Eczema Flashcards
What is eczema?
Common inflammatory skin condition, causing spongiosis within epidermis, acanthosis and inflammation
What causes eczema?
Wide range of external and internal factors- genetics, epidermal barrier dysfunction and environment
What genetics can contribute to eczema?
Atopic family history
Filaggrin gene
What can cause acute flares of eczema?
Viral illness
Stress
Environment- heat, cold, allergens
Food allergens
What are the clinical features of eczema?
Itch Redness Scaling Papules Vesicles Mostly seen in flexures
Where does eczema tend to start on babies?
Fave
What chronic changes are seen in eczema?
Lichenification
Plaques
Fissuring
What are the endogenous causes of eczema?
Atopic eczema Seborrhoeic dermatitis Discoid eczema Venous eczema Pompholyx eczema Juvenile plantar dermatitis
What is atopic eczema?
Itchy skin condone in the last 2 months plus 2 of the following
- onset before age 2
- hitory of flexural involvement
- history of generally dry skin
- history of other atopic disease or family history of
What are the clinical features of seborrhoea dermatitis in infants?
Scalp and proximal flexure pattern
Usually <6 months
Often clears within weeks of treatment
What is the presentation of seborrhoea eczema in adults?
Chronic dermatitis
Red, sharply margined lesions covered with greasy looking scales
Distrubuted over areas rich in sebaceous glands- scalp, face and trunk
Dandruff often recursor
What is the causative organism of seborrhoea eczema?
Malassezia yeast
What is the treatment of seborrhoea eczema?
Topical anti-yeast and HIV test if severe
What are the clinical features of discoid eczema?
Circular plaques of eczema
Cause ten unknown but may develop at sites of trauma/irritation
What are the clinical features of venous eczema?
Increased venous pressure and oedema
Ankle and lower leg involved
Resolution f oedema beneficial
What are the clinical features of pompholyx eczema?
Intensely itchy Distributed across palms and soles of feet Sudden onset of crops of vesicles More common <40 Resolution can include desquamation
What are the types of exogenous eczema?
Allergic contact dermatitis Irritant contact dermatitis Lichem simplex Photoallergic or photoaggravated eczema Asteatotic eczema Eczema herpeticum
What type of reaction is allergic contact dermatitis?
Type 4 hypersensitivity
How long can it take for allergic contact dermatitis to develop?
48-72 hours
What is the immune process of allergic contact dermatitis?
Antigen presenting cells take allergen to lymph nodes and present it to naive T cells
Clonal expansion of T cells released into bloodstream, causing mast cell degranulation, vasodilation and draws in neutrophils
What can cause irritant contact dermatitis?
Friction- microtrauma or cumulative
Environmental- cold, overexposure to water, chemicals
Who is irritant contact dermatitis often seen in?
Hairdressers, cleaners, NHS staff
What is the testing for contact dermatitis?
Patch testing
How is patch testing for irritant contact dermatitis done?
Potential allergens applied the Monday, removed on the Wednesday and skin erased on the friday
What are the clinical features of asteatotic eczema?
Very dry skin
Cracked, scaly appearance
Most commonly shins affected
What causes asteatotic dermatitis?
Heat
Excessive washing/soaps
What is eczema herpeticum?
Disseminated viral infection on top of poorly controlled eczema
What are the clinical features of eczema herpeticum?
Fever and often systemically unwell
Itchy clusters of blisters and erosions
Swollen lymph glands
What is the treatment of eczema?
Avoid causative and exacerbating factors Emollients Soap substitutes Intermittent topical steroids Sometimes antihistamines/antimicrobials Calcineuri n inhibitors
What topical steroids can be used to treat eczema?
Hydrocortisone
Betamethasone
What calcineurin inhibitors can be used in the treatment of eczema?
Topical pimecrolimus and tacrolimus
What is the treatment of severe eczema?
UV light
Immunosuppression
What immunosuppressants can be used to treat severe eczema?
Azathioprine
Ciclosporin
Methotrexate
