Eczema Flashcards
Describe the clinical features of eczema?
Acute vs chronic phase?
- Itchy, erythematous and dry - usually ill defined borders
- As gets older localised to flexures (elbows, behind knees)
- Have elevated levels of circular IgE
- In the acute phase there may be vesicles or blisters which may weep or bleed.
- Chronically fissures and lichenification (skin thickenning) develop
What is the childhood prevalence of atopic eczema?
When does it present?
- 10-20% of children
- Usually presents before 2 years of age and the severity decreases with age.
Describe the aetiology of atopic eczema?
- Mutation of a gene causing a primary skin barrier defect.
- Endogenous (internal cause)
Note commonly effects the face in young children and as they get older often moves to the flexor regions.
Which factors can commonly exacerbate atopic eczema?
- Irritants (soap, nylon sheets)
- Allergies
- Changes in weather
- Stress
- Illness
- Skin infection
Which group is sebhorraeic eczema most common in and what organism is it associated with?
What exacerbates it?
What can it be an early sign of?
- It is most common in middle aged adults.
- It is associated with the Pityosporum spp yeast species and may be due to an immune reaction to these micro-organisms.
- It is exacerbated by alcohol.
- It is an endogenous form of eczema.
Severe in HIV patients - can be an early sign of aids
How does discoid eczema present and in which age groups?
- Any age although most common middle aged men
- Disc like well demarkated lesions
- Often secondarily infected, and thought to potentially be a manifestation of atopic eczema
- It is an endogenous form of eczema
What is irritant contact eczema/dermatitis and who does it usually effect?
- Direct effect of irritant substances affecting the skin integrity usually the hands.
- It is a type 4 immune response.
- It usually effects the following occupations:
- Hairdressers
- Chefs
- Cleaners
- Housewives
- Nurses
- This is an exogenous form of eczema.
List some common irritants in allergic contact dermatitis?
How is diagnosis confirmed?
- Nickle in jewlerry and belt buckles
- Hair Dye
- Plants
- Topical meds
- Frangrances
- Occupation
Diagnosis is confirmed by patch testing.
Describe the management of eczema?
General measures:
- Avoid irritants/exacerbating factors
1st line measures:
- Treat dry skin - emollients (ointments best)
- Treat active eczema - topical steroids (choose weakest one that works), treat in bursts of 1-2X/day to allow periods of steroid free time
2nd line measures:
- Topical immunomodulators (tacrolimus & pimecrolimus)
- Occlusive bandaging (tar, zinc paste & wet wraps)
- Systemic treatments:
- UV light
- Oral steroids (presnisolone)
- Oral abx if infected (ciclosporins - flucloxacillin/erythromycin)
- Anti-histamines
- Oral immunosupression
What are the different strengths of steroid?
Mild: Hydrocortisone 1%
Moderate: Eumovate
Potent: Elocon, Betnovate
Very Potent: Dermovate
(HEMD)
Ointments should be used preferntially to creams and she be applied 1-2 time a day in short courses.
What are the risks of applying potent steroids long term on the face?
- Telangeictasia and striae
- Hirsuitism
- Perio-orbital dermatitis
- Glaucoma and cataracts
- Skin (dermis) thinning
- Bruising (from thinning & vessel wall fragility)
- Rebound effect (worse SEs when removed)
What are the second line treatment options?
Immunomodulators
Bandaging and wet wraps
Photodynamic therapy
Oral steroids
What type of eczema is shown?
Discoid eczema
What type of eczema is shown?
Atopic eczema
Often on face in young children and flexure regions as the child gets older
What type of eczema is shown?
Severe eczema + secondary infection
What type of eczema is shown?
Irritant contact dermatitis
What type of eczema is shown?
Seborrhaeic Eczema
Most commonly seen in middle aged adults on the face
What type of eczema is shown?
Irritant contact dermatitis
Most commonly effects the hands
What type of eczema is shown?
Pompholytic eczema also known as dyshydrotic eczema
It is an eczema of unknown aeitiology and presents as an itchy vesicular rash on the hands, fingers and soles of the feet.
