Eczema

Question 1

What is the atopic triad?

Answer 1

Atopic dermatitis
Asthma
Allergic rhinitis

Question 2

Outline the steroid potency ladder

Answer 2

Mild: Hydrocortisone 0.5-2.5%
Moderate: Betamethasone 0.025% (Betnovate)
Clobetasone 0.05% (Eumovate)
Potent: Fluticasone 0.05% (Cutivate)
Betamethasone 0.01% (Betnovate)
Very potent: Clobetasol 0.05% (Dermovate)

Question 3

What is the finger tip rule?

Answer 3

1 finger tip unit (0.5g) is sufficient to treat a skin area at least twice that of the palm of an adult hand

Question 4

What are the finger tip units for different areas of the body?

Answer 4

A hand and fingers: 1.0
A foot: 2.0
Front of chest and abdomen: 7.0
Back and buttocks: 7.0
Face and neck: 2.5
An entire arm and hand: 4.0
An entire and foot: 8.0

Question 5

What prognostic markers are associated with a worse outcome in eczema?

Answer 5

onset between 3-6m
severe disease in childhood
hx of asthma or hayfever
small family size
high serum IgE levels

Question 6

What is the management of eczema?

Answer 6

Emollients (ideally on moist skin, use as liberally as you can)
Topical steroids (usually 4-6w course is needed)
Tacrolimus if topical steroids fail
UV radiation
Immunosuppressants (ciclosporin, anti-histamines)

Question 7

What is eczema herpeticum and what is the treatment?

Answer 7

More common in children with atopic eczema
Severe primary infection of skin by HSV1 or 2

Should be admitted for IV aciclovir

Question 8

What is varicose eczema?

Answer 8

Also called venous or stasis eczema
Secondary to varicose veins, blood products get pushed towards the overlying skin where inflammation occurs
Red spots, scaling, weeping or crusting can be seen
Atrophie blanche may be seen
Lipodermatosclerosis can be seen

Question 9

What is the treatment of varicose eczema?

Answer 9

Weight loss, exercise, stop smoking
Raise legs, elevate foot over night
Bandaging if leg swelling is severe
Compression stockings once eczema is gone (CI in arterial disease)
Emollients

Question 10

How does pompholyx/dyshidrotic eczema present?

What are the differentials?

Answer 10

Causes small recurrent blisters to form across palms of hand and soles of feet

Pustular psoriasis, atopic dermatitis and scabies are the differentials

Question 11

How do you treat pompholyx/dyshidrotic eczema?

Answer 11

Soak hands and feet in cool water for 15m, followed by emollient
Topical steroids or phototherapy