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Dermatology > Eczema > Flashcards

Eczema Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the core characteristics of eczema?

A

pruritus

erythema

skin dryness

scaling

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2
Q

What are the lesions like in acute eczema?

A

vesicles or blisters

oedema

erthema

often associated with:

pain

bleeding

weeping

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3
Q

What are the lesions like in chronic eczema?

A

skin fissures

lichenification develop

erythema

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4
Q

What is lichenification? (what causes it)

A

It means the skin has become thickened and leathery.

(This often results from continuously rubbing or

scratching the skin)

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5
Q

What is the difference between dermatitis and eczema?

A

They are interchangeable

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6
Q

Explain the pathology seen in acute eczema?

A

Erythema - Dermal vessels dilate

Vesicles and exudate - epidermal oedema causes separation of keratinocytes ‘spongiosis’

Oedema of skin - Inflammatory cells invade the dermis and epidermis

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7
Q

What causes a rapid change in eczema lesion appearance in acute eczema?

A

Scratching

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8
Q

Explain the pathology seen in subacute eczema?

A

Less vesicles -> Less spongiosis

Scaling -> Epidermal cells malfunction:

1) acanthosis (thickening of epidermis)
2) hyperkeratosis (increased keratin production)
3) parakeratosis

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9
Q

Explain the pathology seen in chronic eczema?

A

Thick, roughened skin, dry + scaly (lichenification)

sometimes fissured

the above due to -> Marked acanthosis, hyperkeratosis and parakeratosis, lichenification

Erythema due to -> Persistent vessel dilation and inflammatory cells

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10
Q

What is acanthosis?

A

thickening of epidermis

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11
Q

What is parakeratosis? (where does this occur naturally and how can this help identify its presence)

A

persistence of the nuclei

of keratinocytes

as they rise into the horny layer of the skin

(it occurs normally in the epithelium of the true mucous membrane of the mouth and vagina. hence why the mucous membranes are purple)

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12
Q

What are the types of endogenous eczema?

A

Atopic

Seborrhoeic

Asteatotic

Varicose

Discoid

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13
Q

What are the types of exogenous eczema?

A

Irritant

Infective

Allergic contact

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14
Q

What is the difference between endogenous and exogenous eczema?

A

Endogenous -> internal factor

Exogenous -> external factor

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15
Q

What is varicose eczema also known as?

A

gravitational/stasis eczema

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16
Q

What is asteatotic eczema?

A

Mainly affects >60’s

Asteatotic eczema can be linked to a decrease in the oils on the skin surface

due a number of factors

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17
Q

What is patch testing used for with regards to dermatitis?

A

To test for causes of potentially allergic contact eczema

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18
Q

How long is patch testing conducted for?

A

Put on and checked at:

48hrs

72hrs

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19
Q

What is the key part of the hx for allergic contact eczema?

A

Where the rash started

as this will tell you what the pt is allergic to

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20
Q

Describe where atopic eczema rashes tend to be on differenct age groups?

A

Baby -> on face

Older -> localises to flexures

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21
Q

What is the cause of atopic eczema?

A

It is essentially not known, but is thought to be linked to the fillagrin gene

which encodes a skin barrier protein

thus there is a defect in the skin barrier

which leads to abnormal stimulation of the immune system

IgE Ab play a role too

22
Q

What is atopy?

A

Familial predisposition to:

atopic eczema

allergic rhinitis (hay fever)

allergic asthma

23
Q

What proportion of children have atopic eczema at some point in their lives?

A

15%

24
Q

What is the typical age of onset of atopic eczema?

A

Below 2 yrs

25
Q

Does severity of atopic eczema tend to get worse or better with age?

A

Better with age

26
Q

What proportion of children will grow out of atopic eczema by the age of 2 yrs + adolescence?

A

50% will grow out of it by 2 yrs

80% grown out of it by adolescence

27
Q

Skin prick testing for what, is normally positive in atopic eczema?

A

House dusk mite

28
Q

At what age does discoid eczema often arise?

A

At any age

29
Q

What is a common adverse outcome of discoid eczema?

A

Infection of the lesion

30
Q

Where and why does varicose eczema occur?

A

Occurs on the lower legs of the elderly

Due to a combination of:

dry skin (asteototic eczema) and

varicose veins

31
Q

What is the key to treating varicose eczema?

A

Compression of the leg/lesion

32
Q

What is pompholytic eczema?

A

a.k.a. Dyshidrosis

eczema of unknown cause characterized by

small blisters

on the hands or feet

33
Q

What is the extra treatment of seborrheic eczema and why?

A

antifungals, as there is often co-infection of the lesion(s) with

pityrosporum yeast species

34
Q

What is seborrheic eczema?

A

eczema that affects sebaceous glands (associated with hair follicles)

35
Q

What is the most common exacerbating factor for atopic eczema?

A

House dust mite

36
Q

What are the principles for treatment of all types of eczema?

A

Avoid any exacerbating factors

Emollient for dryness as soap substitutes

Topical steroid for active areas

37
Q

What are the different strengths of topical steroids and give examples?

A

Mild (1% Hydrocortisone acetate)

Moderate (Hydrocortisone butyrate)

Potent (Betamethasone/mometasone)

Very potent (Clobetasone)

38
Q

What are the different types of emollient? (give examples)

A

1) Creams (aqueous cream)
2) Ointments (white soft paraffin)
3) Bath oils (Oilatum)

39
Q

What are generally the most effective yet under-used emolients?

A

Ointments are best, but poor compliance as too greasy

40
Q

What are the side-effects of topical steroids and how can these be avoided?

A

Skin-thinning

use finger-tip unit

41
Q

Other than the classical 1st-line treatments of eczema what other 1st-line treatments are there? (put in indication too)

A

Occlusive bandaging (reduce excoriation of lesion, esp. in children)

Antibiotics (if infected)

topical tacrolimus and pimecrolimus (if on face or if “stuck” on strong steroid)

42
Q

What are the types of occlusive bandaging used in eczema?

A

1) Tar
2) Zinc paste
3) Wet wraps

43
Q

What are signs that eczema is infected?

A

erythema

exuding pustules

44
Q

Which antibiotics are commonly used in eczema?

A

Flucloxacillin

Erythromycin

45
Q

What is the benefit of topical tacrolimus and pimecrolimus?

A

They do not cause skin thinning

46
Q

What is the problem with topical tacrolimus and pimecrolimus?

A

They are extremely expensive

47
Q

What are the 2nd/3rd line treatments for eczema?

A

Oral steroids – short term

Ultraviolet light

Cyclosporin A (Monitor BP, renal function,  risk malignancy)

48
Q

What should be monitored in Cyclosporin A? (explain why)

A

Monitor BP (can cause HTN)

renal function (can cause kidney dysfunction)

increased risk malignancy, thus monitor

49
Q

What are the risks of using topical steroids on the face?

A

telangectasia

perioral dermatitis

eye problems

skin thinning

50
Q

What is the best form of topical steroid and why?

A

steroid ointment, due to:

beneficial emollient effect and

reduced risk of medication allergy with long-term use

51
Q

How can topical steroid s/e’s be reduced?

A

Use an ointment

Twice daily for only a few days

Only treat active areas

Dermatology (11 decks)

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