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Dermatology > Eczema > Flashcards

Eczema Flashcards

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Dermatology Board Prep flashcards
1
Q

What % of children will be diagnosed with eczema in their childhood?

A

24%

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2
Q

How is eczema also known as?

A

Atopic dermatitis

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3
Q

What % of cases of eczema in children have cleared by the time they reach adulthood?

A

60%

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4
Q

What are some theories for the increasing prevalence of eczema, particularly in developed countries?

A

– Social class effect?
– Commoner in cooler climates?
– Pollution? Other environmental factors?

Hygiene hypothesis?

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5
Q

Describe the Modified Hanifin and Rajka criteria for the definition of atopic dermatitis

A

An itchy skin condition in the last 12 months + 3 of the following:
• Onset before age 2
• History of flexural involvement
• History of generally dry skin
• History of other atopic disease
– History in 1st degree relatives if under 4 yo

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6
Q

What gene plays a key role in the pathogenesis of eczema?

A

Filaggrin gene

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7
Q

What components are involved in the pathogenesis of eczema?

A 
Genetics
–	Many genes implicated
–	Key role for Filaggrin gene
–	Atopic family history 
•	Atopic eczema, asthma, allergic rhinitis, food allergy

Epidermal barrier dysfunction

Environmental factors

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8
Q

What 3 processes are involved in the pathology of eczema?

A

Spongiosis (intercellular oedema) within the epidermis.

Acanthosis (thickening of the epidermis).

Inflammation - Superficial perivascular lymphohistiocytic infiltrate.

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9
Q

What are the clinical features of eczema?

A

Itch!!
• Distribution
– Flexures, Neck, Eyelids, Face, Hands and feet
– Tends to spare nappy area

Acute changes
– Pruritus, Erythema, Scale, Papules, Vesicles
– Exudate, crusting, excoriation

Chronic changes
– Lichenification, Plaques, Fissuring

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10
Q

List some external/exogenous types of eczema

A

Contact dermatitis - irritant or allergic

Lichen simplex

Photoallergic or photoaggravated eczema

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11
Q

List some endogenous/internal types of eczema

A 
–	Atopic
–	Discoid
–	Venous
–	Seborrhoeic dermatitis
–	Pompholyx
–	Juvenile plantar dermatitis
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12
Q

What type of eczema does contact dermatitis come under?

A

Exogenous/external eczema

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13
Q

What type of eczema does lichen simplex come under?

A

Exogenous/external eczema

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14
Q

What is lichen simplex?

A

Hyperpigmented, lichenified plaque with accentuated skin lined caused by repeated rubbing of the area. Lichen simplex chronicus (LSC) is a localized, well-circumscribed area of lichenification (thickened skin) resulting from repeated rubbing, itching, and scratching of the skin

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15
Q

What type of eczema does Photoallergic or photoaggravated eczema fall under?

A

Exogenous/external eczema

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16
Q

What type of eczema does Atopic dermatitis fall under?

A

Endogenous/internal eczema

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17
Q

What type of eczema does discoid eczema fall under?

A

Endogenous/internal eczema

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18
Q

What type of eczema does venous eczema fall under?

A

Endogenous/internal eczema

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19
Q

What type of eczema does Seborrhoeic dermatitis fall under?

A

Endogenous/internal eczema

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20
Q

What type of eczema does Pompholyx or vesicular eczema full under?

A

Endogenous/internal eczema

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21
Q

What type of eczema does Juvenile plantar dermatitis fall under?

A

Endogenous/internal eczema

22
Q

Describe asteatotic eczema

A

Asteatotic - diminished or arrested action of the sebaceous glands

Characterized by pruritic, dry, cracked, and polygonally fissured skin with irregular scaling, often on shins of elderly patients

23
Q

Describe allergic contact dermatitis

A

Type 4 Hypersensitivity
Delayed hypersensitivity – can take 48-72 hrs to develop reaction

Antigen presenting cells take hapten/ 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

24
Q

What type of reaction is involved in allergic contact dermatitis?

A

Type 4 Hypersensitivity (delayed)

25
Q

How long after exposure does allergic contact dermatitis flare?

A

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

26
Q

Describe irritant contact dermatitis

A

Skin injured by:
– Friction – micro-trauma, cumulative
– Environmental factors e.g.Cold, over-exposure to water
chemicals such as acids, alkalis, detergents, solvents

27
Q

What occupations are at risk of irritant contact dermatitis

A

– Hairdressers
– NHS staff
– Cleaners

28
Q

How do we test for allergens?

A

Patch testing

Potential allergens are applied on the monday and covered
Washed off on wednesday
Examine on friday for results

29
Q

Describe Seborrhoeic eczema

A

Symptoms include red, scaly, greasy, itchy, and inflamed skin. Areas of the skin rich in oil-producing glands are often affected including the scalp, face, and chest

In babies, when the scalp is primarily involved, it is called cradle cap.

Dandruff is a milder form of the condition, without associated inflammation

30
Q

How does Seborrhoeic eczema present in infants?

A
  • Distinctive pattern
  • Predilection for scalp (cradle cap), proximal flexures.
  • <6months age usually.
31
Q

What type of eczema is linked to cradle cap and dandruff?

A

Seborrhoeic eczema

32
Q

Describe discoid eczema

A
  • Circular plaques of eczema.
  • Cause often unknown.
  • May develop at sites of trauma/irritation.
33
Q

Describe Pompholyx/vesicular eczema

A
  • Affects palms and soles with vesicles/bullae
  • Intensely itchy.
  • Sudden onset of crops of vesicles.
  • Resolution can include desquamation (peeling)
34
Q

What age group is most commonly affected with Pompholyx/vesicular eczema?

A

< 40yo

35
Q

What is Asteatotic eczema linked to?

A
  • Climate – heat

* Excessive washing/soaps

36
Q

Describe Venous eczema/venous stasis eczema

A
  • Stasis eczema or varicose eczema.
  • Increased venous pressure.
  • Oedema.
  • Ankle and lower leg involved.
  • Resolution of oedema can help – compression stockings.
37
Q

How can venous eczema be treated in addition to classic eczema therapy?

A

Compression stockings

38
Q

What is eczema herpaticum?

A
  • Disseminated viral infection
  • Fever and often unwell
  • Itchy clusters of blisters and erosions
  • Herpes Simplex 1 and 2
  • Swollen lymph glands
  • Consider admission, antivirals, consider secondary bacterial infection.
39
Q

What viruses are involved in eczema herpaticum?

A

HSV 1 and 2

40
Q

Describe the signs of infected eczema

A 
o	Fluid oozing from the skin
o	A yellow crust on the skin surface
o	Small yellowish-white spots appearing in the eczema
o	The skin becoming swollen and sore
o	Fever and generally feeling unwell
41
Q

What increases the risk of infected eczema?

A

Scratching

Not using treatment properly

42
Q

How is eczema treated?

A

Patient education
Avoid Causative / exacerbating factors
Emollients (moisturisers)
Soap substitutes
Topical steroids e.g. Hydrocortisone, Betamethasone
Sometimes need antihistamines or antimicrobials
Calcineurin Inhibitors e.g. topical Pimecrolimus, Tacrolimus

43
Q

Describe the different types of emollients used in eczema treatment

A

– Ointment – greasy but effective
– Creams – lighter
– Lotions – more watery

44
Q

Describe a low potency intermittent topical steroid used in eczema treatment

A

Hydrocortisone

45
Q

Describe a high potency intermittent topical steroid used in eczema treatment

A

Betamethasone

46
Q

What are calcinuerin inhibitors?

A

Immunomodulators

47
Q

Give two examples of calcinuerin inhibitors

A

Topical Pimecrolimus and Tacrolimus

48
Q

How is severe eczema treated?

A 
Ultraviolet light.
Immunosuppression.
–	Azathioprine
–	Ciclosporin
–	Mycophenolate mofetil
–	Methotrexate
49
Q

List 4 immunosuppressive agents used in severe eczema

A

– Azathioprine
– Ciclosporin
– Mycophenolate mofetil
– Methotrexate

50
Q

Name the topical PDE-4 inhibitor recently approved by the FDA for eczema

A

Crisaborole

51
Q

What is Dupilumab?

A

– 1st biologic for eczema patients

– IL-4/IL-13 inhibitor

52
Q

What is the first ever biologic developed for eczema, and acts as a IL-4/IL-14 inhibitor?

A

Dupilumab

Dermatology (12 decks)

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