Eczema Flashcards

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1
Q

Why is eczema an important condition to know about?

A
  • It’s common
  • increasing prevalence
  • It’s chronic
  • It’s costly
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2
Q

What is eczema?

A
  • A common inflammatory skin condition.
  • Commonly affects flexural areas.
  • Multiple types and a spectrum of severity
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3
Q

What is the epidemiology of eczema?

A
  • Overall prevalence is 4% in Western countries
  • Most commonly appears in babies and children (by adult life 60% have cleared)
  • Increasing prevelance
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4
Q

What criteria is used to define atopic eczema?

A

Modified Hanifin and Rajka criteria

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5
Q

What is the definition of atopic eczema?

A

-An itchy skin condition in the last 12 months

Plus 3 of the following:

  • Onset before age 2
  • History of flexural involvement
  • History of generally dry skin
  • History of other atopic disease (Asthma/hayfever)
    • History in 1st degree relative if under 4 yrs
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6
Q

What is the triad of atopy?

A
  • Asthma
  • Hayfever
  • Eczema
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7
Q

What is the pathogenesis behind atopic eczema?

A
  • Genetics
  • Epidermal barrier dysfunction
  • Environmental factors
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8
Q

What gene plays a key role in atopic eczema?

A

Filaggrin gene

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9
Q

What atopic family history may there be in atopic eczema?

A
  • Atopic eczema
  • Asthma
  • Hayfever (allergic rhinitis)
  • Food allergy
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10
Q

What is the pathology of atopic eczema?

A
  • Spongiosis (intercellular oedema) within the epidermis.
  • Acanthosis (thickening of the epidermis).
  • Inflammation - Superficial perivascular lymphohistiocytic infiltrate.
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11
Q

What are the causes of acute flares?

A
  • Viral illness - or period poor health
  • Stress
  • Environmental triggers (heat, cold, allergens (house dust mite, cat/dog dander))
  • Food allergies
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12
Q

What are the clinical features of atopic eczema?

A
  • Itch, redness, scaling, papules, vesicles
  • Flexural – however can involve all body sites
  • Babies – usually starts on the face
  • Chronic changes
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13
Q

What are the chronic changes involved in atopic eczema?

A
  • Lichenification
  • Plaques
  • Fissuring
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14
Q

What exogenous types of eczema are there?

A
  • Contact dermatitis (allergic/ irritant)
  • Lichen simplex
  • Photoallergic or photpaggravated eczema
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15
Q

What endogenous types of eczema are there?

A
  • Atopic
  • Discoid
  • Venous
  • Seborrheic dermatitis
  • Pompholyx
  • Juvenile plantar dermatitis
  • Asteatotic
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16
Q

What is allergic contact dermatitis caused by?

A
  • Type 4 Hypersensitivity

- Delayed hypersensitivity – can take 48-72 hrs to develop reaction

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17
Q

Describe the process of a type 4 hypersensitivity reaction.

A
  • Antigen presenting cells take allergen to LN and present to naive T cells
  • Clonal expansion of these T cells, (released into blood stream)
  • When these T cells next encounter hapten
  • Mast cell degranulation, vasodilatation and neutrophils
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18
Q

In irritant contact dermatitis, what can skin be injured by?

A

Friction

  • Micro-trauma
  • Cumulative

Environmental factors

  • Cold
  • Over exposure to water
  • Chemicals such as acids, alkalis, detergents and solvents
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19
Q

What occupations are at particular risk of irritant contact dermatitis?

A
  • Hairdressers
  • NHS staff
  • Cleaners
  • Nappy rash
  • Medical/nursing students!
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20
Q

Describe how patch testing is carried out.

A
  • Potential allergens applied (no needles involved!)
  • Baseline/standard series – applied to all patients
  • Applied Monday
  • Remove Wednesday
  • Re-assess Friday
  • Expect most allergens at 96 hour (Friday reading)
21
Q

Describe the features of seborrheic dermatitis in infants.

A
  • Distinctive pattern
  • Predilection for scalp, proximal flexures.
  • <6months age usually.
  • Often clears within weeks of treatment
22
Q

What is another name for seborrheic eczema?

A

Chronic dermatitis

23
Q

Describe the presentation of seborrheic eczema in adults.

A
  • Malassezia yeast increased in the scaly epidermis of dandruff and seborrehoic dermatitis.
  • Red, sharply marginated lesions covered with greasy looking scales.
  • Distinctive distribution – areas rich in supply of sebaceous glands (scalp, face, upper trunk).
24
Q

What can be a precursor for seborrheic eczema?

A

Dandruff. May gradually progress through redness, irritation and increased scaling

25
Q

How should seborrheic eczema be treated in adults?

A

Topical anti-yeast (ketoconazole)

26
Q

If seborrheic eczema is severe in adults, what should you consider doing?

A

HIV test

27
Q

What is the presentation of discoid eczema?

A

Circular plaques of eczema

28
Q

What is the cause of discoid eczema?

A

Cause unknown

29
Q

Where may discoid eczema develop?

A

May develop at sites of trauma/irritation

30
Q

Describe the features of pompholyx/vesicular eczema.

A
  • Palms and soles.
  • Intensely itchy.
  • More common under 40 years.
  • Sudden onset of crops of vesicles.
  • Resolution can include desquamation.
31
Q

How does asteatotic eczema present?

A
  • Very dry skin

- Cracked scaly appearance

32
Q

What are the most commonly affected areas of asteatotic eczema?

A

Shins affected

33
Q

What can irritate asteatotic eczema?

A
  • Climate (heat)

- Excessive washing/soaps

34
Q

What are other names for venous eczema?

A
  • Stasis eczema

- Varicose eczema

35
Q

What is associated with venous eczema?

A
  • Increased venous pressure

- Oedema

36
Q

What areas are usually involved in venous eczema?

A

Ankle and lower leg

37
Q

What may help in the resolution of venous eczema?

A

Compression stockings

38
Q

What is eczema herpeticum?

A

Disseminated viral infection (herpes simplex)

39
Q

How does someone present with eczema herpticum?

A
  • Fever and often unwell
  • Itchy clusters of blisters and erosions
  • Swollen lymph glands
40
Q

What causes eczema herpeticum?

A

Herpes Simplex 1 and 2

41
Q

How should eczema herpeticum be managed?

A
  • Consider admission
  • Antivirals
  • Consider secondary bacterial infection
42
Q

How should eczema be treated?

A
  • Patient education
  • Avoid causative/ exacerbating factors
  • Emollients (moisturisers)
  • Soap substitutes
  • Intermittent topical steroids
  • Sometimes need antihistamines or antimicrobials
  • Cacineurin inhibitors
43
Q

What types of emollients can be used in eczema?

A
  • Ointments (greasy but effective)
  • Creams (lighter)
  • Lotions (more watery)
44
Q

Give an example of a low potency topical steroid

A

Hydrocortisone

45
Q

Give an examples of a potent topical steroid.

A

Betamethasone

46
Q

Give 2 examples of calcineurin inhibitors.

A
  • Pimecrolimus

- Tacrolimus

47
Q

How can severe eczema be treated?

A
  • Ultraviolet light

- Immunosuppression

48
Q

Give examples of immunosuppressant’s.

A
  • Azathioprine
  • Ciclosporin
  • Mycophenolate mofetil
  • Methotrexate