Eczema Flashcards
Clinical features of eczema?
- Itching
- Erythema + Oedema
- Worse Winter (cold) + Summer (hot)
- Papules /Vesicles /Exudation
- Flexor surfaces (thin skin)
- Diffuse, ill-defined patches
Additional clinical features of chronic eczema?
- Less oedema
- Epidermal thickening
- +/- lichenification
Exogenous forms of eczema?
- Primary irritant contact dermatitis
- Allergic contact dermatitis
- Photodermatitis
Endogenous forms of eczema>
- Atopic eczema
- Seborrhoeic dermatitis
- Discoid eczema
- Varicose / status eczema
- Endogenous eczema of palms and soles
- Asteatotic eczema
- Pompholyx
Atopic eczema model?
Genetic predisposition (filaggrin mutation) leads to reduced barrier function. Environmental triggers thus precipitate eczema.
What is discoid eczema?
Eczema in scattered, well-demarcated annular patches. Mimics psoriasis and tinea.
Discoid eczema treatment?
Potent topical steroids
Pathophysiology of asteatotic eczema?
Decreasing lipid content of stratum corneum with increasing age. Susceptible to ‘degreasing agents’.
Distribution of asteatotic eczema?
Front of legs.
May also affect lower abdomen / arms
Pattern of asteatotic eczema?
Crazy paving pattern
Rx asteatotic eczema.
- Trial emollient
- Often need mild topic steroid ointment
What is pompholyx?
Vesicular eczema of hand and foot. very itchy, often related to sweating).
What precipitates pompholyx?
Excessive washing and sweating
Rx pompholyx?
- Potent topical steroid
- Avoidance of soaps and irritants
- Regular emollients
What is diffuse erythrodermic eczema?
Severe eczema (>90% BSA). Significant morbidity.
Treatment diffuse erythrodermic eczema?
Intense topical steroids and systemic immunosuppression
What are the complications of eczema?
- Bacterial superinfection
- Eczema herpeticum
- Allergic Contact dermatitis
Why is eczematous skin predisposed to bacterial superinfection?
Eczematous skin lacks naturally occurring antibacterial peptides.
Rx bacterial infection of eczema?
Systemic anti-staph ABx (generally infected with Staph aureus).
What is eczema herpeticum?
Secondary infection by HSV virus. MEDICAL EMERGENCY due to risk of corneal scarring.
Clinical features of eczema herpeticum?
Sudden onset worsening of pre-existing eczema with painful vesicles and “punched out” erosions.
Mx eczema herpeticum?
- Assessment by opthalmologist
- Systemic antiviral treatment
How is allergic contact dermatitis diagnosed?
Patch testing
Pathophysiology of allergic contact dermatitis?
Delayed hypersensitivity reaction to an external allergen.
