Eczema

Question 1

exogenous eczema

Answer 1

photosensitive eczema and contact dermatitis

Question 2

endogenous eczema

Answer 2

atopic, seborrheic, discoid, venous, pompholyx and asteatotic forms

Question 3

atopic eczema

Answer 3

• 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)

Question 4

genetics of atopic eczema

Answer 4

mutations affecting filaggrin protein create imperfections in the stratum corneum, increasing skin sensitivity

Question 5

atopic eczema characteristics

Answer 5

itchy, erythematous rash (papules and vesicles on a dry erythematous scaly base) that typically develops in skin creases alongside generally dry skin

Question 6

infant atopic eczema

Answer 6

usually acute, tends to affect the face, scalp, and extensor surfaces of limbs

Question 7

childhood atopic eczema

Answer 7

flexural and will generally clear up by the teenage years, although the skin barriers are never entirely normal

Question 8

adult atopic eczema

Answer 8

usually chronic and associated with generalised dryness and itching, with flares generally localised to one or two areas e.g. hands, eyelids, nipples, flexures

Question 9

chronic eczema rash

Answer 9

lichenification or hyperpigmentation due to excoriation and rubbing

Question 10

acute eczema flare-ups

Answer 10

weeping, crusting, scaling, cracking and swelling of the skin associated with the rash

Question 11

superadded bacterial infection

Answer 11

• 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)

Question 12

patient education for eczema

Answer 12

• 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

Question 13

emollient creams for eczema

Answer 13

• 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

Question 14

soap substitutes for eczema

Answer 14

• aqueous creams and bath oils instead of soap
• showers rather than baths

Question 15

other treatments

Answer 15

if not controlled by topical corticosteroids, topical immunomodulators (Calcineurin inhibitors) such as Tacrolimus or Pimecrolimus can be given

Question 16

phototherapy

Answer 16

• with UVB or oral immunosuppressants (steroids, methotrexate, azathioprine, sulfasalazine)
• can be used in severe cases refractory to topical treatment

Question 17

referral for eczema in children

Answer 17

• not satisfactorily controlled e.g. 1 – 2 weeks of flares per month
• allergic contact dermatitis suspected
• atopic eczema associated with severe and recurrent infections

Question 18

seborrhoeic eczema

Answer 18

• 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

Question 19

seborrhoeic eczema treatment

Answer 19

• anti-yeast (Ketoconazole, Myconazole)
• mild topical steroids

Question 20

discoid eczema

Answer 20

• eruption of itchy coin-shaped lesions
• can be precipitated by insect bites, contact dermatitis, or skin infection
• secondary bacterial infection common

Question 21

discoid eczema management

Answer 21

• skin scrapings for mycology to differentiate from tinea corporis
• potent topical steroid + abx

Question 22

allergic contact dermatitis

Answer 22

• 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

Question 23

allergic contact dermatitis management

Answer 23

• patch testing is used for diagnosis (skin prick is for type 1)
• active dermatitis treatment - emollients + topical steroids

Question 24

venous eczema

Answer 24

• 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

Question 25

venous eczema treatment

Answer 25

• emollient creams + compressive bandages/stockings
• potassium permanganate bandages can be used to dry up oozing patches

Question 26

pompholyx eczema

Answer 26

• occurs recurrently on hands and feet
• presents as an itchy acute vesicular eruption, alongside deep-seated blisters of palms and soles

Question 27

treatment of pompholyx eczema

Answer 27

• 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

Question 28

asteatotic eczema

Answer 28

• 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