Eczema Flashcards

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1
Q

What aspects of the skin does eczema affect?

A

•Commonly affects flexural areas.

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2
Q

To what demographic does eczema most commonly appear?

A

Most commonly appears in babies and children - by adult life 60% have cleared

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3
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 age of 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 years
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4
Q

What gene is associated with eczema?

A

Filaggrin gene

Atopic family history is also associated - atopic eczema, asthma, hay fever (allergic rhinitis), food allergy - overactive immune response to environmental factors

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5
Q

Describe the epidermal barrier in eczema?

A

Impaired

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6
Q

What are the pathological features of eczema?

A
  • Spongiosis (intercellular oedema) within the epidermis.
  • Acanthosis (thickening of the epidermis).
  • Inflammation - Superficial perivascular lymphohistiocytic infiltrate
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7
Q

What differences exist between acute and chronic eczema?

A

Acute:

Erythema

Oedema within the dermis

Intraepidermal vesicles and occasionally bullae

Infiltration of the epidermis with lymphocytes is common

Chronic: Less vesiculation and oedema

Lichenification: Skin thickening (epidermal acanthosis) with pronounced skin markings

Dyspigmentation: Hyper and hypopigmentation can occur

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8
Q

What are causes for acute flares of eczema?

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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9
Q

What are the clinical features of eczema?

A

•Itch, redness, scaling, papules, vesicles

Flexural - however it can involve all body sites (babies usually starts on the face)

Chronic changes - lichenification, plaques, fissuring

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10
Q

What are the exogenous forms of eczema?

A

Contact dermatitis: Irritant, allergic

Lichen simplex - chronic itching and scratching

Photoallergic or photoaggravted eczema

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11
Q

What are the endogenous causes of eczema?

A

Atopic

Discoid

Venous

Seborrhoeic dermatitis

Pompholyx

Juvenile plantar dermatitis

Asteatotic

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12
Q

What type of hypersensitivty is assocaited with allergic contact dermatits?

A

Type 4

Delayed hypersensitvity can take up to 48-72 hours

T cells are sensitised to environmental allergen - once activated stimulate mast cell degranulation, vasodilation and neutrophils

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13
Q

What injures the skin in irritant contact dermatitis?

A

Friction

Environmental factors:

  • Cold
  • Over exposure to water
  • Chemicals such as acids, alkalis, detergents and solvents
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14
Q

What are the relevant investigations for eczema?

A

Patch testing

Viral or bacterial swab for microscopy and culture to investigate for secondary infection

Scrapings to exlude fungal inections

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15
Q

Describe seborrhoeic eczema - Features in areas rich in supply of sebaceous glands (scalp, face, upper trunk

Erythomatous scaly rash

Associated with and may be due to overgrowth of pityrosporum yeasts

When severe it may resemble psoriasis

Severe or recalcitrant seborrhoeic eczema may be a marker of immunodeficiency including HIV infection

A
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16
Q

What can be a precursor of seborrhoeic eczema?

A

Dandruff - may gradually progress through redness, irritation and increased scaling

17
Q

How do you treat seborrhoeic eczema?

A

Topical anti-yeast - ketoconazole

18
Q

What is discoid eczema

A

Circular plaques of eczema

The cause is unknown

May develop at sites of trauma

Can be due to any chronic itching condition (primarily of the skin in the case of atopic eczema, or another system such as renal failure)

19
Q

What is pompholyx eczema?

A

Intensely itchy vesicles and bullae occur on the palms and soles

More common under 40 years

May have several causes, includes atopic eczema, irritant and contact allergic dermatitis

20
Q

What is asteatotic eczema?

A

Occurs in very dry skin

Most common site affected is the lower limbs

Cracked scaly appearance

21
Q

What are predisposing factors to asteatotic eczema?

A

Low humidity caused by central heating

Overwashing / soaps

Diuretics

Cholesterol lowering drugs

22
Q

What is venous eczema?

A

Eczema associated with signs of venous insufficiency: Oedema, loss of hair, increased venous pressure

Resolution of oedema can help - compression sockings

23
Q

What is herpes herpeticum?

A

Disseminated viral infection of herpes simplex

24
Q

What are clinical signs of eczema herpeticum?

A

Fever and often unwell

Itchy clusters of blisters and erosions

Swollen lymph glands

25
Q

What is the treatment for herpes herpeticum?

A

Antivirals

Consider secondary bacterial infection

26
Q

What is the treatment of eczema?

A
  • Patient education
  • Avoid Causative / exacerbating factors

•Emollients (moisturisers)

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

•Soap substitutes

•Intermittent topical steroids

  • Different potency
  • hydrocortisone (low)
  • Betamethasone (potent)

•Sometimes need antihistamines or antimicrobials

•Calcineurin Inhibitors

•Topical Pimecrolimus and Tacrolimus

•Ultraviolet light.

•Immunosuppression.

  • Azathioprine
  • Ciclosporin
  • Mycophenolate mofetil
  • Methotrexate

New agents:

  • Crisaborole
  • Topical PDE-4 inhibitor
  • FDA approved
  • Dupilumab
  • 1st biologic for eczema patients
  • IL-4/IL-13 inhibitor
  • Under EMA/FDA scrutiny