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Dermatology > Eczema > Flashcards

Eczema Flashcards

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Dermatology Board Prep flashcards
1
Q

Describe the epidemiology of eczema

A
  • 24% children
  • 4% in western countries
  • 60% cleared by adulthood
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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

Wide range of external (exogenous) or internal (endogenous) factors can induce the condition

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3
Q

What is another name for eczema?

A

Atopic dermatitis

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4
Q

How is the prevalence of eczema changing?

A

Increased prevalence of atopic eczema

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5
Q

What is the clinical definition of atopic eczema?

A

An itchy skin condition in the last 12 months

Plus 3 of:
• Onset before 2yrs 
• History of flexural involvement 
• H. of generally dry skin 
• H. of other atopic disease
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6
Q

What is the pathogenesis of eczema?

A

Genetics:
• Atopic FH: atopic eczema, asthma, hay fever (allergic rhinitis), food allergy
• Filaggrin gene

  • Epidermal barrier dysfunction
  • Environmental factors
  • Immune system dysregulation - TH2 overactive causing inflammation and leukocyte increase
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7
Q

What are three pathologies on the skin?

A
  • Spongiosis (intercellular oedema) within the epidermis
  • Acanthosis (thickening of the epidermis)
  • Inflammation - superficial perivascular lymphohistiocytic infiltrate
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8
Q

Describe normal structure of skin layers

A
  • Epidermis - outermost layer of skin

* Dermis - contains blood vessels, lymph vessels, hair follicles and sweat glands

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9
Q

Describe the histology of acute dermatitis

A
  • Intercellular oedema within the epidermis
  • Accumulation of intra-epidermal vesicles
  • Infiltration of the epidermis with lymphocytes
  • Dermal changes include varying degrees of oedema and a superficial perivascular infiltrate with lymphocytes, histiocytes and occasional neutrophils and eosinophils.
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10
Q

Describe the histology of chronic spongiotic dermatitis

A
  • Spongiosis is mild
  • Epidermal acanthosis (thickening of epidermis) - psoriasis pattern with hyperkeratosis and hypergranulosis
  • Fibrosis of papillary dermis
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11
Q

What is spongiotic dermatitis?

A

Dermatitis that involves fluid buildup in your skin

Spongiosis is mainly intercellular oedema in the epidermis

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12
Q

What are the clinical features of eczema?

A

• ITCH

Acute changes:
• Pruititus, erythema, scale, papules, vesicles
• Exudate, crusting, excoriation

Chronic changes:
• Lichenification (thickened skin), plaques, fissuring (split or crack)

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13
Q

Describe the distribution of eczema

A
  • Flexure, neck, eyelids, face, hands and feet

* Tends to spare nappy area

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14
Q

What is excoriation?

A

Obsessive-compulsive disorder. It is characterised by repeated picking at one’s own skin which results in skin lesions.

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15
Q

Name other types of exogenous eczema

A
  • Contact dermatitis (irritant and allergic)
  • Lichen simplex
  • Photoallergic or photoaggravated
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16
Q

Name other types of endogenous eczema

A
  • Atopic
  • Discoid
  • Venous
  • Seborrhoeic
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17
Q

What is the pathogenesis of allergic contact dermatitis?

A
  1. Antigen presenting cells take hapten/allergen to LN and present to naive T cells
  2. Clonal expansion of these T cells, released into blood stream
  3. When these T cells next encounter hapten -> mast cell degranulation, vasodilatation and neutrophils
18
Q

What kind of reaction causes allergic contact dermatitis?

A
  • Type 4 hypersensitivity

* Delayed hypersensitivity (48-72hrs)

19
Q

What are the two ways the skin is injured by in Irritant Contact Dermatitis?

A
  1. Friction – micro-trauma, cumulative

2. Environmental factors

20
Q

What are the environmental factors which can cause irritant contact dermatitis?

A
  • Cold
  • Over-exposed to water
  • Chemicals; acids, alkalis, detergents and solvents
21
Q

What test can be used for allergic contact dermatitis?

A

Patch testing

22
Q

What are the principles of patch testing?

A
  • Potential allergens applied
  • Baseline/standard series – applied to all patients
  • Applied Monday, remove Wednesday and re-assess Friday as you’re looking for a delayed hypersensitivity reaction
23
Q

What are the clinical features of seborrhoeic dermatitis (infants)?

A
  • Distinctive pattern
  • Scalp, proximal flexures
  • < 6months age
  • Often clears within weeks of treatment
24
Q

What are the clinical features of seborrhoeic eczema (adults)?

A
  • Chronic dermatitis.
  • Malassezia yeast increased in the scaly epidermis of dandruff
  • Red, sharply marginated lesions covered with greasy looking scales.
  • Distinctive distribution – areas rich in supply of sebaceous glands (scalp, face, upper trunk)
25
Q

What do you treat seborrhoeic eczema?

A

Topical anti-yeast (ketoconazole)

If severe, consider HIV test

26
Q

What are the clinical features of discoid eczema?

A
  • Circular plaques of eczema.
  • Cause often unknown.
  • May develop at sites of trauma/irritation.
27
Q

What are the clinical features of pompholyx/vesiclar eczema?

A
  • Palms and soles
  • Intense itch
  • < 40yrs
  • Sudden onset of crops of vesicles
  • Resolution can include desquamation
28
Q

What are the clinical features of Asteatotic eczema?

A
  • Very dry skin
  • Cracked scaly appearance
  • Most commonly shins affected
  • Climate – heat
  • Excessive washing/soaps
29
Q

What are the clinical features of Venous eczema?

A
  • Stasis eczema or varicose eczema
  • Increased venous pressure
  • Oedema
  • Ankle and lower leg involved

Resolution of oedema can help – compression stockings.

30
Q

What are the clinical features of Venous eczema?

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.

31
Q

What is the treatment of eczema?

A
  • Patient education
  • Avoid Causative / exacerbating factors
  • Emollients (moisturisers)
  • Soap substitutes
  • Intermittent topical steroids
  • Sometime antihistamines or antimicrobials
  • Calcineurin Inhibitors (Pimecrolimus)
32
Q

What intermittent topical steroids can be used?

A

Different potency:
• Hydrocortisone (low)
• Betamethasone (potent)

33
Q

What is the treatment of severe eczema?

A

Ultraviolet light.

Immunosuppression:
• Azathioprine
• Ciclosporin
• Methotrexate
• Mycophenolate mofetil
34
Q

What is a possible side effect of prolonged steroid use?

A

Steroid induced striae (skin atrophy)

35
Q

What are the two key features of eczema?

A
  • Irritated skin

* Barrier dysfunction and inflammation

36
Q

What is the filaggrin protein?

A

Protein of the epidermis and is vital for skin cells to mature properly into the tough, flat corneocytes that form the outermost protective layer of our skin

37
Q

What does a mutation in the filaggrin gene increase risk of eczema?

A

Without filaggrin the outer protective layer does not form properly, the corneocytes dry out and the lipid layer is easily lost so that the skin becomes dry and cracked –> impaired barrier function

38
Q

What is the different between seborrhoeic dermatitis and seb. eczema?

A

Seb. eczema is chronic seb. dermatitis

39
Q

How was children with sea. dermatitis differ from those with seb. eczema?

A

Less itchy so child appears happier than with baby with eczema

40
Q

What is the function of Calcineurin Inhibitors?

A

Immunomodulating agents; this means that they act on the immune system to reduce skin inflammation

Dermatology (8 decks)

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