Eczema

Question 1

What is eczema/dermatitis?

Answer 1

• is an inflammatory reaction pattern of the skin with key clinical features
• reflects underlying histopathology
• has many causes for the same pattern

Question 2

Clinical features of eczema?

Answer 2

1. redness
2. clustered papulo-vesicles
   - include histological spongiosis and its clinical correlates
3. scaling
4. Itching
   – A rash that is never itchy is unlikely to be dermatitis

Question 3

Characteristic features of eczema?

Answer 3

1. affects the epidermis
2. causes itch
3. needs topical treatment

Question 4

Classification of eczema?

Answer 4

1. time course
2. pathology based

Question 5

Time course classification of eczema?

Answer 5

1. ACUTE:
   - redness swelling, papules blisters oozing, crusts
2. SUBACUTE:
   - still red, drier, scalier, pigment changes
3. CHRONIC:
   - lichenification, excoriations scaling, cracks
   Note: sometimes all phases are present at the same time

Question 6

What is the brick wall concept?

Answer 6

irritated skin is weaker is more prone to infection and allergens because the skin layers are disrupted

Question 7

Pathological classification of eczema?

Answer 7

1. endogenous (constitutinal)
2. exogenous

Question 9

Types of endogenous eczema?

Answer 9

1. ATOPIC
2. Seborrhoic
3. Discoid
4. Nummular
5. Dyshidrotic
6. Asteatotic
7. (Ichtyosis)

Question 10

Types of exogenous eczema?

Answer 10

1. CONTACT
   – irritant / toxic
   – allergic
   – photosensitive
   – Vaseline dermatitis
2. Lichen simplex chronicus

Question 11

What is urticaria?

Answer 11

Reaction pattern of the skin
Note: PRIMARY LESION = WHEAL (HIVE)

Question 12

Describe urticaria?

Answer 12

– 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

Question 13

Key charcateristics of urticaria?

Answer 13

1. affects the dermis
2. causes itch (string)
3. needs systemic treatment

Question 14

Describe psoriasis?

Answer 14

• Chronic, recurrent
• Genetically based
• inflammatory (immunologically mediated inflammatory disease)
• non-infectious
• Painful, disfiguring, disabling
• STIGMATIZING

Question 15

What is Auspitz sign?

Answer 15

the appearance of punctuate bleeding spots when psoriasis scales are scraped off

Question 16

Describe seborrheic eczema?

Answer 16

• 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

Question 17

Difference between infantile seborrheic and atopic eczema?

Answer 17

infantile seborrheic eczema - diaper area affected
infantile atopic eczema - diaper area not affected

Question 18

Differential of seborrheic eczema?

Answer 18

1. Tinea capitis
2. Psoriasis
3. Atopic dermatitis
4. Rosacea
5. Vitamin B deficiency /
   Pellagra

Question 19

Treatment of seborrheic eczema?

Answer 19

1. Topical low potency corticosteroids
2. Topical antifungals (Azole derivatives)
3. Topical immunomodulators
4. Others
   - Zinc pyrithione
   - Coal tar

Question 20

General management of eczema?

Answer 20

1. Emollients
   - whether epidermal barrier dysfunction be primary or
   secondary
2. Topical corticosteroids
   - sometimes other topical
   immunomodulators
3. Help with sleeping
   - sedative antihistamines
4. Specific treatments for type of eczema
   e.g. anti-Malassezia / Pityrosporum yeast treatments in seborrheic eczema) and allergen avoidance in
   contact allergic eczema
5. Next-line treatments (phototherapy, PUVA, systemic immunosuppressives e.g. corticosteroids, methotrexate