Eczema

Question 1

atopic eczema

Answer 1

most common form of dermatitis
common in children

dry, scaly and intensely pruritic rash
superimposed with infection can cause it to weep

flexor aspects of limbs (elbows, behind knees) can involve the earlobes, neck and scalp

atopic disorders
+ asthma
+ hay fever

chronically affected areas can become dry and thickened and from repeated scratching (lichenification)

Question 2

pityriasis alba

Answer 2

scaly skin= pityriasis
alba= white

low grade eczematous rash of unknown cause
children and adolescents
scaly pink plaques
shed to leave an area of hypopigmentation

Question 3

asteotoic eczema

Answer 3

elderly
paving like rash
shins
caused btw after loss from stratum corner resulting in dry skin

liberal use of emollients

Question 4

contact dermatitis

Answer 4

broadly divided into irritant and allergic

hairdressers/cleaners

Question 5

discoid eczema

Answer 5

(nummular= coin shaped)
bilateral round patches of eczema
extremely itchy
can be triggered by injury to the skin

Question 6

pathophysiology of eczema

Answer 6

defect in the barrier that the skin provides. tiny gaps in the skin barrier provides entrances for irritants, microbes and allergens. this creates an immune response, resulting in inflammation and the associated symptoms

Question 7

management of eczema

Answer 7

maintenance mx
flares mx

maintinence:
create an artificial barrier over the skin to compensate for defective
emollients (thick and greasy)
avoid bathing in hot water, scratching or scrubbing skin using soaps and body washes
soap substitutes

flares:
thicker emollients
topical steroids
wet wraps (covering affected areas in thick emollients and applying a wrap to keep moisture locked in overnight) 
treat any infections (abx) 

others:
zinc impregnated bandage
topical tacrolimus
phototherapy
systemic immunosuppressants
oral corticosteroids
methotrexate
azathioprine

Question 8

emollients for eczema

Answer 8

maintain skin barrier

thin creams: 
E45
Diprobase cream
Oilatum cream
Aveeno cream
Cetraben cream
Epaderm cream

thick and greasy:
50:50 ointment (50% liquid paraffin)
Hydromol ointment
Diprobase ointment
Cetraben ointment
Epaderm ointment

Question 9

topical steroids

Answer 9

use the weakest steroids for shortest period

settle down immune activity and reduce inflammation
S/E skin thinning, bruising, tears, stretch marks, enlarged blood vessels (telangiectasia)

Mild: Hydrocortisone 0.5%, 1% and 2.5%
Moderate: Eumovate (clobetasone butyrate 0.05%)
Potent: Betnovate (betamethasone 0.1%)
Very potent: Dermovate (clobetasol propionate 0.05%)

Question 10

bacterial infection and eczema

Answer 10

opportunistic bacterial infection due to breakdown in the skin’s protective barrier

most common - staph aureus

tx: flucloxacillin

Question 11

eczema herpeticum

Answer 11

viral skin infection in patients with eczema caused by herpes simplex virus (HSV) or varicella zoster virus (VZV)

HSV-1 is most common and is associated with coldsore

Question 12

how does eczema herpeticum present?

Answer 12

pt previously suffers from eczema

developed widespread, painful vesicular rash with systemic symptoms like fever, lethargy, irritability, reduced oral intake

lymphadenopathy

Question 13

eczema herpeticum rash

Answer 13

widespread and affects any area of the body. erythematous, painful, sometimes itchy. vesicles contains pus.

burst and leave small punched out ulcers with a red base

Question 14

management of eczema herpeticum

Answer 14

viral swabs to confirm diagnosis

tx: acyclovir IV