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*Dermatology > Eczema > Flashcards

Eczema Flashcards

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Dermatology Board Prep flashcards
1
Q

What is another name for eczema?

A

Atopic dermatitis

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2
Q

Where on the body does eczema commonly affect?

A

Flexural areas

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3
Q

What demographic is most commonly affected by eczema?

A

Babies and children

by adult life 60% have cleared

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4
Q

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?

A
  • 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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5
Q

What are the 3 components of pathogenesis of eczema?

A

Genetics
Epidermal barrier dysfunction
Environmental factors

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6
Q

What is the key gene causing eczema?

A

Filaggrin

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7
Q

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

A

Epidermis
Dermis
Hypodermis

Sebaceous glands
Hair follicles
Blood vessels

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8
Q

3 key terms for pathology of eczema?

A

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

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9
Q

What is the main clinical feature of eczema?

A

Itch !

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10
Q

Describe the common distribution of eczema

A

Flexures, neck, eyelids, face, hands, feet

Tends to spare nappy area

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11
Q

Describe acute changes that can be found in eczema

A

Pruritis, erythema, scale, papules, vesicles

Exudate, crusting, excoriation

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12
Q

Describe chronic changes that can be found in eczema

A

Lichenification
Plaques
Fissuring

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13
Q

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

A

Atopic eczema
Asthma
Hay fever (allergic rhinitis)
Food allergy

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14
Q

What are the exogenous types of eczema?

A

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

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15
Q

What are the endogenous types of eczema?

A 
Atopic
Discoid
Venous 
Seborrhoeic dermatitis 
Pompholyx
Juvenile plantar dermatitis 
Asteatotic
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16
Q

What type of hypersensitivity is allergic contact dermatitis?

A

Type 4

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17
Q

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

A

48-2 hrs

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18
Q

Describe the action of T cells in AC dermatitis?

A

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

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19
Q

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

A

1) friction (micro-trauma, cumulative)

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

20
Q

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

A

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

21
Q

What is applied to the skin in patch testing?

A

Potential allergens

Baseline/standard series applied to all patients

22
Q

What is the timeline for patch testing?

A

Applied Mon
Remove Wed
Re-assess Fri

23
Q

What is the predilection for infant seborrhoeic dermatitis?

A

Sclap, proximal features

24
Q

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

A

<6 months

Often clears within weeks of treatment

25
Q

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

A

Malessezia yeast

26
Q

What is the appearance of adult seborrhoeic eczema?

A

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

27
Q

What can be a pre-cursor for seborrhoeic eczema?

A

Dandruff

28
Q

How is seborrhoeic eczema treated?

A

Topical anti-yeast (ketoconazole)

29
Q

What test should be considered if SE is severe?

A

HIV test

30
Q

What is the appearance of discoid eczema?

A

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

31
Q

What is often needed to manage discoid eczema?

A

Strong steroids

32
Q

Where does pompholyx/vesicular eczema usually affect?

A

Palms and soles

Intensely itchy

33
Q

What is the usual onset of pompholyx/vesicular eczema?

A

<40 yrs

Sudden onset of crops of vesicles

34
Q

What can resolution of pompholyx/vesicular eczema include?

A

Desquamation

35
Q

What is the appearance of asteatotic eczema?

A

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

36
Q

What is venous eczema caused by?

A

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

37
Q

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

A

Ankle/lower leg - oedema

38
Q

What can help in venous eczema?

A

Resolution of oedema - compression stockings

39
Q

What is eczema herpeticum?

A

Disseminated viral infection

Herpes Simplex 1 and 2

40
Q

What are the common clinical features associated with eczema herpeticum?

A

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

41
Q

What is to be considered in eczema herpeticum?

A

Admission !
Antivirals
Possible econdary bacterial infection

42
Q

What is the treatment plan for eczema?

A
  • Patient education
  • Avoid causative/exacerbating factors
  • Emollients (moisturisers) (ointments, creams, lotions)
  • Soap substitutes
  • Intermittent topical steroids (in exam prob)
  • Sometimes antihistamines/antimicrobials
  • Calcineurin inhibitors
43
Q

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

A

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

44
Q

What calcineurin inhibitors are used in eczema?

A

Topical pimecrolimus and tacrolimus

45
Q

2 treatments for severe eczema?

A

UV light

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

46
Q

What can result from steroid use in eczema?

A

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

47
Q

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

A

Crisaborole (topical PDE-4 inhibitor)

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

*Dermatology (11 decks)

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