Eczema

Question 1

What is atopic eczema?

Answer 1

Inflammatory skin disease (dermatitis)

Starts in early infancy in >80%, often on the face and extensor surfaces.
- Later the typical flexural pattern develops

Question 2

What is the atopic march?

Answer 2

• Eczema beginning in infancy
• Asthma usually after 2 years of age
• Hay fever from 7yrs

Question 3

What is the clinical picture of seborrhoea can eczema of the newborn?

Answer 3

• Cradle cap
• Flexural eczema
• Napkin eczema
• Often not itchy, may develop into typical atopic eczema
• May develop into psoriasis later

Question 4

What is the UK Working Party’s criteria for diagnosis of atopic dermatitis?

Answer 4

Itching plus 3 or more of:

• Visible flexural rash
• History of flexural rash (cheeks and extensor in infants)
• Personal history of atopy
• Dry skin in past year
• Onset before 2 years of age.

Question 5

Genetic factors involved in atopic eczema?

Answer 5

• Genes involving skin barrier function.
• Over production of inflammatory cytokines.
• Increased IgE production.
• The cornfield cell envelope (CCE) is the main outer cutaneous barrier. It prevents water loss and prevents entry of infections agents. Impaired CCE barrier function is a major cause of atopic eczema.

Question 6

What protein mutations predisposes to ichthosis vulgar is and atopy?

Answer 6

Filaggrin

Filaggriun is a protein present in keratohyalin granules in the granular layer of the epidermis, it helps in terminal differentiation of cells.

Question 7

What type of hypersensitivity reaction is eczema?

Answer 7

Eczema is a delayed type IV +/- type 1 reaction.

Question 8

What are the 3 modes of actions of topical corticosteroids?

Answer 8

• Anti-inflammatory
• Vasoconstrictive
• Antiproliferative

Question 9

How much is one fingertip unit?

Answer 9

Half a gram. (Covers 2 hand areas)

Question 10

What type of medication is Tacrolimus?

Answer 10

It is a calcineurin inhibitor

Question 11

Eczema treatment ladder:

Answer 11

1) Emollients alone
2) Emollients + mild topical corticosteroid (TCS)
3) Emollients + moderate TCS + possible calcineurin inhibitor
4) Emollients + potent/very potent TCS (short term + specialist help)

Question 12

What is the role of antihistamines in atopic eczema?

Answer 12

Contra-indicated under 6 months old.

• Use sedating AH at night to help sleep.
• Non-sedating AH for day or school age.

No good evidence of efficacy but worth a trial if sleep disturbance or severe itching.

Question 13

Eczema herpeticum clinical presentation and management?

Answer 13

• Emergency, needs same day referral.
• Immediate oral or systemic aciclovir.
• Monomorphic rash.
• Circular blisters or crusted erosions.
• May be umbilicated.