Eczema

Question 1

What is the most common skin condition in kids?

Answer 1

Eczema or Atopic Dermatitis

Question 2

What is the positive feedback loop that worsens eczema?

Answer 2

Itching leads to irritation, which in turn causes more itching. This feedback loop can make eczema worse

Question 3

What is the Hygiene Hypothesis?

Answer 3

In today’s super-clean world, vaccinations, anti-bacterial soaps, and airtight doors and windows are keeping disease-causing germs at bay. This lack of exposure could explain why allergies are becoming more common

Question 4

What are the three stages of eczema?

Answer 4

In order of progression…

Acute, sub-acute, and chronic

Question 5

What does the onset of eczema look like?

Answer 5

Blistering —> Dry skin —> Scaling

Pruritis: scratch and itch cycle can cause disturbed sleep

Seen initially in young children (80% of cases are before 5)

Question 6

Where is eczema usually found?

Answer 6

Infants: on the face

Older children and adults: hands, elbows, wrists, and back of knees

Question 7

How are the different severities of eczema described?

Answer 7

Mild: Areas of dry skin, infrequent itching, with or without small areas of redness

Moderate: Areas of dry skin, frequent itching, with or without broken skin or localized skin thickening

Severe: Widespread areas of dry skin, incessant itching, and redness with or without broken skin thickening, bleeding, oozing, cracking, and alteration of pigmentation

Question 8

What is the most common clinical presentation of eczema in children?

Answer 8

2/3 of children have a mild version of eczema

Question 9

What is the prevalence of eczema?

Answer 9

Lifetime prevalence of 17%, increasing every year

Eczema is more common in children (15-20%) than adults (2-10%)

Question 10

What is allergic march?

Answer 10

It is the natural progression of allergic responses in an individual as they get older.

People with eczema are more likely to develop asthma, and allergic rhinitis if individual has asthma

Family history also impacts whether an individual will develop eczema

Question 11

How to differentiate prickly heat?

Answer 11

This skin condition is heat-related and will resolve on its own.

It is caused when salt from sweat glands re-enters follicles and cause irritation

Question 12

How to differentiate seborrhoea dermatitis?

Answer 12

This is usually found in adults and it’s usually concentrated near areas that have lots of sebaceous glands

Question 13

What are some atypical presentations of eczema?

Answer 13

Patches on the legs(looks like tinea)

On the eyelids (looks like inflammation)

Question 14

What are some triggers for eczema?

Answer 14

Low humidity (a humidifier helped reduce static and has a cooling effect on skin)

Irritants like wool, sweat, (hundreds of other substances)

Allergens (dust mites, food, environmental particles)

Question 15

What are some common clothing materials that help reduce irritation?

Answer 15

Cotton is the best material

Cotton>wool>synthetic

Question 16

What are some measures to counter act dry skin?

Answer 16

Take fewer hot showers (increase lipid loss)
Reduce exposure to weather (dry Sask winters)
Use dosage forms that are more effective at trapping skin moisture
Apply a dry skin product immediately after after a shower for best effect

Question 17

What makes a dry skin product “eczema-grade”?

Answer 17

No colourants
No fragrances
Non-allergenic
Gentle and soapless

Question 18

Can steroids alone fully treat eczema?

Answer 18

Frequent use of dry dkin products are essential for eczema. Steroids alone cannot fully treat eczema, but it used to reduce the flare-ups

Question 19

What is the benefit of dry skin products that have ceramide?

Answer 19

Alothough seramide is low in eczematous skin, it needs to be delivered from under the skin. Topical ceramide does not have the same benefit, it is simply another lipid

Question 20

Why do some doctors recommend bleach baths, and how do they recover?

Answer 20

Individuals with infectious skin diseases may take bleach baths to eliminate these pathogens. It is important that these patients use dry skin products to minimize the loss of moisture following bleach baths

Question 21

How to treat weeping lesions?

Answer 21

Plain water (cold compress 20min QID for 2-3 days) or even longer (in severe cases, could do this for hours)

Question 22

Is calamine useful in helping dry skin of eczema?

Answer 22

No, calamine will make the skin drier.

Question 23

Should eczema patients use topical steroids on broken weeping lesions?

Answer 23

Pharmacists are risk averse and try not to encourage this behaviour. Topical steroids can prevent flare-ups from getting particularly bad

Question 24

How long does the acute stage for weeping lesions last?

Answer 24

7 days, use lotion or cream formulations at this stage

Question 25

When should we use topical steroids in eczema?

Answer 25

Dry skin products are good for prevention, topical steroids are emergency response

Question 26

On the corticosteroid potency chart, what value indicates the highest strength?

Answer 26

The scale is not linear

A potency rating of 1-2 is very strong

A potency rating of 7 is very low level (1% hydrocortisone)

Question 27

How long can patients use topical steroids according to the legal guidelines?

Answer 27

3 weeks

but actual practice is a lot more relaxed especially for lower strength topical steroids

Drug holidays can also limit adverse effects

The burden of under- and untreated eczema usually outweighs the risks associated with topical steroids

Question 28

Are concerns about adverse effects in long-term topical streoid use valid?

Answer 28

Yes, long-term streoid use can really damage the skin, but concerns are mostly for stronger formulations and improper use.

We still should be careful about topical steroids

Question 29

What are some adverse effects of long-term steroid use?

Answer 29

Skin atrophy
Striation of skin
Telangiectasia (spider veins): caused by skin thinning

Question 30

What high-potency steroid should we use for severe rashes on face and torso?

Answer 30

We should avoid using high potency steroids, so use a weaker agent on the face and get a second stronger product for the rest of the body

Question 31

What is a rule of thumb for when steroids should be applied?

Answer 31

“rough and red” - apply steroid

“smooth and skin-tone” - time to stop

Question 32

Can topical steroids be used in children under 2?

Answer 32

Yes, but a MD needs to prescribe it. Steroids are commonly used for diaper rash

Question 33

How much area does an Fingertip Unit(FTU) cover?

Answer 33

Treats both sides of one hand

Question 34

How to measure an FTU for babies?

Answer 34

FTU is measured on the parent’s fingertips, NOT THE BABY’S FINGER

Question 35

Should high potency steroids be used to bring patient all the way back to normal skin?

Answer 35

No, steroid strength should ideally match the severity of skin condition. It is best if products with a range of potencies is used to eliminate a skin condition

Question 36

Are concerns about the systemic side effects of topical steroids valid?

Answer 36

Only if agents used are very potent, large quantities applied, for long periods of time(years)

Question 37

What is a good rule of thumb for prescibing for eczema?

Answer 37

Prescribe and treat the simple cases, refer complex cases to doctors

Question 38

Describe some characteristics of calcineurin inhibitors?

Answer 38

They are non-steroid anti-inflammatories
2nd line agents (steroids are used first, then calcineurin inhibitors)

quite useful for thin-skin areas (great for babies, kids, and face)

no skin atrophy

Question 39

How can steroids and calcineurin inhibitors prevent eczema in severe cases of eczema?

Answer 39

Once the flare-up has been resolved, agent is applied 2 times a week on areas that are usually affected by eczema. Moisturizers should still be used

Take drug holidays to limit adverse effects

Question 40

Why are PDE4 or JAK inhibitors used in eczema?

Answer 40

They are non-steroid anti-inflammatory products. This helps people who may have steroid-phobia

Question 41

Can probiotics help prevent eczema in kids and who should take them(pregnant mom or baby)?

Answer 41

Probiotics show promise, but we still need to study which strains are the most useful.

Studies on pregnant and lactating mothers showed lower eczema rates in their children

Question 42

Is menthol an appropriate therapy for eczema?

Answer 42

No, although menthol is a counterirritant and anti-pruritic (depending on concentration), it is another chemical that could cause irritation

Question 43

Are coal tar remdies effective for eczema?

Answer 43

No, they are an irritant and should be avoided

Question 44

Do oral antihistamines play a role in eczema treatment?

Answer 44

Although anti-histamines have anti-inflammatory activity, they do not target the same pathway as eczema.

Question 45

Is diphenhydramine (Benadryl) a good option for itch treatment?

Answer 45

No, use 2nd generation anti-histamines in insect bites, poison ivy, and hives instead

benadryl has unecessary drowsy side effects