Eczema Flashcards
What is one of the most common skin conditions in children?
Eczema
Describe the difference between skin in eczema and healthy
Describe how eczema occurs regarding the skin
Defective Skin Barrier
–> Microbes and allergens can get deeper into the skin and cause you to react
–> Allergens are a false start of the immune system
Protein Deficiency in Skin Component
Describe the hygiene hypothesis
A medical theory that suggests early exposure to germs and microorganisms helps develop a healthy immune system and protects against allergies, asthma, and eczema
Describe the concept of the “allergic march”
The allergic march is characterized by antibody responses to immunoglobulin E and clinical symptoms that can change with age and continue for years or decades.
Eczema
V
Asthma
V
Allergic Rhinitis
Describe the presence of eczema regarding prevalence and its corresponding age
80% of eczema is seen before the age of 5
What is the common progression of symptoms in eczema?
Blistering
V
Dry Skin
V
Scaling
What is a common issue in eczema that pertains to the main bothersome symptom of eczema?
Pruritis: Scratch-itch-scratch
–> Leads to disturbed sleep
Where does eczema commonly occur regarding body parts?
Face especially infants
With age:
—> Hands, elbows, wrists, back of knees
When is a diagnosis of eczema common? Exception? Course of disease?
Usually diagnosed early on in life
Can still occur in older age; but more rare
Often occurs in cycles with flare up occurring with triggers
Describe the areas on the body that eczema commonly occur in different aged individuals?
What is a key distiinguishing feature here to another condition?
No truncal aspect here
If located on the trunk, more likely to be hives
A major location for hives to occur is on the trunk area
Describe the severity of most cases of eczema?
Most cases of eczema are mild
Moderate and severe can have drastic impacts on quality of life
What are some implications of severe eczema on an individuals quality of life?
Waking up with bloody lesions
Wearing clothes can become uncomfortable
Loss of 14 nights of sleep per month
Describe the differential for eczema
Psoriasis
- Usually diagnosed later in adolescence and then between the ages of 30 and 40
Contact Dermatitis
- Quite similar of a presentation to eczema
- Identifiable cause is more likely and helps to clue us in to the diagnosis
- Hopeful parent knows a diagnostic cause
Impetigo
- Yellow crusting commonly present
- Often occurs around the area of the mouth
- However, atypical presentations can make diagnosis hard
Fifth Disease
- Rash is not itchy
- If child is old enough and scratching, less likely to be fifth disease
- If infant, child may just be fussy making diagnosis difficult
- Occurs in response to an URTi
Prickly heat
- Heat related
- Parents can likely timeline when it occurs
- Will resolve in a few days
Seborrhea Dermatitis
- Cradle Cap - Scaly things on the scalp
- Low level condition
- Seborhhea Dermatitis - Does not often occur on infants
How can a parent be confident in knowing that a child may have eczema?
Eczema is a condition that comes and goes
Intensely itchy and can be very uncomfortable
Scratching can cause thickened, darkened or scarred skin over time
Describe how eczema tends to look on an individual with a darker skin colour?
Eczema tends to look darker brown, purple or ashen grey in colour
Individuals are more likely to have more severe disease
More commonly develop small bumps on the torso, arms and legs (called papular eczema)
Tend to have more extensive skin dryness and dark circles
Experience a greater rate of pigmentary changes
Healed skin may look darker or lighter
Once the eczema is controlled, the skin colour typically returns to normal
What are the difference between the stages of eczema?
Inflammation: Allergen and irritant causing a flare up
–> Tends to last 7 days
Can last weeks after that as the body begins to deal with the remnants of that allergen
When is chronic eczema regarding seasons?
Since winter tends to be more dry, tend to see more chronic eczema
What types of eczema may be seen in children?
Some children will have flare ups of eczema
Some will have chronic eczema as the allergen is always present
Describe the process for eczema
Flare Up
- When a trigger, such as stress, diet, infection, nutrient depletion or hormone imbalance causes chemical changes in the body producing burning, tingling, or minor itching sensations that you scratch
- The more you scratch the worse it gets
Outbreak
- Constant scratching damages the skin resulting in significant inflammation
- This often produces redness, swelling, fluid filled vesicles, weeping and crusting
- The outbreak stage doesn’t subside until the root cause trigger is removed
Healing
- Healing begins once the root cause are identified and treated
- During this stage, the skin can become thickened, cracked, dry, scaly, and have red to brownish-gray patches
- This slowly subsides and the skin improves over time
Clear Skin
- Clear skin is revealed once healing is complete
- However if someone doesn’t find and treat the root they could have a flare up as soon as they have another trigger
How commonly do flare ups last?
With proper treatment, flare ups can last for one to three weeks
Chronic eczema can go into remission with the help of a good preventative plan
Remission means that the disease is not active and you remain free of symptoms
Describe how the severity and its corresponding presentation of eczema?
What is the most common severity of eczema in children? What level of care can these individuals be seen at?
Two-thirds of children have mild disease and can be managed at the primary care level
Describe eczema as a condition and it’s course through an individual’s life
Eczema is a non-contagious inflammatory chronically relapsing and intensely pruritic skin disease often occurring in families with atopic disease (eczema, asthma, and allergic rhinitis)
The onset of eczema is typically between the age of 2-6 months however can occur at any age
The majority of affected individuals have resolution of the disease by adulthood
–> Only 10% will go to have a longer course occuring in adulthood
What can worsen eczema?
Eczema can be worsened by:
1) Low humidity
2) Stress
3) Irritants:
–> Wool»_space;> Cotton
–> Fabrics are important for eczema
–> Cotton is ideal; wool and synthetics are bad
–> Sweating
–> Hundreds of others
4) Allergens
–> Dust mites (not common in Canada)
–> Foods (early exposure can be beneficial and avoidance is not the best move; not a pharmacist recommendation)
What are some strategies to manage dry skin?
1) Baths/Showers
- Cut back the temperature of the water
- Shower once a day instead of twice a day
2) Weather Exposure
3) Winter Humidifier
- Help the nose tissues (nose bleeds)
- Questionable of helpful for skin
- Worth a try
4) Cream
- Lotions are too light for eczema
-If you can pump it, too light
- Require thickness to CONTROL EPIDERMAL WATER LOSS
- Eczema grade is the way to go
Describe the benefit of the sue of dry skin creams in eczema
Dry skin cream use can help to reduce overall steroid use
Describe the types of dry skin moisturizers to be used in eczema
Any skin product that you can pump out (like a lotion) is likely too weak for eczema
Need a cream or an even thicker agent
What is the goal of therapy in eczema? What encompasses daily care?
Repair and maintain a functional skin barrier
The two key components of care include moisturizer and bathing recommendations
Patients should be instructed to develop these habits and perform them daily
What is the benefit of moisturizers in the care of eczema?
Helps to decrease itch, prevents and reduces flares, and decreasing the need for prescription medications
Topical moisturizers are used to treat xerosis and transepidermal water loss with tradition agents containing varying amounts of emoillments, occlusive and/or humectant ingredients
Daily mositurizing reduces the qiuality and potency of pharamcological intervention
What is critical for the care of the varying severities of eczema?
Mid eczema - Frequent and consistent use of moisturizers may sufficiently manage the disease
In moderate to severe disease, mositurizing regimens remain a fundamental part of treatment
Mosisturizers are an important compinent of maintenance therapy and prevention of flares
Describe the role of mositurizers in eczema
Mositurizers help protect the outermost layer of skin known as the straum corneum or skin barrier
People living with eczema have a damaged skin barrier which makes skin more sensitive to irritants, allergens, bacteria and other invaders
A damaged skin barrier also make it harder for the skin to retain water leading to chronic, dry, itchy skin which can cause eczema to flare or get worse
What are some triggers for eczema?
Wind, low humdiity, cold temperatures, harsh soaps and prolonged exposure to water all lead to dry skin
How are moisturizers characterized? Which moisturizers should be sued for eczema?
Mositurizers care classified based on the amount of oil and water they contain
The more oil in. amaoisturizer the better it usually is at treating eczema
The best mositurizers are the ones that feel “greasy” such as ointments and creams because they contain more oil
Very effective a keeping moisture in and irritants out
How should mositurizers be applied to the skin?
All moisturizers should be applied to your hands immediately after washing and gently blotting them dry
Good idea to keep mositurizer near every sink in your home and carry a small tube with you at all times so you can reapply it throughput the day
What is commonly recommended mositurizer in eczema? Why?
Ointmnets are usually the first choice for eczema treatment
They have the highest oil content of all the products followed by creams and then lotions
They generally do not burn when they are applied to sensitive skin and are very good at sealing in mositure
Products high in oil content such as petrolateum jelly and mineral oil are particularily good at treating ecczema
What is a name brand of products that can be particularily useful in eczema care?
Spectro Eczema
- Huge line of products
- Eczema grade products - No added perfumes or colours, etc. –> Additional irritants
Why are lotions not recommended for the treatment of eczema?
Lotions contain a higher proportion of water to lipid than creams
Frequent reapplication of lotions is needed to maintain skin hydration
Lotions are not as effective in eczema
High water content leads to evaporative skin drying, irritants, such as fragances and preservatives, may irritate or inflame non-intact skin
What types of ointments are best for eczema? Why? Example?
Hydrophilic ointments and creams without added fragrances or preservatives are recommended over lipophilic ointments, as lipophilic ointments may cause irritation and should be applied to wet skin after bathing
EMulsyfying Ointmnet - 250 g weekly for adults
The best mositurizers are fragrance free and have the least amount of preservatives
Describe the role of ceramide in eczema products
Ceramide is low in eczematous skin. It helps to make the skin more porous
Many sub-types
Maybe not much better than simpler products p becoming just another lipid in the cream
Describe the recommendations for bathing and showering in eczema
Clincians can recommend that patients bathe or shower (5-10 mins) in warm, plain water once daily or every other day
Moisturizing should immediately follow bathing or showering, since exposure to water can exacerbate eczema if the skin is not mositurized soon after exiting the water
Gentle cleansers may be sued only on areas that need cleaning and shgould be used at the end of the bath or shower
A mild synthetic detergents without fragrance should be sued to cleanse soiled areas without fear of exacerbating the skin disease
Describe the microbial colonization of the skin of an individual with eczema
Up to 90% of patients with moderate to severe eczema have a high rate of cutaneous colonizqation of S. Aereus whereas only seen in 5% of the population without dermatitis
The routine use of topical anti-staphylococcal antibiotic treatment in the abscence of clinical signs of infection is not recommended
Bleach baths may have limited therapeutic effect, andd research does not support bleach bathes –> Leap of faith aspect
What is another non-pharamcologic treatment option that may be used? What severity is it common in?
Weeping Lesions
Plain Water - Cool Compress - 20 min QID for 2-3 days
–> cool comp 1 min on/off cycle over 20 mins
Or Longer Contact
Wet-Dressings
–> Wraps are common as well
–> Sveere variant o may be told to have some wet dressings
–> Can be useful to help getmore steroid absorbed into the skin
Describe how a patient can apply wet dressings to a weeping lesion
Describe when certain potencies of corticosteroids should be used based on body area and skin properties
Describe the area of FTU’s and what is required for different areas of the body?
Need 7 FTU’s for the entire chest and abdomen
= area of 14 hand (one side)
= area of 7 hands (both sides)
Describe the MedSask Tx algorithm for eczema?
What are some causes of itch?
Benadryl for itch in eczema
- Overused agent
- Mainly used as a sleep aid now
- Bug Bites - Go for 2nd generation anti-histamines
- Does not work any faster than 2nd generation agents
- A second gen can be slotted any time on the spectrum
