Eczema Flashcards
What is another term used interchangeably for atopic eczema?
Atopic dermatitis
Approximately what % of children will have eczema in childhood?
24%
What is atopic eczema?
Inflammatory skin condition which commonly affects flexural areas
There is inflammation and barrier dysfunction
Which group of people are more likely to get eczema?
Babies and children
->important to note that most eczema clears, 60% has cleared by adult life
What is a definition of atopic eczema?
An itchy skin condition in the last 12 months
PLUS 3 OF THE FOLLOWING:
-onset before age 2
-history of flexural involvement
-history of generally dry skin
-history of other atopic disease (hayfever, asthma, food allergy) or history in 1st degree relative if under 4yrs
Which gene in particular plays a role in the pathogenisis of atopic eczema?
Filaggrin gene
Is atopic eczema related to family history?
Yes- atopic family history so any of asthma, hayfever, food allergy
What are the factors of the pathogenesis of atopic ezcema?
Genetics
Epidermal barrier dysfunction
Environmental factors
Immune system dysregulation
If you have one copy of the Filaggrin gene, what condition are you likely to develop?
Eczema
If you have two copies of the Filaggrin gene, what condition are you likely to develop?
Ichthyosis e.g. ichthyosis vulgaris
Skin biopsies aren’t routinely carried out in eczema but if the diagnosis is unclear, they can be done.
What would be seen under the microscope?
Spongiosis (intercellular oedema) within the epidermis
Acanthosis - thickening of epidermis
Inflammation
What is the main clinical feature of eczema?
Itch!!
What is the usual distribution of eczema?
Flexures, neck, eyelids, face, hands and feet
What are the features of acute eczema?
Erythema
Prurutis
Scale
Papules
Exudate
Crustingq
What are the features of acute eczema?
Plaques, fissuring
What are some of the types of exogenous/external eczema?
Contact dermatitis, either irritant or allergic
Lichen simplex
Photoallergic or photoaggravated eczema
What are some of the types of endogenous/internal eczema?
Atopic
Discoid
Venous
Seborrheic dermatitis
Pompholyx
Juvenile plantar dermatitis
Which type of hypersensitivity is allergic contact dermatitis?
Type 4 hypersensitivity
How long does type 4 hypersensitivity rake to present?
2-3 days
Which cells mediate type 4 hypersensitivity?
T cells
What is irritant contact dermatitis?
Skin injured by either friction or environmental factors
Which environmental factors can cause irritant contact dermatitis?
Cold
Over-exposure to water
Chemicals
List some occupations in which contact dermatitis would be more common.
Hairdressers
NHS staff
Cleaners
If you suspect dermatitis is due to contact allergy, which investigation may be carried out?
Patch testing
->potential allergies applied to skin to see if there is a reaction
Which sites of the body is seborrhoeic dermatitis more likely to affect in children?
Hair bearing regions e.g. scalp, eyebrows, proximal features
Which type of dermatitis/eczema is not as itchy?
Seborrhoeic dermatitis/ezcema
What causes chronic seborrhoeic dermatitis?
Malassezia yeast increased in the scaly epidermis of dandruff and seborrhoeic dermatitis
What does seborrhoeic dermatitis look like in adults?
Red, sharply marginated lesions covered with greasy looking scales
Which sites of the body is seborrhoeic dermatitis more likely to affect in adults?
Area rich in sebaceous glands e.g. scalp, face, upper trunk
What is a pre-cursor of seborrhoeic eczema?
Dandruff
What is the treatment of seborrhoeic eczema?
Topical anti-yeast e.g. ketoconazole, sometimes in a shampoo
What should be considered in severe cases of seborrhoeic eczema?
HIV test
Discoid eczema?
Circular plaques of eczema, amy develop at sites of trauma or irritation
Often presents in middle age in those who had eczema as a child
Pompholyx/vesicular eczema?
Intensely itchy tiny blisters on palms and soles
Common in younger adults
What is asteatotic eczema associated with?
Older age-> involves very dry and cracked skin
Which area of the body is affected most commonly by asteatotic eczema?
Shins
What factors increase risks of asteatotic eczema?
Hot climate
Excessive washing/soaps
Old age
Where is venous eczema most commonly seen>
Legs, ankles
What causes venous eczema?
Increased venous pressure
What is venous eczema associated with?
Oedema
What can be done to help patients with venous eczema?
Compression stockings to help reduce oedema
What is eczema herpeticum?
Eczema like condition which follows a herpes simplex viral infection
What are the features of eczema herpeticum?
Fever, often unwell
Itchy clusters of blisters and erosions
Swollen lymph glands
What is the management of eczema herpeticum?
Consider admission, antivirals and consider secondary bacterial infection
What is involved in the treatment of eczema?
Patient education- avoid causative or exacerbating factors
Emollients (moisturisers)
Soap substitutes
Intermittent topical steroids
Sometimes antihistamines or antimicrobials
Calcineurin inhibitors
What are the factors to consider about different types of emollients?
Ointment- greasy but effective
Creams- lighter
Lotions- more watery
->creams and lotions are easier and quicker to apply but need more frequent application
What are some of the treatment options of severe eczema?
UV light
Immunosuppression
Biologics
