Eczema Flashcards
Definition of eczema?
Type of inflammatory reaction pattern in the skin which may be provoked by a number of external or internal factors
Symptoms of eczema? (6)
Pruritus Erythema Oedema (acutely) Lichenification (chronic) Papules/vesicles Exudation
What sign of chronic eczema can sometimes be seen in the nails?
Polished-looking fingernails due to persistent scratching
Types of exogenous eczema (2)
Primary irritant contact dermatitis
Allergic contact dermatitis
What causes primary irritant contact dermatitis?
Physical irritants e.g. soap powder, washing up liquid; nappy rash (urine)
What increases the risk of suffering contact dermatitis?
If the patient also has atopic dermatitis
Treatment of irritant contact dermatitis (2)
Avoidance/minimization of exposure to the substance responsible
Liberal use of emollients
A type IV hypersensitivity reaction to an external allergen, occuring after sensitization to the allergen
Allergic contact dermatitis
Common allergens in allergic contact dermatitis? (4)
Nickel
Cosmetics
Rubber additives e.g. latex
Textile dyes
Investigation of allergic contact dermatitis
48h patch testing (when the acute eczema has settled)
What is atopic eczema?
Commonest dermatosis, often associated with asthma and/or allergic rhinitis
How does eczema manifest in a newborn?
Starts in early infancy; often displays an extensor surface pattern before becoming mainly flexural
How does seborrhoeic eczema of the newborn manifest? (3)
Cradle cap/nappy rash
Often not itchy
May develop into atopic eczema
What are the complications of persistent scratching? (4)
Lichenification
Scarring
“Habit scratching” e.g. when stressed, nervous
Infection
Mutations in which gene predispose to atopic eczema?
Filaggrin
What is the association between food allergy and atopic eczema?
Most cases there is no association; in 30% of infants, egg and milk allergy symptoms (GI upset) may coincide with eczema symptoms
What tests can be used to detect specific allergies?
RAS test for specific IgE
What factors can cause eczema flares? (5)
Allergens/irritants Dryness/heat/cold Inhaled allergens Stress Infection
Management principles of eczema
Use antimicrobial soap substitutes
Use emollients even when eczema not flaring
Topical steroids, stepped up/down according to response
Why should the use of strong steroids e.g. dermovate be avoided on the face?
Steroid acne, telangiectasia
Commonly used steroids in order of potency (4)
Hydrocortisone
Eumovate
Betnovate
Dermovate
Other treatment approaches for brittle/unstable atopic eczema (5)
Calcineurin inhibitors e.g. tacrolimus Impregnated bandages (zinc oxide) Antihistamines Wet wrap therapy Ultraviolet light therapy
When might antihistamines be worthwhile in eczema?
Sedating antihistamines may help at night, especially school age
Management of staph-infected eczema
Fusidic acid + steroid e.g. Fucibet
