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Year 2 - Dermatology > Eczema > Flashcards

Eczema Flashcards

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Dermatology Board Prep flashcards
1
Q

Atopic dermatitis aka

A

atopic eczema

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2
Q

Eczema patients often have a personal or family history of other atopic diseases such as (2)

A

asthma or allergic rhinitis (hay fever)

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3
Q

Eczema typically affects what areas

  • in infants (4)
  • in children (4)
A

Infants typically show involvement of the cheeks, forehead, scalp, and extensor surfaces

Skin flexures

  • popliteal fossa
  • antecubital fossa
  • wrists
  • ankles
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4
Q

2 key pathogenic factors of the development of eczema

A

Epidermal barrier dysfunction
+
Immune dysregulation following allergen exposure –> INFLAMMATION

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5
Q

How does mutation of the filaggrin gene contribute to eczema

A

Loss-of-function mutation in the structural protein filaggrin predisposes to a less effective mechanical barrier against the environment –> INCREASED SENSITISATION to cutaneous antigens

also causes lower lower levels of natural moisturising factor in stratum corneum –> DRY SKIN

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6
Q

Pathological (histological) findings in atopic dermatitis (atopic eczema) (3)

A

Spongiosis (intercellular oedema in the epidermis) - manifests as intra-epidermal vesicles

Acanthosis (thickening of epidermis)

Inflammation - lymphocytic infiltrate

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7
Q

Acute v chronic eczema

A

Acute eczema is used to describe a flare-up of symptoms, e.g. sudden onset of lots of vesicles, swelling and oedema

Chronic is used to describe the condition when the patient develops signs of chronic inflammation (e.g., lichenification)

  • spongiosis is mild (little intra-epidermal vesicles)
  • LOTS of acanthosis
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8
Q

Chronic eczema typically affects what areas

A

neck, upper back, and arms, as well as the hands and feet.

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9
Q

Typical clinical features of eczema (2)

A

Pruritus

Xerosis (dry skin)

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10
Q

Clinical features of acute eczema (5)

A
  • erythema
  • scaling
  • papules
  • vesicles
  • crusting
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11
Q

Clinical features of chronic eczema (3)

A

lichenification (thickened and leathery skin, often resulting from continuously rubbing/scratching the skin)

plaques

hypopigmentation

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12
Q

Name some exogenous/external types of eczema

A

Contact dermatitis (irritant or allergic)

Lichen simplex

Photoallergic eczema

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13
Q

Name some endogenous/internal types of eczema apart from atopic eczema

A 
Discoid eczema
Venous eczema
Seborrhoiec dermatitis/eczema
Pompholyx eczema
Asteatotic eczema
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14
Q

Allergic contact dermatitis (a type of contact dermatitis) is what type hypersensitivity reaction

A

Type 4 - delayed hypersensitivity

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15
Q

Describe how the type 4 hypersensitivity reaction works in allergic contact dermatitis, e.g. reaction to metal in necklace

A

Antigen presenting cells take hapten/ allergen to LN and present to naive T cells

Clonal expansion of these T cells, released into blood stream

When these T cells next encounter hapten –> mast cell degranulation, vasodilatation and neutrophils

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16
Q

Irritant contact dermatitis (a type of contact dermatitis) is when the skin is injured by what 2 factors

A

Friction - e.g. microtrauma

Environmental factors

  • cold
  • chemicals, e.g. acid, detergents
17
Q

Investigation of allergic contact dermatitis

A

Patch testing - looking for delayed hypersensitivity reaction

18
Q

Seborrhoeic dermatitis in infants manifests as what

A

aka CRADLE CAP in babies

  • rough scaly greasy patches on the scalp usually
  • and also maybe scaling on forehead/eyebrows
19
Q

Seborrhoiec dermatitis in adults is different from infants as it usually goes away itself in infants, what is it defined as in adults

A

Chronic dermatitis characterised by erythematous and greasy scaly patches

20
Q

Seborrheic dermatitis is associated with proliferation of what fungus + what does this cause

A

malassezia furfur

21
Q

Clinical features of seborrhoeic dermatitis (4)

A

Red, sharply marginated lesions covered with greasy looking scales

  • on the scalp
  • on the nose
  • on the nasolabial folds
  • behind ear

Itchy scalp

White flakes in hair

22
Q

Treatment of seborrhoeic dermatitis

  • in infants (cradle cap) (1)
  • in children/adults if only scalp affected (1)
  • in children/adults if non-scalp areas affected (2)
A

Infants
-emollient

Scalp affected
-medicated shampoo (anti fungal - ketoconazole)

Non-scalp affected
-topical corticosteroids or anti fungal

23
Q

Explosive often generalised onset of SD may be a marker of what infection

A

HIV

24
Q

Characteristic clinical feature of discoid eczema

A

Distinctive circular or oval patches of itchy, reddened, swollen and cracked skin

Initially, these patches are often swollen, blistered (covered with vesicles)

Over time, the patches may become dry, crusty, cracked and flaky

25
Q

Clinical features of pompholyx eczema + duration

A

Starts as intense itching and burning of the palms (and sometimes the soles of the feet) then erupt into tiny itchy vesicles

persist for 2 to 3 weeks and return at variable intervals

26
Q

Asteatotic eczema is characterised by what clinical features + where is it most commonly found

A

pruritic, dry, cracked, and fissured skin with a ‘crazy pavement’ pattern.

most commonly on the shin

27
Q

Asteatotic typically affects the elderly and is precipitated by what factors

A

Excessive washing/scrubbing
Low humidity/very cold weather
Decrease in oils in the skin

28
Q

What is venous/stasis/varicose eczema (an internal type of eczema)

A

Eczema of the lower legs usually due to increased pressure in the legs veins (varicose veins) –> fluid can leak out to surrounding tissue and it’s thought that varicose eczema may develop as a result of the immune system reacting to this fluid

29
Q

Clinical features of venous/stasis/varicose eczema (an external type of eczema

A

Dry, erythematous itchy scaly skin
Oedema - swollen legs
Varicose veins

30
Q

Topical treatment of eczema (4)

A

Emollients - ointment/cream/lotion

Soap substitutes

Topical corticosteroids

Topical calcineurin inhibitor - pimecrolimus

31
Q

Systemic treatment of eczema (i.e. not topical)

A

Antihistamines - for persistent pruritus but not that helpful in eczema

Oral antibiotics - if evidence of infection

UV therapy - anti-inflammatory

Immunosuppressants - ciclosporin

32
Q

UV light therapy and immunosuppressants are used for SEVERE ECZEMA under what circumstances

A

UV light therapy if resistant to high potency topical steroids

Immunosuppressants if resistant to topical steroids and UV light therapy

33
Q

Topical corticosteroids used in eczema can be low potency or high potency - name these steroids

A

Low potency - hydrocortisone

High potency - betamethasone

Year 2 - Dermatology (10 decks)

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