Eczema Flashcards
Dermatitis refers to a group of _______ conditions. It affects the outer layer of the skin known as the _______.
Inflammatory, Epidermis
The word dermatis can be used interchangeably with with?
Eczema - BUT this is generally used when reffering to ‘atopic dermatitis’
In some cases, the term Eczema Dermatitis is used
Is Dermatitis acute, chronic or both?
Can be ANY (acute, chronic or both)
Describe the rash and location of Eczema (clinical features)
Dry and Itchy - usually bilateral and symmetrical? check
Occurs on the flexor surfaces of the body and/or areas of exposed skin
List 4 specific locations eczema tends to occur in
Flexor surfaces: sides of elbow, creases of wrists, backs of knees
Exposed skin: face, hands, feet
Compare presentation of Atopic dermatitis in infants vs children?
Infants: face and scalp
Children: flexor surfaces
Which age group is most commonly affected by Eczema?
Young children - but can affect all age groups
What causes the inflammation seen in Eczema?
Allergy - Type I or 4 hypersensitivity reaction
CHECK
Pathophysiology of Atopic dermatitis and the characteristic ‘cycle’ which occurs
1. Allergy mediated inflammation makes skin barrier leaky
- ↑allergen entry and ↑water escape ➞ skin becomes Dry and scaly
- Results in Itching which furthur damages the skin and worsens process, starting a vicious cycle
List triggers of atopic dermatitis
- Allergens ie cigarette smoke, mold, animal dander and saliva, dust mite droppings, pollen
- Overheating
- Soap and detergents
- Rough clothing
- Skin infections
- Food
- Stress
What specific triggers more commonly affect older children/adults vs younger children/infants
Older children/adults: aeroallergens (pollen)
Younger children/infants: food
Describe how skin may worsen in atopic dermatitis
Red, itchy, dry ➞ blister and peel ➞ lichenified (leather-like)
When is itchiness with Eczema most prominant?
Why?
Worse at night - no distractions, children are most likley to scratch the lesions
How may eczema affect a patients wellbeing?
Although it is not contagious, social stigma still exists
Can cause young children and teenagers to suffer depression and/or social axiety
Is there a genetic link with Atopic dermatitis?
YES!
What is the atopic triad?
Atopic dermatitis, Asthma and Allergic Rhinitis
As AD has a strong genetic link is is commonly associated with the above conditions
Atopic Dermatitis may also be part of what 3 syndromes?
- Hyper-IgE syndrome
- Phenylketonurea
- Wiskott-Aldrich syndrome
Triad of Wiskott-Aldrich syndrome + inherritance pattern:
Eczema, thrombocytopenia, Immunodeficiency
X-linked recessive
What is Erythrodermic Eczema?
Eczema with widespread erythema with desequamation
Can be painful, incredably itchy, patient may be systemically unwell
How is a diagnosis of Atopic dermatitis made?
Generally clinical diagnosis
What is the aim of treatment for Atopic dermatits
Aimed at breaking the ‘cycle’ to relieve the symptoms BUT currently no cure
Many cases improve over time but severe eczema can have significant impact on daily life
List 4 factors we must consider when choosing an emollient to prescribe for eczema
- Weepy vs dry
- Skin type
- Affected area
- Day vs night use
- Greasier the better but…???
- Cosmetic acceptibility
- Quantity to prescribe
- How much to use
How is the ‘emolliant ladder’ classified?
List 3 specific examples of management for Eczema
Reducing scratching and avoiding triggers
Emollients (moisturising treatments) - Dry skin
Topical corticosteroids - reduce swelling, redness and itching during flare-ups
When would we prscribe emolliants as creams and lotions vs ointments?
- Creams and lotions - red, inflamed areas of skin
- Ointments - dry skin (that is not inflamed)
Often, several different emollients will be required
What forumulation of emolliant must we avoid prescribing and why?
Aqueous cream as it is thought to cause a disproportionate amount of skin reaction
List 4 clinical actions of corticosteroids
- Anti-inflammatory
- Immunosuppressive
- Anti-proliferative
- Vasoconstrictive
Topical steroid absoprtion depends ______. It is enhanced by _______
skin thickness, occlusion (what does this mean?)
Which areas of the body have higher vs lower absorption?
High: eyelids, genitals, skin creases
Low: palms and soles
How do we classify the “steroid ladder”
Based on potency: mild, moderate, potent, very potent
List a common example within each steroid classification
Mild - hydrocortisone 0.1%, 0.5%, 1.0%, and 2.5%
Moderate - betamethasone valerate 0.025% and clobetasone butyrate 0.05%
Potent - betamethasone valerate 0.1% and betamethasone dipropionate 0.05%
Very potent - clobetasol propionate 0.05% and diflucortolone valerate 0.3%
Which classification of TCS is used for mild vs moderate vs sever Eczema?
Mild - mildly potent
Moderate - moderately potent
Severe eczema - potent topical
How often do we advise patients to use TCS and when specifically?
Once daily to inflamed skin for 5 days to several weeks
If response to once daily application is inadequate, increase to twice daily. Can step up or down depending on effect
Quantities of TCS required to treat a flare of eczema for 1 week in an adult are listed on image below, how would dosage change for children?
About half of this is needed for a child
If a patient is prescribed both an emolliant and TCS, what avice do we give regarding application?
- Apply emolliant
- Wait several minutes after application (about 15–30 mins if possible)
- Apply the TCA
Slides say: emolliants can be applied before or after… but above info is from NICE - double check
Using a ‘fingertip unit’ state how you would advise a patient to use TCS’s for the following body parts:
- One foot
- Face and neck
- One arm
- One leg
- Trunk, front and back
- Entire body
One foot: 2 FT units
Face and neck: 2.5 FT units
One arm: 3 FT units
One leg: 6 FT units
Trunk, front and back: 14 FT units
Entire body: ~40 FT units
Why do we only prescribe topical corticosteroids for a short period of time?
Longer use increases the likelihood of resistance and of sensitisation
List 4 side effects of topical corticosteroids
- Skin thinning (atrophy)
- Stretch marks (striae) in armpits or groin
- Easy bruising (senile/solar purpura) and tearing of skin
- Enlarged blood vessels (telangiectasia)
- Localised increased hair thickness and length (hypertrichosis)
- Aggrevate or mask skin infections
