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Clinical Methods > Eczema > Flashcards

Eczema Flashcards

1
Q

Dermatitis refers to a group of _______ conditions. It affects the outer layer of the skin known as the _______.

A

Inflammatory, Epidermis

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2
Q

The word dermatis can be used interchangeably with with?

A

Eczema - BUT this is generally used when reffering to ‘atopic dermatitis’

In some cases, the term Eczema Dermatitis is used

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3
Q

Is Dermatitis acute, chronic or both?

A

Can be ANY (acute, chronic or both)

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4
Q

Describe the rash and location of Eczema (clinical features)

A

Dry and Itchy - usually bilateral and symmetrical? check

Occurs on the flexor surfaces of the body and/or areas of exposed skin

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5
Q

List 4 specific locations eczema tends to occur in

A

Flexor surfaces: sides of elbow, creases of wrists, backs of knees

Exposed skin: face, hands, feet

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6
Q

Compare presentation of Atopic dermatitis in infants vs children?

A

Infants: face and scalp

Children: flexor surfaces

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7
Q

Which age group is most commonly affected by Eczema?

A

Young children - but can affect all age groups

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8
Q

What causes the inflammation seen in Eczema?

A

Allergy - Type I or 4 hypersensitivity reaction

CHECK

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9
Q

Pathophysiology of Atopic dermatitis and the characteristic ‘cycle’ which occurs

A

1. Allergy mediated inflammation makes skin barrier leaky

  1. ↑allergen entry and ↑water escape ➞ skin becomes Dry and scaly
  2. Results in Itching which furthur damages the skin and worsens process, starting a vicious cycle
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10
Q

List triggers of atopic dermatitis

A
  1. Allergens ie cigarette smoke, mold, animal dander and saliva, dust mite droppings, pollen
  2. Overheating
  3. Soap and detergents
  4. Rough clothing
  5. Skin infections
  6. Food
  7. Stress
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11
Q

What specific triggers more commonly affect older children/adults vs younger children/infants

A

Older children/adults: aeroallergens (pollen)

Younger children/infants: food

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12
Q

Describe how skin may worsen in atopic dermatitis

A

Red, itchy, dry ➞ blister and peel ➞ lichenified (leather-like)

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13
Q

When is itchiness with Eczema most prominant?

Why?

A

Worse at night - no distractions, children are most likley to scratch the lesions

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14
Q

How may eczema affect a patients wellbeing?

A

Although it is not contagious, social stigma still exists

Can cause young children and teenagers to suffer depression and/or social axiety

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15
Q

Is there a genetic link with Atopic dermatitis?

A

YES!

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16
Q

What is the atopic triad?

A

Atopic dermatitis, Asthma and Allergic Rhinitis

As AD has a strong genetic link is is commonly associated with the above conditions

17
Q

Atopic Dermatitis may also be part of what 3 syndromes?

A
  1. Hyper-IgE syndrome
  2. Phenylketonurea
  3. Wiskott-Aldrich syndrome
18
Q

Triad of Wiskott-Aldrich syndrome + inherritance pattern:

A

Eczema, thrombocytopenia, Immunodeficiency

X-linked recessive

19
Q

What is Erythrodermic Eczema?

A

Eczema with widespread erythema with desequamation

Can be painful, incredably itchy, patient may be systemically unwell

20
Q

How is a diagnosis of Atopic dermatitis made?

A

Generally clinical diagnosis

21
Q

What is the aim of treatment for Atopic dermatits

A

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

22
Q

List 4 factors we must consider when choosing an emollient to prescribe for eczema

A
  1. Weepy vs dry
  2. Skin type
  3. Affected area
  4. Day vs night use
  5. Greasier the better but…???
  6. Cosmetic acceptibility
  7. Quantity to prescribe
  8. How much to use
23
Q

How is the ‘emolliant ladder’ classified?

A
24
Q

List 3 specific examples of management for Eczema

A

Reducing scratching and avoiding triggers

Emollients (moisturising treatments) - Dry skin

Topical corticosteroids - reduce swelling, redness and itching during flare-ups

25
Q

When would we prscribe emolliants as creams and lotions vs ointments?

A
  • Creams and lotions - red, inflamed areas of skin
  • Ointments - dry skin (that is not inflamed)

Often, several different emollients will be required

26
Q

What forumulation of emolliant must we avoid prescribing and why?

A

Aqueous cream as it is thought to cause a disproportionate amount of skin reaction

27
Q

List 4 clinical actions of corticosteroids

A
  1. Anti-inflammatory
  2. Immunosuppressive
  3. Anti-proliferative
  4. Vasoconstrictive
28
Q

Topical steroid absoprtion depends ______. It is enhanced by _______

A

skin thickness, occlusion (what does this mean?)

29
Q

Which areas of the body have higher vs lower absorption?

A

High: eyelids, genitals, skin creases

Low: palms and soles

30
Q

How do we classify the “steroid ladder”

A

Based on potency: mild, moderate, potent, very potent

31
Q

List a common example within each steroid classification

A

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%

32
Q

Which classification of TCS is used for mild vs moderate vs sever Eczema?

A

Mild - mildly potent

Moderate - moderately potent

Severe eczema - potent topical

33
Q

How often do we advise patients to use TCS and when specifically?

A

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

34
Q

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?

A

About half of this is needed for a child

35
Q

If a patient is prescribed both an emolliant and TCS, what avice do we give regarding application?

A
  1. Apply emolliant
  2. Wait several minutes after application (about 15–30 mins if possible)
  3. Apply the TCA

Slides say: emolliants can be applied before or after… but above info is from NICE - double check

36
Q

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
A

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

37
Q

Why do we only prescribe topical corticosteroids for a short period of time?

A

Longer use increases the likelihood of resistance and of sensitisation

38
Q

List 4 side effects of topical corticosteroids

A
  1. Skin thinning (atrophy)
  2. Stretch marks (striae) in armpits or groin
  3. Easy bruising (senile/solar purpura) and tearing of skin
  4. Enlarged blood vessels (telangiectasia)
  5. Localised increased hair thickness and length (hypertrichosis)
  6. Aggrevate or mask skin infections

Clinical Methods (21 decks)

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