Eczema

Question 1

Forms of exogenous eczema

Answer 1

Irritant

Allergic contact

Question 2

Forms of endogenous eczema

Answer 2

Pompholyx

Venous stasis

Asteatotic

Sebborheic

Discoid

Atopic

Question 3

Demographics of atopic eczema

Answer 3

Children 2-6mo

Most grow out by 10 y

Positive FHx for atopic disease

PMHx asthma, hayfever (or v.v. atopic march)

Question 4

Distinction between eczema and psoriasis

Answer 4

Eczema is ill-defined, Psoriasis has demarcated plaques

Psoriasis extensor surfaces, eczema flexor

Psoriasis has silvery scales

Psoriasis may have arthritis assoc

Question 5

Genetic association of atopic eczema

Answer 5

Null mutation in fillagrin (not straightforward)

Question 6

Features of sebborheic dermatitis

Answer 6

Adult males

Affects eyebrows, lips, umbilicus, hair, ears

May be assoc with reactivity to pityrosporum yeasts

Question 7

Discoid eczema features

Answer 7

Multiple plaques

Crusted, vesicular, red - staph colonisation (gold)

Often limbs

Middle aged males

Question 8

Differential for discoid eczema

Answer 8

Tinea

Psoriasis

Bowen’s disease (non-itchy, singular, growing)

Question 9

Features of pompholyx

Answer 9

Blistering, esp on fingers/toes

Differential: tinea (scrape!), herpes simplex

Question 10

Features of stasis aka venous eczema

Answer 10

Associated with venous insufficiency

Rule out contact dermatitis to dressings

Assoc w/ varicose veins, leg ulcers, oedema, haemosiderin deposition

Question 11

Asteototic eczema

Answer 11

Affects elderly

Background of dry skin

Red, lacy fissures

Management w/ emollients

Question 12

Irritant vs allergic dermatitis

Answer 12

Allergic = delayed type IV hypersensitivity reaction, diagnosed with patch test

Irritant - from repeated contact to irritant (e.g. occupational exposure)

Question 13

Severity of eczema

Answer 13

Mild: infrequent itching

Moderate: Frequent itching, redness

Severe: incessant itching, redness, thickening, oozing/bleeding, widespread dryness

Question 14

Management of eczema

Answer 14

Emollients for everyone

1st line: topical corticosteroids

2nd line: calcineurin inhibs e.g. tacrolimus

Consider anti-fungal (yeast) for seb dermatitis

Consider topical abx (e.g. fluclox) if overt infx (usually S. aureus, discoid)

Question 15

Steroid use duration

Answer 15

Every day during flare ups, weekend treatment in remission

Question 16

Face and neck steroid recommendations

Answer 16

Mild potency

Moderate potency 3-5d course during flare-up

Question 17

Use of moderate-potent topical steroid preparations

Answer 17

7-14 days in vulnerable areas (e.g. axillae, groin) during flareups

Question 18

Presentation of eczema herpeticum

Answer 18

Widespread eruption as a complication of atopic eczema

Punched-out erosions

Clustered, crusted papules/blisters

Malaise, lethargy, distress

Caused by HSV and herpes zoster (50/50)

Question 19

Management of eczema herpeticum

Answer 19

Oral aciclovir - high-dose to cover zoster aswell

Consider ophtho r/v

Question 20

Complications of eczema herpeticum

Answer 20

Corneal ulceration

Herpes hepatitis, encephalitis

DIC

Question 21

Answer 21

Sebborheic dermatitis

Question 22

Answer 22

Asteatotic

Question 23

Answer 23

Discoid

Question 24

Answer 24

Pompholyx

Question 25

Differential for itchy eruption - systemic causes

Answer 25

Renal f(x)

Anaemia

LFTs - hyperbilirubinaemia, jaundice

Hyperthyroidism

Question 26

Derm differential for itchy eruption

Answer 26

Eczema

Lichen planus

Scabies

Urticaria

(psoriasis)

Question 27

Differential for itchy eruption - drugs

Answer 27

Morphine, opioids

ACEi

Digoxin

Statins

Chloroquine

Sulphonamides

Question 28

Management of discoid eczema

Answer 28

Topical steroids to discoid lesions

Emollients to everywhere

Question 29

Distinctive feature of HSV eczema herpeticum

Answer 29

Lymphadenopathy, not found in HZV

HZV - dermatomal, may present w/ hyperaesthesia before rash