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Eczema Flashcards

1
Q

Another name for eczema

A

Atopic dermatitis

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2
Q

What kind of condition is eczema?

A

An inflammatory skin condition

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3
Q

Where does eczema commonly effect?

A

Flexural areas

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4
Q

Definition of atopic eczema (criteria)

A

An itchy skin condition in the last 12 months PLUS 3 of the following

  • onset before age 2
  • history of flexural involvement
  • history of general dry skin
  • history of other atopic disease
  • history in 1st degree relative if under 4 years
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5
Q

What is asked about in an atopic family history?

A

Atopic eczema
Asthma
Hay fever (allergic rhinitis)
Food allergy

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6
Q

Pathology of eczema

A

Spongiosis (intracellular oedema) within the epidermis
Acanthosis (thickening of the epidermis)
Inflammation - superficial perivascular lymphohistiocytic infiltrate
Accumulation of intra epidermal vesicles

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7
Q

Pathology of chronic spongiotic dermatitis

A

Vesiculation uncommon
Significant epidermal acanthosis - which may show psoriasiform pattern with hyperkeratosis, hypergranulosis and minimal parakeratosis
Fibrosis of papillary dermis may be present

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8
Q

What is epidermal acanthosis?

A

Thickening of epidermis

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9
Q

Presentation of eczema

A 
ITCHY
Erythema
Scale
Papules
Vesicles 
Exudate
Crusting
Excoriation
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10
Q

Distribution of eczema

A 
Flexures
Neck 
Eyelids
Face
Hands 
Feet
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11
Q

Where does eczema tend to spare?

A

Nappy area

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12
Q

Chronic changes of eczema

A

Lichenification
Plaques
Fissuring

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13
Q

Types of eczema

A 
Chronic 
Atopic 
Contact dermatitis
Lichen simplex
Photoallergic or photoaggravated eczema 
Discoid 
Venous
Serborrhoeic dermatitis 
Pompholyx 
Juvenile plantar dermatitis 
Asteatotic
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14
Q

Pathology of allergic contact dermatitis

A

Type 4 hypersensitivity
Delayed hypersensitivity
Antigen presenting cells take hapten / allergen to LN and present to naïve T cells
Clonal expansion of these T cells, released into blood stream
When these T cells next encounter hapten
Mast cell degranulation, vasodilation and neurophils

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15
Q

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

A

48 - 72 hours

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16
Q

What is irritant contact dermatitis?

A

A form of contact dermatitis, in which the skin is injured by friction and environmental factors

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17
Q

How is skin injured in irritant contact dermatitis?

A 
Friction 
- micro trauma 
- cumulative 
Environmental factors
- cold
- over exposure to water
- chemicals such as acids, alkalis, detergents and solvents
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18
Q

What occupations tend to get irritant contact dermatitis?

A

Hairdressers
NHS staff
Cleaners

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19
Q

Who gets seborrheic eczema?

A

Infants < 6 months

Adults with chronic dermatitis

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20
Q

Where does seborrheic dermatitis affect in infants?

A

Scalp

Proximal flexures

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21
Q

Where does seborrhoeic dermatitis affect in adults?

A

Malasseia yeast increased in the scaly epidermis of dandruff and seborrheic dermatitis
Affects areas rich in supply of sebaceous glands
- scalp
- face
- upper trunk

22
Q

Presentation of seborrheic dermatitis in adults

A

Red, sharpley marginated lesions covered with greasy looking scales

23
Q

What can be a precursor for seborrheic eczema?

24
Q

Progression from dandruff to seborrhoiec eczema

A

Redness
Irritation
Increased scaling

25
Treatment of seborrheoic eczema in adults that started with dandruff
Topical anti yeast (ketoconazole)
26
If have severe seborrheic eczema, what test should be done?
HIV test
27
What is discoid eczema?
Circular plaques of eczema
28
Where may discoid eczema develop?
Sites of trauma | Irritation
29
Where do you get pompholyx/vesicular eczema?
Palms and soles
30
Who is pompholyx/vesicular eczema common in?
< 40 y/o
31
Presentation of pompholyx/vesicular eczema
Sudden onset of crops of vesicles | Intensley itchy
32
What can resolution of pompholyx/vesicular eczema include?
Desquamation
33
Features of asteatotic eczema
Very dry skin | Cracked scaley appearance
34
What is most commonly affected in asteatotic eczema?
Shins
35
Causes of asteatotic eczema
Hot climate | Excessive washing / soaps
36
Pathology of venous eczema
Stasis eczema or varicose eczema Increased venous pressure Oedema
37
What areas are involved in venous eczema?
Ankle | Lower leg
38
What can help to treat venous eczema?
Resolution of oedema | - compression stockings
39
What is eczema herpeticum?
Disseminated viral infection with poorly controlled eczema
40
Presentation of eczema herpeticum
Itchy clusters of blisters and erosions Fever Often unwell Swollen lymph glands
41
Causes of eczema herpeticum
Herpes simplex 1 and 2
42
Treatment of eczema herpeticum
Admission Anitvirals Consider secondary bacterial infection
43
Treatment of eczema
``` Avoid causative/exacerbating factors Emoillients (moisturisors) Soap substitutes Intermittent topical steroids - hydrocortisone - betamethasone Antihistamines or antimicrobials Calcineurin inhibitors - topical pimecrolimus - tacrolimus ```
44
Treatment of severe eczema
``` UV light Immunosuppression - azathioprine - ciclosporin - methotrexate - mycophenolate mofetil ```
45
Two main types of contact dermatitis
Irritant contact dermatitis | Allergic contact dermatitis
46
What is irritant contact dermatitis due to?
Weak acids or alkalis (e.g. detergents)
47
Is irritant contact dermatitis common?
Yes
48
Is irritant contact dermatitis an allergic reaction?
No
49
Where is contact dermatitis often seen?
Hands
50
Pathology of allergic contact dermatitis
Type IV hypersensitivity reaction
51
Name a common cause of contact dermatitis
Cement

Dermatology (11 decks)

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