Eczema Flashcards
exogenous eczema
photosensitive eczema and contact dermatitis
endogenous eczema
atopic, seborrheic, discoid, venous, pompholyx and asteatotic forms
atopic eczema
- most common form
- affects around 20% of children
- TH-2 dominant disease involving TNFα and eosinophils
- has a multifactorial aetiology with a strong genetic cause (90% +ve for FHx)
genetics of atopic eczema
mutations affecting filaggrin protein create imperfections in the stratum corneum, increasing skin sensitivity
atopic eczema characteristics
itchy, erythematous rash (papules and vesicles on a dry erythematous scaly base) that typically develops in skin creases alongside generally dry skin
infant atopic eczema
usually acute, tends to affect the face, scalp, and extensor surfaces of limbs
childhood atopic eczema
flexural and will generally clear up by the teenage years, although the skin barriers are never entirely normal
adult atopic eczema
usually chronic and associated with generalised dryness and itching, with flares generally localised to one or two areas e.g. hands, eyelids, nipples, flexures
chronic eczema rash
lichenification or hyperpigmentation due to excoriation and rubbing
acute eczema flare-ups
weeping, crusting, scaling, cracking and swelling of the skin associated with the rash
superadded bacterial infection
- S. aureus, group A strep
suggested by crusting, weeping, pustulation, and surrounding cellulitis treated with steroids and a 14-day course of oral abx (Flucloxacillin)
patient education for eczema
- natural history is relapse–remission
- complications, e.g. infection, treatment
- for childhood eczema, most people will grow out of it (90% by teens)
- treatment is a control not a cure (2Tier approach)
- psychological support
emollient creams for eczema
- should be applied 3 – 4 times per day until skin is white, greasy and saturated
- in frequent flare-ups, switch to an emollient with a higher lipid/urea content and apply more frequently
soap substitutes for eczema
- aqueous creams and bath oils instead of soap
- showers rather than baths
other treatments
if not controlled by topical corticosteroids, topical immunomodulators (Calcineurin inhibitors) such as Tacrolimus or Pimecrolimus can be given
phototherapy
- with UVB or oral immunosuppressants (steroids, methotrexate, azathioprine, sulfasalazine)
- can be used in severe cases refractory to topical treatment
referral for eczema in children
- not satisfactorily controlled e.g. 1 – 2 weeks of flares per month
- allergic contact dermatitis suspected
- atopic eczema associated with severe and recurrent infections
seborrhoeic eczema
- commonest in teenagers/young adults
- red, scaly inflammatory eruption with dandruff
- typical distribution - sides of the nose, forehead, eyebrows, and scalp
- can also distribute over the parasternal area (petaloid) or groin area
seborrhoeic eczema treatment
- anti-yeast (Ketoconazole, Myconazole)
- mild topical steroids
discoid eczema
- eruption of itchy coin-shaped lesions
- can be precipitated by insect bites, contact dermatitis, or skin infection
- secondary bacterial infection common
discoid eczema management
- skin scrapings for mycology to differentiate from tinea corporis
- potent topical steroid + abx
allergic contact dermatitis
- type 4 hypersensitivity
- more common later in life
- often occurs after repeated contact with nickel or occupational substances
- distribution is often unusual, situated where skin is in contact with the allergen
- commonest on the hands
allergic contact dermatitis management
- patch testing is used for diagnosis (skin prick is for type 1)
- active dermatitis treatment - emollients + topical steroids
venous eczema
- occurs in the elderly due to venous incompetence and venous hypertension
- commonly presents with flaking skin, lipodermatosclerosis, haemosiderin pigmentation, and atrophy blanche
- may result in ulceration
venous eczema treatment
- emollient creams + compressive bandages/stockings
- potassium permanganate bandages can be used to dry up oozing patches
pompholyx eczema
- occurs recurrently on hands and feet
- presents as an itchy acute vesicular eruption, alongside deep-seated blisters of palms and soles
treatment of pompholyx eczema
- emollients and wet dressings can be used to dry up blisters (e.g. potassium permanganate, acetic acid)
- very potent topical corticosteroids for new vesicles
- short course oral prednisolone for severe flares
asteatotic eczema
- tends to affect the limbs of elderly patients
- presents with fissuring and cracking of the skin in a ‘crazy paving’ pattern
- can be treated with moisturising
