Eczema Flashcards
Describe the clinical features of eczema?
Acute vs chronic phase?
- Itchy, erythematous and dry - usually ill defined borders
- As gets older localised to flexures (elbows, behind knees)
- Have elevated levels of circular IgE
- In the acute phase there may be vesicles or blisters which may weep or bleed.
- Chronically fissures and lichenification (skin thickenning) develop
What is the childhood prevalence of atopic eczema?
When does it present?
- 10-20% of children
- Usually presents before 2 years of age and the severity decreases with age.
- 50% grow out of by 2 and 80% by adolescence
Describe the aetiology of atopic eczema?
- Mutation of filaggrin gene causing a primary skin barrier defect in 50% severe cases
- Endogenous (internal cause)
- environment = important role (weather, food allergy and irritants)
Note commonly effects the face in young children and as they get older often moves to the flexor regions.
Which factors can commonly exacerbate atopic eczema?
- Irritants (soap, nylon sheets)
- Allergies
- Changes in weather
- Stress
- Illness
- Skin infection
Which group is sebhorraeic eczema most common in and what organism is it associated with?
What exacerbates it?
What can it be an early sign of?
- It is most common in middle aged adults.
- It is associated with the Malasezia Furfur yeast species and may be due to an immune reaction to these micro-organisms.
- It is exacerbated by alcohol.
- It is an endogenous form of eczema.
Severe in HIV patients - can be an early sign of aids
Standard Eczema Treatment and antifungals
How does discoid eczema present and in which age groups?
- Any age although most common middle aged men
- Disc like well demarkated lesions
- Often secondarily infected, and thought to potentially be a manifestation of atopic eczema
- It is an endogenous form of eczema
- scattered itchiy and round
- topical emolients and topical potent steroids
What is irritant contact eczema/dermatitis and who does it usually effect?
- Direct effect of irritant substances affecting the skin integrity usually the hands.
- varies from eythema to large bulae, oedema, dryness andf fiddureny
- It is a type 4 immune response.
- It usually effects the following occupations:
- Hairdressers
- Chefs
- Cleaners
- Housewives
- Nurses
- This is an exogenous form of eczema.
- allergen avoidance, emmolients and topical steroids
List some common irritants in allergic contact dermatitis?
How is diagnosis confirmed?
- Nickle in jewlerry and belt buckles
- Hair Dye
- Plants
- Topical meds
- Frangrances
- Occupation
Diagnosis is confirmed by patch testing.
Describe the management of eczema?
General measures:
- Avoid irritants/exacerbating factors
1st line measures:
- Treat dry skin - emollients (ointments best)
- Treat active eczema - topical steroids (choose weakest one that works), treat in bursts of 1-2X/day to allow periods of steroid free time
2nd line measures:
- Topical immunomodulators (tacrolimus, cyclosporin & pimecrolimus) - calcineurin inhibitors . .no skin thinning
- Occlusive bandaging (tar, zinc paste & wet wraps)- not if infected
- Systemic treatments:
- UV light
- Oral steroids (presnisolone)
- Oral abx if infected (ciclosporins - flucloxacillin/erythromycin)
- Anti-histamines
- Oral immunosupression
What are the different strengths of steroid?
Mild: Hydrocortisone 1%
Moderate: Clobetasone (Eumovate)
Potent: Betamethasone (Elocon, Betnovate)
Very Potent: Clobetasol (Dermovate)
(HEMD)
Ointments should be used preferntially to creams and she be applied 1-2 time a day in short courses.
What are the risks of applying potent steroids long term on the face?
- Telangeictasia and striae
- Hirsuitism
- Perio-orbital dermatitis
- Glaucoma and cataracts
- Skin (dermis) thinning
- Bruising (from thinning & vessel wall fragility)
- Rebound effect (worse SEs when removed)
What are the second line treatment options?
- Immunomodulators
- ciclosporins . . . monitor renal function and BP
- azathioprine - measure TPMT - risks of malignancy and photosensitivity
- methotrexate . .. with folate supplement
- Biologics - Dupilumab (IL4/3 blocker
- banddaging and wet wraps
- Photodynamic therapy - alongside the emolients and topical steroids
- Oral steroids
What type of eczema is shown?
Discoid eczema
What type of eczema is shown?
Atopic eczema
Often on face in young children and flexure regions as the child gets older
What type of eczema is shown?
Severe eczema + secondary infection
What type of eczema is shown?
Irritant contact dermatitis
What type of eczema is shown?
Seborrhaeic Eczema
Most commonly seen in middle aged adults on the face
What type of eczema is shown?
Irritant contact dermatitis
Most commonly effects the hands
What type of eczema is shown?
Pompholytic eczema also known as dyshydrotic eczema
It is an eczema of unknown aeitiology and involves the development of intensely itchy watery blisters, mostly affecting the sides of the fingers, the palms of the hands and the soles of feet.
young adults
topical emollients and steroids + wet dressing s to dry blisters
- Venous/varicous eczema
- lower legs
- middle aged to elderly
- patches or widespread
- topical/moderate steroids and emolients
- compression may be helpful
Asteatotic eczema
- elderly when skin fat content decreases
- crazy paving when skin drys out
- topical steroids and long term emollients
