Eczema

Question 1

What us eczema?

Answer 1

(also known as atopic dermatitis) is a chronic inflammatory skin condition that affects people of all ages, although it most frequently presents in early childhood (mostly before 5 years of age).
It is characterised by dry, pruritic skin, and is typically an episodic disease of flares (exacerbations, which may occur as frequently as two or three times each month) and remissions; in severe cases, disease activity may be continuous

Question 2

Causes of eczema

Answer 2

Genetic, environment, immunologic factors -> dysfunctional skin barrier + immune system dysregulation
Atopic genes - filaggrin, IgE, IL3,4,5,13 - stratum corneum
Th cell dysregulation?

Question 3

Triggers for eczema

Answer 3

Soaps and detergents, animal dnader, house dust mites
Extreme temps
Rough lothing
Pollen
Certain foods
Skin infections
Stress
Type 1 and 4 allergic reactions

Question 4

Complications of eczema

Answer 4

S.aureus infection

Question 5

How does s.aureus infection of eczema present?

Answer 5

Typical impetigo
Worsening eczema
-Increased redness, oozing, crusting of skin

Question 6

Presentation of herpes simplex infection of eczema

Answer 6

Grouped vesicles and punched out eroisions
Disseminated -> eczema herpeticum

Question 7

Eczema herpeticum presentation

Answer 7

Widespread lesions
Coalesce -> large denuded, bleeding areas extend over entire body, can be complciated with staph or strep
Fever, lymphadenopathy, malaise
Medical emergency

Question 8

Sequelae of eczema herpeticum

Answer 8

Eye or meningeal involvement
Results in scarring

Question 9

Risk factors eczema herpeticum

Answer 9

Early omset + severe atopic eczema
Severe atopic eczema
Marked elevations in IgE
Peripjheral eosinophilia
Filaggrin mutations

Question 10

What other atopic comorbidities is eczema ass with?

Answer 10

Asthma, allergic rhinitis, food allergy, eosinophilic, oesophagitis

Question 11

Non atopic comorbidities ass with atopic eczema

Answer 11

Allergic contact dermatitis, obesity, CVS disease

Question 12

Presenting complaint eczema

Answer 12

Presence itching
Pattern, time of onset, natural history of rash

Question 13

Identifying eczema qs

Answer 13

Itching
Pattern, when onset,
FH or personal of atopy
treatments tried and reaction
Trigger factors

Question 14

Surfaces eczema found on

Answer 14

Flexor surfaces

Question 14

Surfaces eczema found on

Answer 14

Flexor surfaces

Question 15

Where is eczema found in infants?

Answer 15

Face
scalp
Extensor surfaces
Nappy area usually sparred

Question 16

Chronic eczema

Answer 16

Lichenified skin from scratching
Follicular hyperkeratotoic papules/keratosis pilaris

Question 17

Follicular hyperkeratotic papules

Answer 17

Asymptomatic
Extensor surfaces, upper arms, buttocks, anterior thighs

Question 18

Severity categories of eczema?

Answer 18

Clear - no evidence
Mild - dry skin, infrequent itching
Moderate - dry skin, frequent itching, redness
Severe - widespread areas dry sin, incessant itch, red +/- excoriation, thickening, bleed, ooze, cracking
Infected

Question 19

Tools to assess eczema severity

Answer 19

Visual analogues scales - 0-10
Patient oriented eczema measure

Question 20

What non pathological aspect of eczema needs assessing at every appointment?

Answer 20

Psychological impact - infants and childrens dermatology/dermatitis quality of life index
Dermatitis family impact

Question 21

Mild eczema management

Answer 21

Emollients - frequent and liberal
Mild topical corticosteroid eg hydrocortisone 1% for red skin

Question 22

Explaining eczema

Answer 22

Chronic illness characterised by flares which usually can be controllled with appropriate treatment
Signs and symptoms of infected eczema and eczema herpeticum

Question 23

Moderate eczema management

Answer 23

Emollinets
Inflamed - moderately potnent corticosteroid
Betamethasone valerate 0.025% or clobetasone butyrate 0.05%

Question 24

Examples of moderately potent topical corticosteroids

Answer 24

Betamethasone valerate 0.025% or clobetasone butyrate 0.05%

Question 25

Mild topical corticosteroids

Answer 25

Mild topical corticosteroid eg hydrocortisone 1% for red skin

Question 26

What prescribe if severe itch or urticaria in eczema?

Answer 26

non sedating antihistamine - cetrizine, loratidine, fexofenadine

Question 27

Second line option for moderate eczema

Answer 27

Topical calcineurin inhibitors
Tacrolimus 0.03%
Pimecrolimus 1% cream

Question 28

Risk of long term topical corticosteroid use

Answer 28

Skin thnning and loss of function
Topical calcineurin inhibitors have lower risk

Question 29

What is acute vs chronic eczema

Question 30

What is discoid eczema

Answer 30

Oval or round lesions of eczema

Question 31

What is varicose eczema

Answer 31

Eczema on lower legs - over varicose veins, leg ulcers, cellulitis

Question 32

Symptoms of varicose eczema on top of normal eczema

Answer 32

discolouration of the skin
tender and tight skin that can eventually become hardened (lipodermatosclerosis)
small, white scars (atrophie blanche)
pain

Question 33

Treatment of varicose

Answer 33

Compression stockings based on ankle brachial pressure index

Question 34

When are sedating antihistamines used in eczema?

Answer 34

Itching is severe enough to affect sleep

Question 35

First line oral corticosteroid for severe eczema affecting QOL

Answer 35

30mg prednisolone for 1 week

Question 36

Referral options eczema

Answer 36

Dermatology
Immunology
Paediatrics
Clinical psychologist

Question 37

Managemtn infective eczema

Answer 37

Flucloxacillin (clarithromycin if penicillin allergy)
Co-exist with a flare - require concomitant treatment

Question 38

When is topical fusidic acid prescribed?

Answer 38

Localised areas of infection of eczema

Question 39

What to do if infected eczema doesn’t respond to treatment?

Answer 39

Consider skin swab
Refer urgently within 2 weeks