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Dermatology > Eczema > Flashcards

Eczema Flashcards

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Dermatology Board Prep flashcards
1
Q

Give the definition of atopic eczema

A

Atopic dermatitis caused by inflammation in flexural areas.

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2
Q

Describe the distribution of atopic eczema

A 
Usually has a symetrical distribution:
Flexures
Neck
Eyelids
Face
Hands
Feet
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3
Q

What is the key gene associated with eczema?

A

Filaggrin gene

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4
Q

Describe the pathology of eczema

A
  • Spongiosis = epidermis cells swell and split apart due to oedema
  • Acanthosis = thickening of epidermis
  • Inflammation = due to lymphohistiocytic infiltration
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5
Q

Describe the appearance and distrubution of contact dermatitis

A

Redness, vesicles/papules, crusting/scaling
Areas exposed to irritant/allergen
Often hands/nails and nappy rash

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6
Q

Describe the appearance of lichen simplex eczema

A

Localised demarcated plaque

Scaling, excoriations, lichenification

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7
Q

Describe the distrubution of lichen simplex eczema

A

Common on calves, elbows, shins, behind the neck, and genitals

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8
Q

What is the main symptom of lichen simplex eczema?

A

severe itch

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9
Q

Describe the appearance and distrubution of seborrhoeic eczema

A

Red, inflamed skin with greasy yellow scales. May also have salmon-pink patches/plaques.
Affects “sweaty areas” e.g. face, scalp, armpits, groin, chest

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10
Q

Which type of eczema is usually painless and non-itchy?

A

Seborrhoeic eczema (children are not distressed - “happy baby”)

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11
Q

Describe the appearance and distribution of discoid eczema

A

Circular erythematous plaques
Symmetrical distrubution
Often on extremities, especially the legs, but can occur anywhere

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12
Q

List the types of internal/endogenous eczema

A

P. DAVIES:

Pompholyx
Discoid
Atopic
Venus
Infected
Eczema herpeticum
Seborrhoeic
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13
Q

Which type of eczema may sting/burn and is worse at night?

A

Discoid eczema

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14
Q

Which type of eczema is mainly distrubuted on the soles of the feet and palms of the hands?

A

Pompholyx eczema

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15
Q

Describe the appearance of pompholyx eczema

A

Vesicular eruptions (small, fluid-filled lesions)

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16
Q

Which type of eczema commonly affects the shins of elderly patients? Describe the appearance of this type of eczema

A

Asteatotic eczema

Very dry skin

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17
Q

Describe the appearance of venous eczema

A

Poorly defined scaling and erythema. Pigment changes e.g. browning. Skin can blister and weep. Patients also often have varicose veins.

18
Q

Describe the distribution of venous eczema

A

Bilateral ankles and lower legs

19
Q

What is eczema herpeticum?

A

Disseminated infection of herpes simplex virus. It is often a complication of atopic eczema.

20
Q

Describe the appearance of eczea herpeticum

A

Itchy clusters of blisters and erosions. Distribution depends on the initial eczema distrubution.

21
Q

What other symptoms may be associated with eczema herpeticum?

A

Fever

Swollen lymph nodes

22
Q

Suggest some potential causes/triggers of atopic eczema

A 
Irritants, infections, contact allergens, inhaled allergens
Extremes of temperature and humidity
Genetic factors (filaggrin gene)
Stress
Hormonal factors
23
Q

Describe the aetiology of allergic contact dermatitis and suggest some potential allergens

A

Type 4 hypersensitivity reaction
T-cell mediated
Cosmetics, metals (e.g. cobalt, nickel), topical drugs, textiles, plants

24
Q

Describe the aetiology of irritant contact dermatitis

A

Friction
Environmental: cold, over-exposure to water
Chemical: acids, alkalies, detergents, solvents

25
Q

Which type of eczema begins as eczema of another cause but is exacerbated by an itch-scratch cycle? How can this be managed?

A

Lichen simplex eczema

Apply dressings to prevent scratching

26
Q

What causes seborrhoeic eczema?

A

In adults: Inflammatory reaction to Malassezia yeast

In newborns: Sometimes caused by yeast, other times is caused by over-activity of the sebaceous glands

27
Q

Which fungi is linked to seborrhoeic eczema?

A

Malassezia yeast

28
Q

How is seborrhoeic eczema treated?

A

Topical anti-yeast shampoo e.g. ketoconazole

Often self-limiting in infants so may not need treatment

29
Q

What underlying pathology should be considered in cases of seborrhoeic eczema that are severe, prolonged and/or have no family history?

A

Underlying HIV infection; consider HIV testing

30
Q

Describe the aetiology of discoid eczema

A

Usually idiopathic/unknown
May develop at site of trauma or irritation
N.B. infection is usually occurs secondary to the eczema rather than being a cause.

31
Q

Describe the aetiology of pompholyx eczema

A 
Unknown but is associated with:
 - Stress
 - Allergy
 - Genetics
 - HIV
Usually self-limiting but symptomatic treatment of itch is often required
32
Q

What can exacerbate asteatotic eczema?

A

Climate (heat)

Excessive washing/soaps

33
Q

How is asteatotic eczema managed?

A

Does not require steroids

Apply lots of emollient

34
Q

Describe the aetiology of venous eczema. How can this be managed?

A

Increased venous pressure causes oedema.
Compression stockings should be worn to improve venous circulation.
Also important to manage fluids as the skin can weep, leading to dehydration.

35
Q

What underlying pathology is associated with an increased risk of eczema herpeticum?

A

HIV infection

36
Q

Describe the general management of eczema

A 
Emollient/moisturisers
 - ointment, cream, lotion
Topical steroids
 - hydrocortisone
Severe eczema may be treated with UV light and/or immunosuppression.
?anti-histamines
?calcineurin inhibitors
37
Q

Describe the role of epidermal barrier dysfunction in the pathophysiology of eczema

A

Two-way barrier defect:

  • water gets out
  • irritants/allergens get in
38
Q

Describe the general acute changes seen in eczema

A

– Pruritus, Erythema, Scale, Papules, Vesicles

– Exudate, crusting, excoriation

39
Q

Describe the general chronic changes seen in eczema

A

Lichenification,
Plaques,
Fissuring

40
Q

How is allergic contact dermatitis investigated?

A

Patch Testing

  • can take 48-72 hours to develop reaction (type 4 hypersensitivity):
  • potential allergens applied (no needles involved!)
  • baseline/standard series of around 40 allergens isapplied to all patients. Some patients may require additional series (e.g. occupation-dependant).
  • Apply Monday
  • Remove Wednesday
  • Re-assess Friday

Dermatology (6 decks)

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