eczema

Question 1

What is another name for eczema

Answer 1

dermatitis

Question 2

What is atopic eczema - atopic dermatitis

Answer 2

Inflammatory skin condition which affects the flexural areas

Question 3

Who does atopic dermatitis occur more in

Answer 3

children and babies

Question 4

What is the definition of atopic eczema

Answer 4

An itchy skin condition that was in the last 12 months which has 3 of the following :

Onset before 2
flexure involvement
generally dry skin
Family history of other atopic diseases - asthma, hay fever and food allergy…

Question 5

What gene is commonly affected in atopic eczema

Answer 5

Filaggrin gene

Question 6

What happens in atopic eczema

Answer 6

There is barrier dysfunction:

Spongiosis - intracellular oedema in the epidermis

Acanthosis - thickening of the epidermis

Inflammation - superficial perivascular lymphohistiocyte infiltrate

Question 7

What is the presentation of atopic dermatitis

Answer 7

Itch
distribution in the flexers, neck, eyelids, face, hands and feet

Acute changes:
pruritis - feeling of wanting to itch
erythema
scale
papule
vesicles
exudate
crusting
excoriation

Chronic changes - lichenification - thickening of the skins which can become plaques and have the potential to split

Question 8

What is allergic contact dermatitis

Answer 8

type 4 hypersensitivity - T cell mediated 48-72 hour long delay for reaction to occur

Antigen presenting cells take the harmless substance and present it to the lymph nodes and the T cells expand and produce antibodies for the harmless substance

The T cells are released into the blood stream and the next time the harmless substance (hapten) is encountered, the antibodies will be released and cause mass degranulation, vasodilation and neutrophils

Question 9

What is irritant contact dermatitis

Answer 9

Skin is injured by friction, environmental factors such as cold, over-exposure to water, chemicals and detergents and solvents

Question 10

What are common ways of getting irritant contact dermatitis

Answer 10

hand washing

Question 11

Which occupations are at risk of irritant contact dermatitis

Answer 11

Occupations where hand washing is frequent:

Hairdressers
NHS staff
cleaners

Question 12

What is the test for allergic contact dermatitis

Answer 12

patch testing :

type 1 hypersensitivity - few minutes to hours for a reaction due to it being regulated by IgE so finger prick can be used

Type 4 hypersensitivity which is what allergic contact dermatitis is takes 2-3 days so patch testing over a week has to be done

Question 13

What is seborrhoeic dermatitis in infants

Answer 13

In infants under 6 months commonly - predilection for scalp, flexures, eyebrows and nasolabral folds - severe dandruff can be seen

It appears as yellow greasy crust on top of scalp commonly known as cradle cap in infants

Question 14

How do the patients with sebarrhoeic dermatitis present

Answer 14

The kids are quite happy and unbothered by the seborrhoeich dermatitis

Question 15

What is seborrhoeic dermatitis in adults

Answer 15

Chronic dermatitis in adults

Question 16

How does seborrhoeic dermatitis present

Answer 16

more malassezia yeast in the epidermis of dandruff and seborrhoeic dermatitis

red sharply marginated lesions covered in greasy scales

Areas rich in sebaceous glands are affected - face, scalp and upper trunk

yellow greasy crust on the scalp - cradle cap - seen in infants - seborrhoea dermatitis is also known as dandruff in adults

Question 17

Who is more likely of developing adult seborrhoeic eczema

Answer 17

People with neurological disorders

Question 18

What is a usual precursor for seborrhoeic eczema

Answer 18

dandruff

Question 19

What is the treatment of seborrhoeic eczema

Answer 19

topical anti-yeast - ketoconazole - if dandruff, use shampoo

If it is severe and unresponsive to treatment do a HIV test

Question 20

What is discoid eczema

Answer 20

Circular plaques of eczema which develops at irritation or trauma sites

Common in middle aged men

Question 21

What is presentation of vesicular eczema

Answer 21

Intensely itchy
Palms and soles affected
under 40 is more common
Resolution requires desquamation - outer layer of skin is shed

Question 22

What is the presentation of asteatotic eczema

Answer 22

very dry skin at and scaly appearance

Shins are commonly affected

Question 23

What is venous eczema

Answer 23

Venoud drainage in the legs get worse as we age which leads to increased venous pressure and inflammation

there is pooling of the blood in the legs and due to the iron in the blood, colour change of the skin can also occur

Question 24

What is the presentation of venous eczema

Answer 24

stasis eczema or varicose eczema
increased venous pressure
oedema
ankle and lower leg involved

Question 25

What is the presentation of eczema herpeticum

Answer 25

Disseminated viral infection
fever and unwell
itchy clusters of blisters and erosions
swollen lymph glands

Question 26

What causes eczema herpeticum

Answer 26

Herpes simplex 1 or 2

Question 27

What is the treatment of eczema

Answer 27

emollients

ointments - greasy but effective
creams - lighter
lotions - more watery

Topical steroids -
hydrocortisone - if mild dermatitis
Betamethasone - used in hands and feet where skin is thick

Antihistamines - short term use

Calcineurin inhibitors - topical pimecolimus and tacrolimus - steroid free and long term use is indicated

Question 28

What is the treatment of severe eczema

Answer 28

UV light - immunosuppressant

Immunosuppressant - cyclosporin first line but if need long term use, methotrexate is given

Biologics - dupilumab but side effects in the eyes

Question 29

What is a side effect of high potent steroids

Answer 29

striae

Question 30

What is the simple meaning of eczema

Answer 30

barrier dysfunction and inflammatory response