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Dermatology SOH > Eczema > Flashcards

Eczema Flashcards

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Dermatology Board Prep flashcards
1
Q

Types of eczema

A 
Atopic eczema 
Contact allergic dermatitis
Irritant contact dermatitis 
Eczema Herpeticum
Discoid Eczema
Seborrhoeic eczema
Lichen Simplex
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2
Q

Eczema - acute phase presentation

A 
Erythematous lesions 
Oedema 
Relatively flat 
Scaling and crusting 
Papulovesicular
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3
Q

Eczema - chronic phase presentation

A

Lichenification - thickening due to the epidermis being scratched
Elevated plaques
Scaling

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4
Q

Histology

A

Spongiosis - Collection of fluid between the keratinocytes in the epidermis
Acanthosis - increased thickening of the epidermis

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5
Q

Atopic eczema - Cause

A

Genetic and environmental factors resulting in inflammation
Familial disease
Strong maternal inheritance
Formation of excessive IgE

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6
Q

Atopic eczema - Association with other conditions

A

Hayfever

Asthma

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7
Q

Atopic eczema - What is fillagrin

A

Skin barrier gene found in granular layer

Binds to water molecules so they retain water and therefore prevent water loss

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8
Q

Atopic eczema - Fillagrin

A

Fillagrin is MISSING in patients with eczema resulting in a defective skin barrier.
Easy penetration of microbes and allergens
Stimulation of immune system
Inflammatory response (IgE mediated)

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9
Q

Atopic eczema - Morphology

A 
Dry skin
Scaling 
Erythematous patches 
ill-defined borders
Acute: can have papules and vesicles
Chronic: more likely to have lichenification
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10
Q

Atopic eczema - Clinical presentation

A

Intense itch
Sleep disturbance
Cognitive impairment (due to lack of sleep)
Exaggerated skin markings (looks like wrinkles)

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11
Q

Atopic eczema - Commonly affected areas

A 
Flexural distribution (behind knees, neck, front of wrists, elbows, ankles) 
- Can have eczema affecting extensor surfaces at beginning of disease
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12
Q

Atopic eczema - Diagnostic criteria

A

Itching + 3 of the following:

  • visible flexural rash
  • Hx of flexural rash
  • personal history of atopy (hay fever, asthma)
  • general dry skin
  • onset in first 2 years of life
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13
Q

Atopic eczema - Complications

A

Secondary infection

- crusting indicates staph aureus

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14
Q

Atopic eczema - Investigations

A

Diagnosis is clinical
Confirm diagnosis by
- high serum IgE levels
- blood eosinophilia

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15
Q

Atopic eczema - Prognosis

A

Onset very early - eczema likely to clear up in teenage years
Onset later in childhood - eczema follows a more chronic course

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16
Q

Atopic eczema - Management (first line)

A

Avoid irritants and allergens
Emollients
Topical steroids - can be used long term if applied to correct areas
Topical immunomodulators - useful alternative to chronic use of potent steroid
Soap substitute
Anti-histamines - at night time

Antibiotics - if secondary infection present

17
Q

Atopic eczema - second line management

A

Bandaging
Phototherapy
Systemic immunosuppressants - ciclosporin
Biologic therapy - azathioprine

18
Q

Allergic contact dermatitis - hypersensitivity reaction

A

Type 4 (delayed)

19
Q

Allergic contact dermatitis - cause

A

Contact with antigens such as:

  • chemicals (perfume)
  • topical therapies
  • latex in gloves
  • nickel in belts
20
Q

Allergic contact dermatitis - Clinical presentation

A

Localised distribution where skin has come in contact with allergen
Sharp cut off point in skin
Reaction more severe at areas of thin skin - allergen an penetrate the skin quicker here

21
Q

Allergic contact dermatitis - immunopathology

A

Allergen presented to skin
APCs (dendritc or langerhanns) recognise allergen
Allergen presented (by APC) to Th cells in dermis
Transported to lymph nodes where memory cells reside
If pt comes into contact with same allergen in future, there will be an immediate response due to generation of immunological memory

22
Q

Allergic contact dermatitis - investigations

A

Patch test

23
Q

Irritant contact dermatitis - causes e.g.

A 
Soap
Detergents 
Cleaning products 
Under a pts ring - soap stuck under ring not adequately washed off
Nappy rash 
Mechanical oils at work
24
Q

Irritant contact dermatitis - Clinical presentation

A

Non specific physical irritation

25
Q

Irritant contact dermatitis - who gets it?

A 
Anyone can get it
Most common occupations:
- hairdresser
- mechanic 
- cleaner
26
Q

Eczema Herpeticum - cause

A

Herpes Simplex Virus

27
Q

Eczeam Herpeticum - morphology

A

Multiple monomorphic punched out crusty lesions

28
Q

Eczema Herpeticum - management

A

Oral Aciclivir

29
Q

Discoid Eczema - cause

A

Scratching

30
Q

Discoid Eczema - morphology

A

Coin shaped eczematous lesions
Well defined
Can sometimes be confused with psoriasis

31
Q

Discoid Eczema - commonly affected areas

A

Limbs

32
Q

Seborrhoeic eczema - clinical presentation

A

In babies: cradle cap - yellowish thick crusts on scalp

In adults: dandruff, wide spread rash (not itchy)

33
Q

Photosensitive eczema - cause

A

UV exposure

34
Q

Photosensitive eczema - Clinical presentation

A

Cut off at t-shirt area is an important clue

35
Q

Lichen simplex - cause

A

Scratching or rubbing the skin

Dermatology SOH (27 decks)

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