Eczema Flashcards
Define eczema
dermatitis
terms can be used interchangeably
List eczema types
atopic eczema
irritant contact eczema
allergic contact eczema
varicose eczema
stasis/gravitational eczema
asteatotic eczema
discoid
seborrhoeic
lichen simplex
Describe pompholyx
itchy bubbles of fluid down sides of fingers
Atopic eczema causes
atopic genes
Irritant contact eczema causes
irritants
Allergic contact eczema causes
contact allergy
Varicose eczema causes
varicose veins
Gravitational/stasis eczema causes
standing
occupation
wheelchair
Seborrhoeic eczema causes
yeast sensitivity
Discoid eczema causes
bacteria on skin
Lichen simplex causes
eczema
scratch cycle
Eczema symptoms
Itch:
- scratch
- bleed
- affected sleep
- concentration loss
- anger
What is DLQI?
Dermatology Life Quality Index
effect of dermatological condition on patient’s life
Eczema signs
erythema
scale
excoriation (scratch marks)
exudate (weeping)
crusting (scab)
hyperkeratosis (thick skin)
lichenification (increased skin markings due to rubbing)
vesicles (little blisters)
What causes erythema?
more blood or more translucent skin
What causes scale?
excessive production of epidermis which peels off or stays stuck to the top layer sp becomes thick`
What is lichenification?
thickened hyperkeratotic skin due to rubbing with more lines/wrinkles
What causes exudate?
fluid oozing which dris to form crust
What causes vesicles?
fluid accumulating in epidermis due to inflammation
Describe atopic eczema
adult or child
associated with fillagrin gene abnormalities
makes skin ‘leaky’
so things irritate easily
use oil on skin to ‘waterproof’ skin
linked with other atopic diseases (asthma, hayfever, urticaria)
List 4 atopic diseases
asthma
hayfever (allergic rhinitis)
eczema
urticaria
Difference between cream and ointment?
ointment has more oil than cream
What units are used for steroid creams?
fingertip units
Mild steroid example
Hydrocortisone 1%
Medium steroid example
Eumovate
generic name = clobitasone
Potent steroid example
Betnovate
Very potent steroid example
Dermovate
generic name = clobitasol
What is asteatotic eczema?
lack of oil
more oil removed than produced
looks like dry river bed
Asteatotic eczema treatment
bathe less often, shorter and cooler
use less detergent
apply oil to skin
Describe irritant contact eczema
many chemicals can irritate skin cells
irritation is not the same as allergy (allergy = due to immune process)
yellow crust = secondary infection
Describe allergic contact eczema
few to 96 hours after contact
common causes = nickel, fragrance, rubber accelerators, chromate, formaldehyde, plants
investigate with patch tests
Describe how to carry out a patch test
apply patches day 1
remove day 3
read days 3 and 5
select batteries according to history and distribution
Describe varicose eczema
stasis = gravitational
important as commonly breaks down (infection or scratching) to form leg ulcer
How is venous stasis treated?
lose weight
exercise
elevate legs
avoid standing/sitting for long periods
compression bandages
varicose vein surgery
Why should you use weaker steroids on occluded areas?
occlusion causes increased penetration of steroid
eg. armpits
Describe infected eczema
often due to scratching
commonly due to staph aureus infection
produce yellow crusts and/or blisters of impetigo (impetiginised eczema)
Viral causes of infected eczema
Herpes Simplex
-causes cold sores
Eczema Herpeticum
Describe discoid eczema
round/disc-shaped
variant of bacterial infected eczema
odd pattern often confused with psoriasis
- has follicular areas, less well-defined and lacks psoriasis scale
antibiotic or antiseptic/steroid combinations needed
often co-exists with small areas of follicular eczema
Describe pompholyx eczema
little blisters down sides of fingers
intensely itchy
episodic
can be due to allergy or endogenous
stronger steroids needed as skin thicker
Describe seborrhoeic eczema
due to sensitivity to yeast on skin
not due to yeast in diet
very common + made worse by stress
severe in HIV
causes dandruff, rash on eyebrows, nose, nasolabial folds + flexures
treat with systemic or topical antifungals +/- corticosteroid creams
Eczema general treatments
emollients if dry
antiseptic soaks if oozing
topical steroids depending on degree of inflammation
antibiotic courses if infected or discoid
antifungals if seborrhoeic
antivirals if herpes
bandaging if scratching
elevation etc if stasis
local PUVA (can reach dermis)
oral alitretinoin (if on hands)
oral azathioprine, ciclosporin
What skin layer can UVA reach?
dermis
What skin layer can UVB reach?
epidermis
Eczema differential diagnoses
scabies (burrows between fingers, friends/family usually affected)
fungal infection hands (often unilateral)
psoriasis (can be itchy - different physical signs)
drug eruption (take a good history to exclude)
rarer diseases (eg. bullous pemphigoid, dermatitis, herpetiformis, mycosis fungoides)
Describe fungal (tinea) hand infection
fine silver scale in the creases
lack of cracking
unilateral
take fungal scrapings if unsure
What nail changes can occur in psoriasis and discoid eczema?
pitting
onycholysis
