Eczema

Question 1

Definition of eczema?

Answer 1

Type of inflammatory reaction pattern in the skin which may be provoked by a number of external or internal factors

Question 2

Symptoms of eczema? (6)

Answer 2

Pruritus
Erythema
Oedema (acutely)
Lichenification (chronic)
Papules/vesicles
Exudation

Question 3

What sign of chronic eczema can sometimes be seen in the nails?

Answer 3

Polished-looking fingernails due to persistent scratching

Question 4

Types of exogenous eczema (2)

Answer 4

Primary irritant contact dermatitis

Allergic contact dermatitis

Question 5

What causes primary irritant contact dermatitis?

Answer 5

Physical irritants e.g. soap powder, washing up liquid; nappy rash (urine)

Question 6

What increases the risk of suffering contact dermatitis?

Answer 6

If the patient also has atopic dermatitis

Question 7

Treatment of irritant contact dermatitis (2)

Answer 7

Avoidance/minimization of exposure to the substance responsible
Liberal use of emollients

Question 8

A type IV hypersensitivity reaction to an external allergen, occuring after sensitization to the allergen

Answer 8

Allergic contact dermatitis

Question 9

Common allergens in allergic contact dermatitis? (4)

Answer 9

Nickel
Cosmetics
Rubber additives e.g. latex
Textile dyes

Question 10

Investigation of allergic contact dermatitis

Answer 10

48h patch testing (when the acute eczema has settled)

Question 11

What is atopic eczema?

Answer 11

Commonest dermatosis, often associated with asthma and/or allergic rhinitis

Question 12

How does eczema manifest in a newborn?

Answer 12

Starts in early infancy; often displays an extensor surface pattern before becoming mainly flexural

Question 13

How does seborrhoeic eczema of the newborn manifest? (3)

Answer 13

Cradle cap/nappy rash
Often not itchy
May develop into atopic eczema

Question 14

What are the complications of persistent scratching? (4)

Answer 14

Lichenification
Scarring
“Habit scratching” e.g. when stressed, nervous
Infection

Question 15

Mutations in which gene predispose to atopic eczema?

Answer 15

Filaggrin

Question 16

What is the association between food allergy and atopic eczema?

Answer 16

Most cases there is no association; in 30% of infants, egg and milk allergy symptoms (GI upset) may coincide with eczema symptoms

Question 17

What tests can be used to detect specific allergies?

Answer 17

RAS test for specific IgE

Question 18

What factors can cause eczema flares? (5)

Answer 18

Allergens/irritants
Dryness/heat/cold
Inhaled allergens
Stress
Infection

Question 19

Management principles of eczema

Answer 19

Use antimicrobial soap substitutes
Use emollients even when eczema not flaring
Topical steroids, stepped up/down according to response

Question 20

Why should the use of strong steroids e.g. dermovate be avoided on the face?

Answer 20

Steroid acne, telangiectasia

Question 21

Commonly used steroids in order of potency (4)

Answer 21

Hydrocortisone
Eumovate
Betnovate
Dermovate

Question 22

Other treatment approaches for brittle/unstable atopic eczema (5)

Answer 22

Calcineurin inhibitors e.g. tacrolimus
Impregnated bandages (zinc oxide)
Antihistamines
Wet wrap therapy
Ultraviolet light therapy

Question 23

When might antihistamines be worthwhile in eczema?

Answer 23

Sedating antihistamines may help at night, especially school age

Question 24

Management of staph-infected eczema

Answer 24

Fusidic acid + steroid e.g. Fucibet

Question 25

Scaly erythema on the face (particularly nasolabial folds) and scalp- occurs particularly severely in AIDS patients

Answer 25

Seborrhoeic dermatitis

Question 26

What yeast is linked to the development of seborrhoeic dermatitis?

Answer 26

malassezia yeasts

Question 27

Management of seborrhoeic dermatitis (2)

Answer 27

Scalp- medicated anti-dandruff shampoos

Anti-fungal + steroid combination creams elsewhere in the body

Question 28

Episodic eczema of the palms/soles, in which bulla formation occurs

Answer 28

Acute pompholyx eczema