Eczema Flashcards
Definition
Chronic inflammatory disorder of the skin
Who gets eczema
Childhood onset is very common, but adult onset can occur
Risk factors
- FH of atopy
Pathophysiology
- an IgE mediated response, type 1
- Causes dermatitis which causes keratinocytes in the epidermis to start detaching from one another
Histological appearance
Epidermal acanthosis: thickening of the epidermis due to hyperplasia.
Hyperkeratosis: thickening specifically of the stratum corneum.
Parakeratosis: retained nuclei in the stratum corneum indicating problems with the usual differentiation process.
Presentation
types of eczema
Atopic - normal
Allergic contact dermatitis
Seborrheic dermatitis (cradle cap)
Venous eczema
Erythrodermic eczema (severe and life threatening)
presentation of atopic eczema (SCAM)
Site - flexor surfaces
Colour - erythematous, grye brown in darker skin
Associated changed - itchy, excoriations
Morphology - papules and vesicles
also may have asthyma, hayfever, raised eosinophils.
Prx of erythrodermic eczema
Widespread redness across the body
Skin exfoliation
This is an emergency
Prx of Seborrhoeic Dermatitis (SCAM)
Site - face and hairline
Colour - erythematous
Associated changes - minimal pain and itching
Morphology - flakey, oily skin and sometimes plaques can form.
investigations
- bloods, total IgE and eosinophils
- patch test for allergens
- skin swabs if concerns of bacterial or viral infection
- skin biopsy, especially if suspected erythroderma
Conservative Management
Avoid triggers and allergens
keep area cool and dry
use antihistamines
Topical Treatments
Mild - emollients and topical steroid creams
Moderate - emollients and stronger topical steroid creams
Severe - emollients, stronger topical steroid creams and consider oral corticosteroids
Systemic medication management
- oral steroids
- retinoids
- DMARDs e.g. methotrexate, ciclosporin and azathioprine
- Biologics
Complications
Poor sleep
Low moode
Insecurity
Eczema herpeticum - herpes simplex infection with eczema, a derm emergency.
