Eczema Flashcards
What is eczema/dermatitis?
- is an inflammatory reaction pattern of the skin with key clinical features
- reflects underlying histopathology
- has many causes for the same pattern
Clinical features of eczema?
- redness
- clustered papulo-vesicles
- include histological spongiosis and its clinical correlates - scaling
- Itching
– A rash that is never itchy is unlikely to be dermatitis
Characteristic features of eczema?
- affects the epidermis
- causes itch
- needs topical treatment
Classification of eczema?
- time course
- pathology based
Time course classification of eczema?
- ACUTE:
- redness swelling, papules blisters oozing, crusts - SUBACUTE:
- still red, drier, scalier, pigment changes - CHRONIC:
- lichenification, excoriations scaling, cracks
Note: sometimes all phases are present at the same time
What is the brick wall concept?
irritated skin is weaker is more prone to infection and allergens because the skin layers are disrupted
Pathological classification of eczema?
- endogenous (constitutinal)
- exogenous
Types of endogenous eczema?
- ATOPIC
- Seborrhoic
- Discoid
- Nummular
- Dyshidrotic
- Asteatotic
- (Ichtyosis)
Types of exogenous eczema?
- CONTACT
– irritant / toxic
– allergic
– photosensitive
– Vaseline dermatitis - Lichen simplex chronicus
What is urticaria?
Reaction pattern of the skin
Note: PRIMARY LESION = WHEAL (HIVE)
Describe urticaria?
– Transient swelling, edematous papule / plaque, of the
superficial dermiis
– develops within few minutes
– duration: minutes to hours (< 24 hours)
– Intensively itching
– lesions are not scratched but chafed or rubbed
– NO SEQUALE
Key charcateristics of urticaria?
- affects the dermis
- causes itch (string)
- needs systemic treatment
Describe psoriasis?
- Chronic, recurrent
- Genetically based
- inflammatory (immunologically mediated inflammatory disease)
- non-infectious
- Painful, disfiguring, disabling
- STIGMATIZING
What is Auspitz sign?
the appearance of punctuate bleeding spots when psoriasis scales are scraped off
Describe seborrheic eczema?
- Infantile and adult forms
- Lesions favor the scalp, ears, face, central chest, and
intertriginous areas - Etiologic links with active sebaceous glands, abnormal sebum
composition, and Malassezia ( Pityrosporum ) spp. - Can be a cutaneous sign of HIV infection
Difference between infantile seborrheic and atopic eczema?
infantile seborrheic eczema - diaper area affected
infantile atopic eczema - diaper area not affected
Differential of seborrheic eczema?
- Tinea capitis
- Psoriasis
- Atopic dermatitis
- Rosacea
- Vitamin B deficiency /
Pellagra
Treatment of seborrheic eczema?
- Topical low potency corticosteroids
- Topical antifungals (Azole derivatives)
- Topical immunomodulators
- Others
- Zinc pyrithione
- Coal tar
General management of eczema?
- Emollients
- whether epidermal barrier dysfunction be primary or
secondary - Topical corticosteroids
- sometimes other topical
immunomodulators - Help with sleeping
- sedative antihistamines - Specific treatments for type of eczema
e.g. anti-Malassezia / Pityrosporum yeast treatments in seborrheic eczema) and allergen avoidance in
contact allergic eczema - Next-line treatments (phototherapy, PUVA, systemic immunosuppressives e.g. corticosteroids, methotrexate
