Eczema Flashcards by Lucy Jefford

What is another term used interchangeably for atopic eczema?

Atopic dermatitis

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Approximately what % of children will have eczema in childhood?

24%

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What is atopic eczema?

Inflammatory skin condition which commonly affects flexural areas

There is inflammation and barrier dysfunction

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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

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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

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Which gene in particular plays a role in the pathogenisis of atopic eczema?

Filaggrin gene

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Is atopic eczema related to family history?

Yes- atopic family history so any of asthma, hayfever, food allergy

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What are the factors of the pathogenesis of atopic ezcema?

Genetics
Epidermal barrier dysfunction
Environmental factors
Immune system dysregulation

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If you have one copy of the Filaggrin gene, what condition are you likely to develop?

Eczema

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If you have two copies of the Filaggrin gene, what condition are you likely to develop?

Ichthyosis e.g. ichthyosis vulgaris

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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

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What is the main clinical feature of eczema?

Itch!!

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What is the usual distribution of eczema?

Flexures, neck, eyelids, face, hands and feet

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What are the features of acute eczema?

Erythema
Prurutis
Scale
Papules
Exudate
Crustingq

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What are the features of acute eczema?

Plaques, fissuring

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What are some of the types of exogenous/external eczema?

Contact dermatitis, either irritant or allergic
Lichen simplex
Photoallergic or photoaggravated eczema

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What are some of the types of endogenous/internal eczema?

Atopic
Discoid
Venous
Seborrheic dermatitis
Pompholyx
Juvenile plantar dermatitis

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Which type of hypersensitivity is allergic contact dermatitis?

Type 4 hypersensitivity

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How long does type 4 hypersensitivity rake to present?

2-3 days

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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