Eczema

Question 1

eczematous diseases

Answer 1

Atopic Dermatitis
Nummular Eczema
Dyshidrosis
Lichen Simplex Chronicus

Question 2

Atopic dermatitis

Answer 2

o An acute, subacute but usually chronic, pruritic inflammation of epidermis and dermis, often occurring in association with personal or family history of hay fever, asthma, allergies or atopic dermatitis
o Age: onset in first 2 mos of life and by first year in 60% of patients
 60% by age 1
 30% by age 5
 10% between 6-20 yrs
o Over 2/3 have personal or family history of atopy
o Commonly involves face, neck, arms, inner fold of elbows and knees, toes
o Pruritis is the hallmark: constant scratching leads to vicious cycle of itch-scratch-rash-itch
o Made worse by wool, detergents, soaps, change in room temperature, mental or physical stress

Question 3

Atopic dermatitis lesions

Answer 3

-erythema, papules, scaling, excoriations, crusting, lichenification
 Usually confluent and well-defined –> you can easily see where it starts and stops

Question 4

Atopic dermatitis labs

Answer 4

Increased IgE levels; culture and sensitivity for bacterial infection, herpes culture if indicated
 Culture and sensitivity if you’re concerned about MRSA

Question 5

Atopic dermatitis course

Answer 5

-spontaneous, complete remission during childhood is the rule, can persist into adolescence
 By the time that kids get into school, the rule is that if they haven’t resolved the atopic derm by the age of 6, it will never fully resolve –> these kids are much more likely to develop the rest of the triad
o About 50% of patients will develop asthma

Question 6

Atopic dermatitis treatment

Answer 6

o Treatment: patient education paramount –no rubbing or scratching, avoid soap or perfumed detergents, stress management
 PREVENTION IS KEY!! You want to avoid things that will cause a flare up –> NO PERFUMES, double rinse everything, don’t use dryer sheets
 Hydration of skin followed by emollient
• Lukewarm bath a few times a week; emollients daily to twice daily, after the bath, pat dry and then use vasoline or aquaphor
• Hot baths dry the skin so don’t do hot bath!
• Kids with exzema don’t need a bath every day
 Topical steroids for short-term use in exacerbations
• Low potency on the face, medium potency on the body
 Topical antipruritic agents (menthol, camphor) may help
 Oral antihistamines may help –> especially at bedtime so that they don’t scratch in their sleep
• Antihistamines can cause CNS depression and they will stop breathing
 Topical immune modulators 2nd line therapy: tacrolimus (Protopic), pimecrolimus (Elidel)
 Secondary infections treated with systemic antibiotics (Staph most likely)
• Because kids scratch and they have dirty fingernails
 Emerging evidence for dilute bleach baths (decrease skin bacteria and AD severity)

Question 7

OTC products for atopic dermatitis

Answer 7

o Ointments&raquo_space; creams&raquo_space; lotions

o Aveeno uses oatmeal so its soothing for the skin

Question 8

nummular (discoid eczema)

Answer 8

o Chronic, pruritic, inflammatory dermatitis occurring in the form of shaped plaques composed of grouped small plaques and vesicles on an erythematous base, especially on the lower legs in older males in winter.
o Age: 50-80 in males
 20-40 in females
o History: lesions last weeks, relapse and recur
o Pruritis is often intense
o Treatment: keep skin hydrated and lubricated
 Topical steroids for acute exacerbations
o You can always do a scraping and do a KOH prep and if you DON’T see spaghetti and meatballs, its probably eczema

Question 9

dyshidrotic eczema

Answer 9

o Age <40, M=F
o 50% pts have atopic background
o Eruptions follow stress or occur in hot humid weather
o Primarily on hands and feet
o Small vesicles in clusters to large bullae, intensely itchy; last several weeks then desquamate; Recurrent
o AKA acute palmoplantar eczema

Question 10

dyshidrosis tx

Answer 10

o Treatment is avoid triggers
o Topical steroids for acute stage, high potency
o Oral steroids for severe episode
o PUVA may be needed for chronic cases
o Think about scabies if you see vesicles between fingers

Question 11

lichen simplex chronicus (LSC)

Answer 11

o A circumscribed area of lichenification resulting from repeated physical trauma (rubbing and scratching) occurring especially in women on the nuchal areas, arms, legs, and ankles and in the anogenital regions of both sexes
o Age: >20 yrs; Women > men
o Race: possibly higher in Asians
o Lesions last weeks to months
o Skin symptoms: pruritis, often in paroxysms. Lichenified skin becomes like an erogenous zone
o Often areas on feet are rubbed at night with the heel; becomes reflexive and unconscious habit
o This is basically chronic eczema that we see in adults  when you scratch you release chemicals that make you itchy more and the cycle continues
o This is usually on ankles and feet whereas nummular eczema is more discoid  this is the difference.
o Solid plaque of lichenification, scaling usually minimal
o Brown or black hyperpigmentation
o Treatment: Difficult!!! Rubbing and scratching MUST be stopped
 Topical steroids, cover lesions
 Occlusive dressings are really helpful and using an ointment