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Dermatology > Dermatitis/Eczema > Flashcards

Dermatitis/Eczema Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the characteristic features of any dermatitis rash?

A

ITCHY
Ill-defined
Erythematous
Scaly

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2
Q

What may been in the acute phase of the rash?

A 
Papules, vesicles
Erythema
Spongiosis (oedema)
Ooze
Scaling
Crusting
Excoriations
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3
Q

What may be seen int he chronic phase of the rash?

A

Lichenification (thickening)
Elevated plaques
Increased scaling
Excoriations

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4
Q

What are the two different types of contact dermatitis?

A

Irritant

Allergic

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5
Q

Which type of hypersensitivity is contact allergic dermatitis?

A

Type 4 (delayed)

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6
Q

How do you diagnose contact allergic dermatitis?

A

Patch testing

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7
Q

Give some examples of causes of contact allergic dermatitis

A

Nickel, chemicals, plants, topical therapies

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8
Q

What is the process of having patch testing done?

A

Three appointments in 1 week

  • allergens put on back (first appointment)
  • allergens taken off back 48 hours later
  • reactions checked at 96 hours (third appointment)
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9
Q

How is irritant dermatitis different to allergic?

A

Non-specific physical irritation rather than specific allergic reaction
(difficult to tell the difference)

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10
Q

Give some examples of causes of irritant dermatitis?

A 
Soap, detergent, cleaning products
Nappy rash (urine is irritant)
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11
Q

What is the typical distribution of atopic eczema?

A

Flexural (from of wrists, back of knees etc)

In infants –> cheeks and extensor surfaces

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12
Q

Which other conditions is atopic eczema associated with?

A

Asthma
Allergic rhinitis (hay fever)
Other allergies e.g. food

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13
Q

Which chronic changes are seen in atopic eczema?

A

Lichenification
Excoriation
Secondary infections

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14
Q

Which gene may be involved in eczema?

A

Filaggrin gene

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15
Q

What is the diagnostic criteria for atopic eczema?

A

ITCHING + 3 or more of:

  • visible flexural rash (cheeks/extensors in infants)
  • history of flexural rash
  • personal history of atopy (or first degree relative if < 4 years old)
  • generally dry skin
  • onset before age of 2
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16
Q

What is step 1 in the management of eczema?

A

Emollients alone

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17
Q

What is step 2 in the management of eczema?

A

Emollients + mild TCS (topical corticosteroid)

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18
Q

What is step 3 in the management of eczema?

A

Emollients + moderate TCS

+/- calcineurin inhibitor

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19
Q

What is step 4 in the management of eczema?

A

Emollients + potent TCS (short term)

+ specialist advice

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20
Q

What practical advice should be given to someone with eczema?

A

Avoid allergens/irritants
Emollients twice daily, even if eczema is fine
Avoid having sweaty skin
Use emollients in place of soaps in bath/shower

21
Q

When are ointments better than creams?

A

For dry, scaly, fissured or lichenified skin

22
Q

When are creams better than ointments?

A

For hot, inflamed, urticated skin

23
Q

What advice should be given for using ointments?

A

Use a spoon to take out of pot rather than fingers

–> doesn’t contain preservative so easily contaminated

24
Q

Name a mild TCS?

A

Hydrocortisone 1%

25
Q

Name some moderate TCS?

A

Modrasone, Clobetasone, Butyrate 0.05%

26
Q

Name some potent TCS?

A

Elocon, Betamethasone (betnovate), Valerate 0.1%

27
Q

Name a very potent TCS?

A

Clobetasol proprionate 0.05%

28
Q

What are some side effects seen with potent/very potent steroids?

A

Skin thinning –> striae
Increased skin infections
Telangiectasia + steroid acne (Betnovate)
Systemic absorption –> poor growth, cushingoid features

29
Q

How much surface are does a fingertip unit of TCS cover?

A

2 hand areas

30
Q

How much TCS would be required to cover a whole adult body?

A

20 - 30g

31
Q

How much emollient should be prescribed to last 1 week?

A

250 - 500g

32
Q

What are calcineurin inhibitors and when are they used?

A

Potent anti-inflammatory agents without the steroid side effects
Second like topical therapy for severe eczema

33
Q

Give two examples of calcineurin inhibitors

A

Tacrolimus 0.1%

Pimecrolimus (face only)

34
Q

Give some examples of physical therapies used in eczema?

A

Bangages - impregnated with zinc oxide paste +/- tar, antimicrobials
Wet wrap therapy

35
Q

What is the role for antihistamines in eczema?

A

No evidence for efficacy but sedative effects may help children to sleep if this is a problem
–> contraindicated in children < 6 months

36
Q

What does Staph aureus infected eczema look like?

A

Golden crust

37
Q

How should you treat Staph aureus infected eczema?

A 
Fucidin ointment (antibiotic) --> 5-10 days
Consider antiseptics
38
Q

How should eczema herpeticum be treated?

A

Emergency oral aciclovir

39
Q

What is a rare complication of eczema herpeticum?

A

Encephalitis

40
Q

What is seborrhoeic dermatitis?

A

pink scaly patches on scalp, eyebrows and nasolabial folds (oily areas)
–> very common (stubborn dandruff)

41
Q

Which conditions are associated with seborrhoeic dermatitis?

A

HIV and other immunosuppressive states

42
Q

What does discoid eczema look like?

A

Discs of eczema, similar to psoriasis but not as well demarcated

43
Q

What causes discoid eczema?

A

Chronic itch, rubbing and scratching

–> atopic eczema, itch from CKD

44
Q

What is nodular prurigo?

A

Similar to discoid eczema, consequence of chronic itch

45
Q

What is pompholyx eczema?

A

Itchy vesicular eczema on palms and soles

46
Q

Which eczema is seen only on sun exposed sites?

A

Photosensitve eczema aka chronic actinic dermatitis

47
Q

What is stasis eczema?

A

Aka venous eczema
Seen in lower legs secondary to hydrostatic pressure, oedema and red cell extravasation
–> chronic venous insufficiency, varicose veins, DVT

48
Q

What does lichen simplex look like and what causes it?

A

Localised plaque of lichenified, chronic eczema

Response to scratching/rubbing over a long period of time

Dermatology (18 decks)

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