Eczema

Question 1

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

Answer 1

Inflammatory, Epidermis

Question 2

The word dermatis can be used interchangeably with with?

Answer 2

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

In some cases, the term Eczema Dermatitis is used

Question 3

Is Dermatitis acute, chronic or both?

Answer 3

Can be ANY (acute, chronic or both)

Question 4

Describe the rash and location of Eczema (clinical features)

Answer 4

Dry and Itchy - usually bilateral and symmetrical? check

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

Question 5

List 4 specific locations eczema tends to occur in

Answer 5

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

Exposed skin: face, hands, feet

Question 6

Compare presentation of Atopic dermatitis in infants vs children?

Answer 6

Infants: face and scalp

Children: flexor surfaces

Question 7

Which age group is most commonly affected by Eczema?

Answer 7

Young children - but can affect all age groups

Question 8

What causes the inflammation seen in Eczema?

Answer 8

Allergy - Type I or 4 hypersensitivity reaction

CHECK

Question 9

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

Answer 9

1. Allergy mediated inflammation makes skin barrier leaky

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

Question 10

List triggers of atopic dermatitis

Answer 10

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

Question 11

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

Answer 11

Older children/adults: aeroallergens (pollen)

Younger children/infants: food

Question 12

Describe how skin may worsen in atopic dermatitis

Answer 12

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

Question 13

When is itchiness with Eczema most prominant?

Why?

Answer 13

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

Question 14

How may eczema affect a patients wellbeing?

Answer 14

Although it is not contagious, social stigma still exists

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

Question 15

Is there a genetic link with Atopic dermatitis?

Answer 15

YES!

Question 16

What is the atopic triad?

Answer 16

Atopic dermatitis, Asthma and Allergic Rhinitis

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

Question 17

Atopic Dermatitis may also be part of what 3 syndromes?

Answer 17

1. Hyper-IgE syndrome
2. Phenylketonurea
3. Wiskott-Aldrich syndrome

Question 18

Triad of Wiskott-Aldrich syndrome + inherritance pattern:

Answer 18

Eczema, thrombocytopenia, Immunodeficiency

X-linked recessive

Question 19

What is Erythrodermic Eczema?

Answer 19

Eczema with widespread erythema with desequamation

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

Question 20

How is a diagnosis of Atopic dermatitis made?

Answer 20

Generally clinical diagnosis

Question 21

What is the aim of treatment for Atopic dermatits

Answer 21

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

Question 22

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

Answer 22

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

Question 23

How is the ‘emolliant ladder’ classified?

Answer 23

Question 24

List 3 specific examples of management for Eczema

Answer 24

Reducing scratching and avoiding triggers

Emollients (moisturising treatments) - Dry skin

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

Question 25

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

Answer 25

* Creams and lotions - red, inflamed areas of skin * Ointments - dry skin (that is not inflamed) Often, several different emollients will be required

Question 26

What forumulation of emolliant must we avoid prescribing and why?

Answer 26

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

Question 27

List 4 clinical actions of corticosteroids

Answer 27

1. Anti-inflammatory 2. Immunosuppressive 3. Anti-proliferative 4. Vasoconstrictive

Question 28

Topical steroid absoprtion depends \_\_\_\_\_\_. It is enhanced by \_\_\_\_\_\_\_

Answer 28

skin thickness, occlusion (what does this mean?)

Question 29

Which areas of the body have higher vs lower absorption?

Answer 29

High: eyelids, genitals, skin creases Low: palms and soles

Question 30

How do we classify the "steroid ladder"

Answer 30

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

Question 31

List a common example within each steroid classification

Answer 31

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%

Question 32

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

Answer 32

Mild - mildly potent Moderate - moderately potent Severe eczema - potent topical

Question 33

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

Answer 33

**Once** daily to **inflamed** skin for 5 days to several weeks ## Footnote If response to once daily application is inadequate, increase to twice daily. Can step up or down depending on effect

Question 34

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?

Answer 34

About half of this is needed for a child

Question 35

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

Answer 35

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

Question 36

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

Answer 36

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

Question 37

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

Answer 37

Longer use increases the likelihood of resistance and of sensitisation

Question 38

List 4 side effects of topical corticosteroids

Answer 38

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