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2ND YEAR SYSTEMS: Dermatology > Eczema > Flashcards

Eczema Flashcards

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Dermatology Board Prep flashcards
1
Q

What is eczema ?

A

Also known as atopic dermatitis

inflammatory skin condition

Commonly affects flexural areas

Multiple types and a spectrum of severity

Wide range of external and internal causes

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2
Q

Which 3 factors are associated with Eczema?

A

Genetics - affects skin’s barrier function.

Immunology

Environment - temperature, central heating

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3
Q

Definition of atopic eczema

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 generally dry skin
  • History of other atopic disease or History in 1st degree relative if under 4 yrs (asthma, hayfever, atopic eczema)
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4
Q

What is Spongiosis?

A

Swelling between cells

within the epidermis

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5
Q

More general definition of eczema

A

Barrier dysfunction and inflammation

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6
Q

Which gene is key in eczema?

A

Filaggrin gene

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7
Q

What is Acanthosis?

A

Thickening of the epidermal layer

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8
Q

Pathology of acute dermatitis

A

Spongiosis around cells - cells are pushed apart by swelling.

Can lead to accumulation of intra-epidermal vesicles

Infiltration of the epidermis with lymphocytes is common

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9
Q

Pathology of chronic dermatitis

A

The degree of spongiosis is often mild and difficult to appreciate.

Vesiculation is uncommon. There is significant epidermal acanthosis (thickening of epidermis)

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10
Q

Clinical features of eczema

A

Itch
Distribution - flexures, neck, eyelids, face, hands + feet

Acute - Pruritus, Erythema, Scale, Papules, Vesicles
Exudate, crusting, excoriation

Chronic - Lichenification, Plaques, Fissuring

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11
Q

What is a very unlikely cause of atopic eczema in children?

A

Allergy

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12
Q

What are some exogenous types of eczema (3)

A

Contact dermatitis -Irritant or Allergic

Lichen simplex - response to the skin being repeatedly scratched or rubbed over a long period of time

Photoallergic or photoaggravated eczema

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13
Q

What are some endogenous types of eczema

A 
Atopic
Discoid 
Venous
Seborrhoeic dermatitis
Pompholyx
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14
Q

Which type of hypersensitivity reaction is allergic contact dermatitis

A

Type 4

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15
Q

Describe type 4 hypersensitivity reactions. Also how is it tested?

A

Delayed hypersensitivity – can take 48-72 hrs to develop reaction. T cell mediated

APC’s take allergen to LN and present to naive T cell - Clonal expansion of these T cells released into blood stream

Next encounter of allergen results in Mast cell degranulation, vasodilatation and neutrophils

Tested by a patch test

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16
Q

Describe type 1 hypersensitivity reactions. Also how is it tested?

A

allergy that causes things like anaphylaxis, bronchospasm, angioedema.

Happens quickly after.

Test by blood tests (IgE antibodies) or skin prick test.

17
Q

What types of things can cause allergic contact dermatitis?

A

Toothpaste/make up

Nickel (belt zips, jewelry)

18
Q

Causes of Irritant contact dermatitis

A

Friction - micro-trauma, cumulative

Environmental factors - cold, over-exposure to water, chemicals such as acids, alkalis, detergents/solvents

Occupation - Hairdressers, cleaners, NHS staff, nappy rash

19
Q

What is Patch testing?

A

Test used to determine whether a specific substance causes allergic inflammation of a patient’s skin.

Potential allergens are applied to the skin

Applied Monday
Remove Wednesday
Re-assess Friday

20
Q

Seborrhoeic dermatitis (infants)

A

Common in infants <6 months age usually.

Tends to affect the ears/eyebrows/scalp and proximal flexures.

Often clears within weeks of treatment

21
Q

Seborrhoeic eczema (adults)

A

Chronic dermatitis.

Malassezia yeast increased in the scaly epidermis of dandruff and seborrehoic dermatitis (yeast imbalance from childhood)

Dandruff can be a pre-cursor and may gradually progress through redness

Red, sharply marginated lesions covered with greasy looking scales.

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

22
Q

If you come across a severe case of seborrhoeic eczema which test should you consider

A

HIV test

23
Q

How should you treat seborrhoeic eczema

A

Topical anti-yeast (ketoconazole)

24
Q

Features of Discoid eczema

A

Circular plaques of eczema

Cause often unknown

May develop at sites of trauma/irritation

25
Q

Features of Pompholyx/vesicular eczema

A

Found on palms and soles

Intensely itchy

More common under 40 years

Sudden onset of groups of vesicles

Resolution can include skin peeling

26
Q

Features of Asteatotic eczema

A

Very dry skin - cracked, scaly appearance

Most commonly shins affected

Climate affects it (heat) or excessive washing/soaps

Improved with lots of emollient

27
Q

Venous eczema

A

Stasis eczema or varicose eczema

Increased venous pressure

Oedema

Ankle and lower leg involved

Resolution of oedema can help – compression stockings.

28
Q

Features of Eczema herpeticum

A

Disseminated viral infection

Fever and often unwell

Itchy clusters of blisters and erosions

Herpes Simplex 1 and 2
Swollen lymph glands

Consider admission!
Antivirals

29
Q

Treatment of eczema (7)

A

Patient education

Avoid Causative / exacerbating factors

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

Soap substitutes

Intermittent topical steroids

Sometimes need antihistamines or antimicrobials

Calcineurin Inhibitors - immunosuppression of skin without action of steroids

30
Q

Which drugs are commonly used in immunosuppression treatment of severe eczema

A

Azathioprine
Ciclosporin
Mycophenolate mofetil
Methotrexate

31
Q

Treatment of severe eczema

A

UV light

Immunosuppression

32
Q

What was the first biologic used for eczema patients?

A

Dupilumab

33
Q

Types of eczema

A 
Asteatotic eczema
Seborrhoeic eczema
Discoid eczema
Pompholyx/vesicular eczema
Venous eczema

2ND YEAR SYSTEMS: Dermatology (11 decks)

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