Very common:

Nickel

Chemicals, e.g: in gloves

Topical therapies

Plants

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14
Q

Immunopathology of contact allergic dermatitis?

A
  1. Langerhan cells in the epidermis process the antigen (increased immunogenicity)
  2. Processed antigen is then presented to Th cells in the dermis
  3. Sensitised Th cells migrate into lymphatics and then to regional nodes where antigen presentation is amplified
  4. On re-exposure, sensitised T cells proliferate and migrate to and infiltrate skin, leading to dermatitis
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15
Q

What pathological features can be seen in this picture? IMAGE 1

A

Spongiosis (white spaces between keratinocytes)

Inflammatory infiltrate

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16
Q

Diagnosing contact allergic dermatitis?

A

PATCH TESTING:

Batteries of allergens placed in small wells and applied to back skin

Left in place for 48-96 hrs, checking at both times

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17
Q

Differentiating between irritant dermatitis and contact allergic dermatitis?

A

Difficult; the two may overlap or co-exist

18
Q

5 clinical features seen?

A
  1. Erythematous
  2. Erosions (breaks in epidermis)
  3. Scaling
  4. Lichenification (increased skin markings) and hyperlinearity
  5. Nail dystrophy
19
Q

Examples of irritant contact dermatitis?

A

Nappy rash (irritant contact dermatitis to urine) - flexures are spared

Lip-lick dermatitis (to saliva)

20
Q

How does atopic eczema impact on quality of life?

A

Very common in children; pruritus leads to sleep disturbance and neurocognitive impairment

This affects the whole family

21
Q

Describe the itch-scratch cycle

A

Itchiness leads to desire to scratch; but this causes more itchiness

22
Q

Features of atopic eczema?

A
  1. ILL-DEFINED
  2. Generalised dry skin
  3. Flexural distribution but this varies with age; in infants, it often affects the cheeks and abdomen (also, neck flexure and below earlobes) but, as they grow older, begins to affect the flexures
  4. Assoc. with other atopic disease, e.g: asthma, allergic rhinitis, food allergies
23
Q

3 chronic changes with atopic eczema?

A
  1. Lichenification
  2. Excoriation
  3. Secondary infection (gold crusting indicated Staph. aureus infection)
24
Q

What is eczema herpeticum?

A

Caused by HSV and SHOULD NOT BE MISSED

Characterised by:

Monomorphic (look the same), punched-out lesions

Systemically unwell child (high fever)

25
Q

Diagnostic criteria for atopic eczema?

A

Itching + 3/more of:

Visible flexural rash*

History of flexural rash*

Personal history of atopy (or in a 1st degree relative if under 4 yrs)

Generally dry skin

Onset before age 2 years

*cheeks and extensor surfaces in infants

26
Q

Treatment of eczema, from mild to severe?

A
  1. Plenty of emollients
  2. Avoid irritants including shower gels and soaps
  3. Topical steroids
  4. Treat infection
  5. Phototherapy – mainly UVB
  6. Systemic immunosuppressants
  7. (Biologic agents) - mono/poly clonal antibodies against cytokines in the inflammatory pathway
27
Q

What is the most important gene in the development of atopic eczema?

A

Fillagrin

28
Q

What is discoid eczema?

A

Scattered, roundish patches of eczema with an unknown cause but is sometimes assoc. with Staph. aureus infection; the rash is WELL-DEFINED making it an exception in eczema

Patients are often atopic

29
Q

What is chronic actinic dermatitis?

A

Rare skin condition mainly affecting men >50 years.

Patients are often atopic

Characterised by severely itchy, red, inflamed, and thickened dry skin, mainly in areas that have been exposed to sunlight or artificial light (cut-off at the collar)

30
Q

What is seborrheic dermatitis?

A

Chronic or relapsing form of eczema/dermatitis that mainly affects the scalp and face

31
Q

What is pompholyx dermatitis?

A

Hand/foot eczema characterised by spongiotic vesicles or bullae (vesicular dermatitis)

32
Q

What is lichen simplex?

A

Localised area of chronic, lichenified eczema/dermatitis

Follows repetitive scratching/rubbing due to chronic, localised itch, often on back of head and top of foot ; it is more common in people with anxiety or OCD

33
Q

What histological features are shown in the biopsy:

a: Spongiosis
b: Inflammatory infiltrate
c: Dermal hyperplasia
d: Epidermal hyperplasia
e: a and b

A

e

34
Q

How would you distinguish between irritant and allergic contact dermatitis in this patient:

a: Occupational history
b: Family history
c: Social history
d: Patch testing
e: All of the above

A

e

35
Q

What does this patch test result show?

a: Contact allergic reaction to multiple specific allergens
b: Contact allergic reaction to tape adhesive
c: a and b
d: The patient does not have contact allergy
e: Rare ‘blue’ reaction

A

c

36
Q

What type of dermatitis does this 6 month old baby have:

a: Allergic contact
b: Irritant contact
c: Atopic eczema
d: Psoriasis
e: Candida (thrush)

A

b

37
Q

What has caused this rash and what would you do:

a: Atopic eczema, treat with steroids
b: Contact allergic reaction to nickel, perform patch tests
c: Contact allergic reaction to plastic, perform patch tests
d: Contact allergic reaction to nickel, advise nickel avoidance
e: Irritant dermatitis, treat with emollients

A

d

38
Q

What clinical sign gives the clue to the diagnosis:

a: Erythema
b: Scaling
c: Lichenification
d: Cut-off at collar line
e: Grey hair indicating advanced age of patient

A

d (photosensitivity)

39
Q

What pattern of eczema does this patient have:

a: Acute
b: Pompholyx
c: Lichenified
d: Infected
e: a and b

A

e

40
Q

What infection does this young child have as a complication of their eczema:

a: Fungal – candida
b: Staph aureus
c: Varicella zoster virus
d: Herpes simplex virus
e: b and d
f: It is acute eczema and may not be infected

A

e

Year 2 Clinical (119 decks)

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