eczema

Question 1

how common is eczema in children?

Answer 1

24% of children are diagnosed with eczema at some point in their childhood

Question 2

is the prevelance of eczema rising or declining?

Answer 2

rising

Question 3

what is eczema?

Answer 3

inflammatory skin condition

also known as atopic dermatitis

irritated skin

barrier dysfunction and inflammation

Question 4

where does eczema commonly affect?

Answer 4

flexural areas

Question 5

what is the definition of atopic eczema?

Answer 5

An itchy skin condition in the last 12 months

Plus 3 of the following:
Onset before age 2
History of flexural involvement
History of generally dry skin
History of other atopic disease 
History in 1st degree relative if under 4 yrs

Question 6

what are the risk factors for eczema?

Answer 6

genetics- many genes implicated
key role for filaggrin gene

epidermal barrie dysfunction

environmental factors

immune system dysregulation

Question 7

what is the pathology of eczema?

Answer 7

Spongiosis (intercellular oedema) within the epidermis.
Acanthosis (thickening of the epidermis).
Inflammation - Superficial perivascular lymphohistiocytic infiltrate.

Question 8

what are the contents of the dermis?

Answer 8

contains blood vessels, lymph vessels, hair follicles and sweat glands..

Question 9

what are the histological changes in acute dermatitis?

Answer 9

Intercellular oedema within the epidermis

Can lead to accumulation of intra-epidermal vesicles

Infiltration of the epidermis with lymphocytes is common

Dermal changes include varying degrees of oedema and a superficial perivascular infiltrate with lymphocytes, histiocytes and occasional neutrophils and eosinophils.

Question 10

what are the histological changes in chronic dermatitis?

Answer 10

the degree of spongiosis is often mild and difficult to appreciate. Vesiculation is uncommon.

There is significant epidermal acanthosis (thickening of epidermis), which may show a psoriasiform pattern with hyperkeratosis, hypergranulosis and miminal parakeratosis. Fibrosis of the papillary dermis may be present.

Question 11

what are clinical features of eczema?

Answer 11

itch

distribution- flexures, neck, eyelids, face, hands and feet

acute changes- pruritus, erythema, scale papules, vesicles

chronic changes- Lichenification, Plaques, Fissuring

Question 12

what are other types of eczema?

Answer 12

exogenous-
contact dermatitis
lichen simplex
photoallergic or photo aggravated eczema

endogenous-
Atopic
Discoid
Venous
Seborrhoeic dermatitis
Pompholyx
Juvenile plantar dermatitis
Asteatotic

Question 13

what is allergic contact dermatitis?

Answer 13

type 4 hypersensitivity

delayed hypersensitivity

Question 14

what is the pathogenesis of allergic contact dermatitis?

Answer 14

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

Question 15

how is the skin injured in irritant contact dermatitis?

Answer 15

friction

environmental factors- cold, over exposure to water

Question 16

what occupations are likely to get irritant contact dermatitis?

Answer 16

Hairdressers
NHS staff
Cleaners
Dermatitis – under a ring on finger – soaps can accumulate –irritant
Nappy rash

Question 17

when are infants likely to present with seborrhoea dermatitis?

Answer 17

<6months age usually

Question 18

what is seborrhoeic eczema classed as in adults?

Answer 18

chronic dermatitis

Question 19

what is increased in the scaly epidermis of dandruff and seborrhehoic dermatitis?

Answer 19

Malassezia yeast

Question 20

what are the symptoms of seborrhoeic eczema?

Answer 20

Red, sharply marginated lesions covered with greasy looking scales.

Distinctive distribution – areas rich in supply of sebaceous glands (scalp, face, upper trunk).

Question 21

what is a precursor for seborrhoeic eczema?

Answer 21

dandruff

Question 22

how do you treat seborrhoeic eczema?

Answer 22

Treat with topical anti-yeast (ketoconazole).

Question 23

what are the symptoms of discoid eczema?

Answer 23

Circular plaques of eczema.

Question 24

where is pompholyx/vesicular eczema likely to present?

Answer 24

palms and soles

Question 25

what are the symptoms of asteatotic eczema?

Answer 25

Very dry skin.

Cracked scaly appearance.

Question 26

how is asteatotic eczema caused?

Answer 26

Climate – heat

Excessive washing/soaps

Question 27

what causes venous eczema?

Answer 27

increased venous pressure

Question 28

what are the symptoms of venous eczema?

Answer 28

increased venous pressure

oedema

Question 29

what is eczema herpeticum?

Answer 29

Disseminated viral infection

Question 30

what are symptoms and signs of eczema herpeticum?

Answer 30

Fever and often unwell
Itchy clusters of blisters and erosions
Herpes Simplex 1 and 2
Swollen lymph glands

Question 31

what are the treatments of eczema?

Answer 31

Patient education
Avoid Causative / exacerbating factors

Emollients (moisturisers)
Ointment – greasy but effective
Creams – lighter 
Lotions – more watery
Soap substitutes

Intermittent topical steroids
Different potency
hydrocortisone (low)
Betamethasone (potent)

Sometimes need antihistamines or antimicrobials

Calcineurin Inhibitors
Topical Pimecrolimus and Tacrolimus

Question 32

what are the treatments of severe eczema?

Answer 32

Ultraviolet light.

Immunosuppression.
Azathioprine
Ciclosporin
Mycophenolate mofetil
Methotrexate