Dermatitis/Eczema Flashcards
What are the characteristic features of any dermatitis rash?
ITCHY
Ill-defined
Erythematous
Scaly
What may been in the acute phase of the rash?
Papules, vesicles Erythema Spongiosis (oedema) Ooze Scaling Crusting Excoriations
What may be seen int he chronic phase of the rash?
Lichenification (thickening)
Elevated plaques
Increased scaling
Excoriations
What are the two different types of contact dermatitis?
Irritant
Allergic
Which type of hypersensitivity is contact allergic dermatitis?
Type 4 (delayed)
How do you diagnose contact allergic dermatitis?
Patch testing
Give some examples of causes of contact allergic dermatitis
Nickel, chemicals, plants, topical therapies
What is the process of having patch testing done?
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)
How is irritant dermatitis different to allergic?
Non-specific physical irritation rather than specific allergic reaction
(difficult to tell the difference)
Give some examples of causes of irritant dermatitis?
Soap, detergent, cleaning products Nappy rash (urine is irritant)
What is the typical distribution of atopic eczema?
Flexural (from of wrists, back of knees etc)
In infants –> cheeks and extensor surfaces
Which other conditions is atopic eczema associated with?
Asthma
Allergic rhinitis (hay fever)
Other allergies e.g. food
Which chronic changes are seen in atopic eczema?
Lichenification
Excoriation
Secondary infections
Which gene may be involved in eczema?
Filaggrin gene
What is the diagnostic criteria for atopic eczema?
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
What is step 1 in the management of eczema?
Emollients alone
What is step 2 in the management of eczema?
Emollients + mild TCS (topical corticosteroid)
What is step 3 in the management of eczema?
Emollients + moderate TCS
+/- calcineurin inhibitor
What is step 4 in the management of eczema?
Emollients + potent TCS (short term)
+ specialist advice
What practical advice should be given to someone with eczema?
Avoid allergens/irritants
Emollients twice daily, even if eczema is fine
Avoid having sweaty skin
Use emollients in place of soaps in bath/shower
When are ointments better than creams?
For dry, scaly, fissured or lichenified skin
When are creams better than ointments?
For hot, inflamed, urticated skin
What advice should be given for using ointments?
Use a spoon to take out of pot rather than fingers
–> doesn’t contain preservative so easily contaminated
Name a mild TCS?
Hydrocortisone 1%
