Eczema Flashcards by Sophia Boyce

What is another name for eczema?

Atopic dermatitis

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Where on the body does eczema commonly affect?

Flexural areas

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What demographic is most commonly affected by eczema?

Babies and children

by adult life 60% have cleared

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The main diagnostic criteria is ‘an itchy skin conditions in the last 12 months’; what are the other criteria of which there should be 3 to diagnose eczema?

Onset before age 2
History of flexural involvement
History of generally dry skin
History of other atopic disease (or history in 1st degree relative if under 4)

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What are the 3 components of pathogenesis of eczema?

Genetics
Epidermal barrier dysfunction
Environmental factors

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What is the key gene causing eczema?

Filaggrin

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What r the layers of skin again? And what is found there?

Epidermis
Dermis
Hypodermis

Sebaceous glands
Hair follicles
Blood vessels

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3 key terms for pathology of eczema?

SPONGIOSIS (intercellular oedema)
ACANTHOSIS (thickening of the epidermis)
INFLAMMATION (superficial perivascular lymphohistiocytic infiltrate)

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What is the main clinical feature of eczema?

Itch !

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Describe the common distribution of eczema

Flexures, neck, eyelids, face, hands, feet

Tends to spare nappy area

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Describe acute changes that can be found in eczema

Pruritis, erythema, scale, papules, vesicles

Exudate, crusting, excoriation

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Describe chronic changes that can be found in eczema

Lichenification
Plaques
Fissuring

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Atopic family history is also associated with eczema e.g.

Atopic eczema
Asthma
Hay fever (allergic rhinitis)
Food allergy

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What are the exogenous types of eczema?

Contact dermatitis (irritant or allergic)
Lichen simplex
Photoallergic or photoaggravated eczema

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What are the endogenous types of eczema?

Atopic
Discoid
Venous 
Seborrhoeic dermatitis 
Pompholyx
Juvenile plantar dermatitis 
Asteatotic

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What type of hypersensitivity is allergic contact dermatitis?

Type 4

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How long can it take to develop a reaction in allergic contact dermatitis?

48-2 hrs

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Describe the action of T cells in AC dermatitis?

They are sensitised to an antigen and when they encounter it initiate mast cell degranulation, vasodilatation and neutrophil stimulation

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What 2 things can the skin be injured by in irritant contact dermatitis?

1) friction (micro-trauma, cumulative)

2) environmental factors (cold, over-exposure to water, chemicals such as acids, alkalis, detergents and solvents)

What people can be more commonly affected by irritant contact dermatitis?

Hairdressers
NHS staff
Cleaners (soap can accumulate e.g. under ring)
Babies - nappy rash

What is applied to the skin in patch testing?

Potential allergens

Baseline/standard series applied to all patients

What is the timeline for patch testing?

Applied Mon
Remove Wed
Re-assess Fri

What is the predilection for infant seborrhoeic dermatitis?

Sclap, proximal features

What is the usual age of infant seborrhoeic dermatitis and how quickly does it clear up?

<6 months

Often clears within weeks of treatment

What fungus is increased in the scaly epidermis of dandruff in adult seborrhoeic eczema?

Malessezia yeast

What is the appearance of adult seborrhoeic eczema?

Red, sharply marginated lesions covered with greasy looking scales Found in areas rich in supply of sebaceous glands (scalp, face, upper trunk)

What can be a pre-cursor for seborrhoeic eczema?

Dandruff

How is seborrhoeic eczema treated?

Topical anti-yeast (ketoconazole)

What test should be considered if SE is severe?

HIV test

What is the appearance of discoid eczema?

Circular plaques; may develop at sites of trauma/irritation (cause often unknown)

What is often needed to manage discoid eczema?

Strong steroids

Where does pompholyx/vesicular eczema usually affect?

Palms and soles | Intensely itchy

What is the usual onset of pompholyx/vesicular eczema?

<40 yrs | Sudden onset of crops of vesicles

What can resolution of pompholyx/vesicular eczema include?

Desquamation

What is the appearance of asteatotic eczema?

V dry skin; cracked, scaly appearance; commonly affects shins (from heat or excessive washing etc)

What is venous eczema caused by?

Increased venous pressure ('stasis' or 'varicose' eczema); blood leaks out and causes inflammation

What part of the body is usually involved? What pathology is associated?

Ankle/lower leg - oedema

What can help in venous eczema?

Resolution of oedema - compression stockings

What is eczema herpeticum?

Disseminated viral infection | Herpes Simplex 1 and 2

What are the common clinical features associated with eczema herpeticum?

Fever/unwell Itchy clusters of blisters and erosions - monomorphic pattern of vesicles which coalesce and crust Swollen lymph glands

What is to be considered in eczema herpeticum?

Admission ! Antivirals Possible econdary bacterial infection

What is the treatment plan for eczema?

- Patient education - Avoid causative/exacerbating factors - Emollients (moisturisers) (ointments, creams, lotions) - Soap substitutes - Intermittent topical steroids (in exam prob) - Sometimes antihistamines/antimicrobials - Calcineurin inhibitors

What are the low v potent topical steroids used to treat eczema?

Hydrocortisone (low) Betamethasone (potent) (but irl would look up in BNF)

What calcineurin inhibitors are used in eczema?

Topical pimecrolimus and tacrolimus

2 treatments for severe eczema?

UV light | Immunosuppression (azathiorprine, cyclosporin, methotrexate, mycophenolate mofetil) - not common

What can result from steroid use in eczema?

Striae - common in areas of thinner skin like axilla - use on back etc is fine

(prob not important) Looking forward what could be 2 treatments for eczema?

Crisaborole (topical PDE-4 inhibitor) | Dupilumab (1st biologic for eczema patients; IL-4/IL-13 inhibitor)