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DERMATOLOGY > ECZEMA > Flashcards

ECZEMA Flashcards

1
Q

What is the other name used for eczema?

A

Dermatitis

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2
Q

What is the principal symptom of eczema?

A

Itching

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3
Q

What are the clinical signs of acute eczema?

A 
Erythema
Oedema
Papules
Vesicles
Exudate
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4
Q

What are the clinical signs of chronic eczema?

A

Thickened epidermis - Lichenification

Exaggerated skin surface markings

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5
Q

How do we classify the different forms of eczema?

A

Exogenous - Outside factors
Endogenous - eg Atopic eczema
Unclassified

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6
Q

What are the three types of exogenous eczema?

A

Irritant contact eczema
Allergic contact eczema
Photocontact eczema

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7
Q

What are some of the most important irritants that are known to lead to irritant contact dermatitis (a form of exogenous eczema)?

A 
Water
Abrasives
Chemicals - e.g. Acids and alkalis
Solvents (alcohol gel)
Detergents
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8
Q

Name 5 occupations that can be a risk factor for irritant dermatitis.

A 
Hairdresser
Mechanic
Nurse
Doctor
Caterer
Engineer
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9
Q

What type of hypersensitivity leads to allergic contact dermatitis (allergic eczema)?

A

Type IV hypersensitivity - delayed reaction (48-72 hours after contact begins)

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10
Q

How do we test for sensitivity to different allergens in people with allergic contact dermatitis?

A

Patch testing - several patches with common allergens are kept on the patients back for several days to look for dermatitis reaction.

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11
Q

What are some of the common allergens responsible for allergic contact dermatitis?

A 
Nickel - cheap jewellery
Chromates
Cobalt
Rosin
Fragrance
Paraphenylenediamine (Henna)
Plants
Preservatives in hand creams
Rubber and latex
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12
Q

What is a photocontact eczema reaction?

A

Activation of eczema by UV radiation of topically or systemically administered agent (eg some antibiotics such as doxycycline)

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13
Q

What are the different types of endogenous eczema?

A 
Atopic eczema
Seborrhoeic eczema
Discoid eczema
Venous stasis eczema
Pompholyx
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14
Q

What is atopic disorder?

A

Genetic predisposition to develop eczema, hayfever and asthma.

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15
Q

Which bacteria is found in particularly high amounts in the natural flora of patients with atopic eczema?

A

Staphylococcal colonisation

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16
Q

When does atopic eczema tend to start?

A

In the first 6 months of life

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17
Q

What proportion of patients will still suffer from atopic eczema by the age of 15?

A

25%

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18
Q

Where do infants with atopic disorder tend to develop eczema?

A

Face

Hands

19
Q

Where do children with atopic disorder tend to develop eczema?

A

Flexure aspects of arms, legs, and neck (antecubital fossae, wrists and popliteal fossae)

20
Q

Where do adults with atopic disorder tend to develop eczema?

A

Flexure aspects of arms, legs and neck

Hands

21
Q

What are the complications of atopic eczema?

A

Bacterial infection with staphyloccocus aureus

Viral infection – Molluscum and Herpes Simplex (very important)

Growth retardation (failure to thrive from chronic conditions)

22
Q

What do we call eczema that has been complicated by herpes simplex infection?

A

Eczema Herpeticum

23
Q

How do you manage someone with eczema herpeticum?

A

Hospital admission with IV aciclovir. Can become septic.

24
Q

What advice can be given to a patient or the parent of a patient who suffers from atopic eczema?

A

Use cotton or silk clothing only
Use non-bio detergent
Make sure flexure aspects of limbs are well dried after shower or swimming
Dab skin dry with towel rather than brushing
Avoid contact with pets
There is special eczema clothing for kids to help protect from damaging skin whilst itching during sleep

25
Q

What topical treatment options are available for someone with atopic eczema?

A

Emolient therapy - this is the most important aspect of treatment

Topical steroids

Sedative anti-histamines - helps patient sleep without itching

Antibiotics

Tacrolimus - immunosuppressor

Wet wrapping - wrapping emolient under clothing

Tar bandages

26
Q

What systemic treatment options are available for someone with atopic eczema?

A

Azathioprine

Cyclosporin

27
Q

Apart from topical and systemic treatments, what else might be helpful in treating someone with atopic eczema?

A

Phototherapy:

  • Narrow band UVB (TLO1)
  • PUVA (psoralen combined with ultraviolet A)
28
Q

What are the features of seborrhoiec eczema?

A

Chronic, scaly inflammatory eruption of face, scalp and chest.
Can occur severely in immunocomprised patients who are HIV positive

29
Q

What is the underlying pathology that causes seborrhoiec eczema?

A

Sebum production is normal, but eczema happens in sebaceous gland areas. It is caused by overgrowth of yeast (Malassezia and pityrosporum)

30
Q

How do you treat seborrhoiec eczema?

A

Anti-fungal agents

Topical steroids

31
Q

What are the features of discoid eczema?

A

Scattered well demarcated coin shaped areas of exuding and crusting eczema on trunks and limbs.

32
Q

How do you treat discoid eczema?

A

Potent steroids

33
Q

What are the clinical features of pomphylox eczema?

A

Crops of tiny vesicles over the hands and feet. They are intensely itchy so often the vesicles will have been scratched off by the time the patient presents.
Affects those aged between 10-40 and is worse in the summer.

34
Q

What are the three types of unclassified eczema (ie not purely exogenous or endogenous)?

A

Asteototic eczema
Lichen simplex
Juvenile plantar dermatosis

35
Q

What are the features of asteototic eczema?

A

Dry skin
Fissuring
Cracking
Affects limbs

36
Q

What are the risk factors for developing asteototic eczema?

A 
Overwashing
Diuretics
Dry winter climate
Over heating
Hypothyroidism
37
Q

What are the features of juvenile plantar dermatitis?

A

Soles of forefeet become shiny and glazed
Develop painful fissures (cracks) which then take weeks to heal

The toe webs are spared

38
Q

What is the underlying cause of juvenile plantar dermatitis?

A

Friction in shoes

39
Q

How do you treat juvenile plantar dermatitis?

A

Reduce friction through different footwear

Greasy emollients

Rest days out of shoes

40
Q

What parts of the body are most commonly affected by lichen simplex?

A 
Scalp
Nape of neck
Extensor forearms and elbows
Vulva and scrotum
Inner medial thighs, knees, ankles
41
Q

What are the features of lichen simplex?

A

Erythematous, scaly, well-demarcated, lichenified, firm, rough plaques with exaggerated skin lines
Hyperpigmentation

42
Q

What are the underlying causes of lichen simplex?

A

Rubbing and scratching by the patient, which can eventually lead to erosion and ulceration from deeper scratching.

43
Q

How do you treat lichen simplex?

A

Stop scratching

This can be helped by potent steroids that will break the itch-scratch cycle

DERMATOLOGY (6 decks)

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