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Paediatrics > Eczema > Flashcards

Eczema Flashcards

1
Q

What are these: atopic & infantile seborrheic eczema, irritant & allergic contact dermatitis?

A

These are the 4x main types of eczema / dermatitis in paediatrics

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2
Q

who does irritant contact dermatitis occur in? (epidemiology)

A

anyone exposed to sufficient amount of offending agent; more common in those with atopic eczema (diminished skin barrier)

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3
Q

What is the aetiology/cause of irritant contact dermatitis?

A

irritating substance –> contact –> causes skin inflammation

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4
Q

What is this

rough, dry skin & white scaling with variable erythema caused by low relative humidity (dry) & aggravated by soaps and bathing?

A

asteatotic eczema

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5
Q

What are asteatotic eczema and nappy rash clinical features of?

A

irritant contact dermatitis!

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6
Q

How is the diagnosis of irritant contact dermatitis made?

A

clinical dx

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7
Q

What is the Rx of irritant contact dermatitis?

A
  • emmolients
  • topical corticosteroids
  • avoidance of irritant
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8
Q

What is the difference between eczema and dermatitis?

A

both are generic terms for skin inflammation

eczema = endogenous

dermatitis = exogenous

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9
Q

what are these types of:

atopic, venous / gravitational, asteatotic, seborrhoeic, discoid, pompholys, pityriasis alba?

A

Eczemas!

e.g. endogenous

  • *Atopic Eczema
  • Venous/ gravitational Eczema
  • Asteatotic eczema
  • Seborrhoeic dermatitis
  • Discoid
  • Pompholyx
  • Pityriasis alba
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10
Q

What are these types of:

irritant contact, allergic contact, photodermis, eczema herpeticum

A

= dermatitis types!

e.g. exogenous

  • Irritant contact
  • Allergic contact
  • Photodermatitis
  • Eczema herpeticum (vesicles, punched out haemorrhagic lesions, caused in HSV infectino)
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11
Q

What is the aetiology of allergic contact dermatitis e.g. cause?

A

abnormal immunological response –> inflammation caused by Type 4 cell mediated hypersensitivity to an allergen

~10% of childhood dermatitis

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12
Q

what are nickel, lanolin and urushiol in relation to allergic contact dermatitis?

A

they can be allergens –> Type 4 cell mediated hypersensitivity

in allergic contact dermatitis

lanolin = sheep wool wax

urushiol = a chemical in some plants

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13
Q

Where does the lesion from allergic contact dermatitis occur?

A

typically restricted to area of contact

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14
Q

What types of lesion can occur from allergic contact dermatitis & their differences?

A
  • Allergic contact dermatitis –> acute & subacute
    • Acute = really itchy dermatitis –> vesicle and blister formation
      • From potent sensitizers e.g. poison ivy
    • Subacute –> linchenification (leathery from itching) and scaling
      • from less potent sensitisors e.g. nickel
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15
Q

How do you diagnose allergic contact dermatitis?

A
  • Use HISTORY to identify possible allergen
  • PATCH TESTING
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16
Q

How do you manage allergic contact dermatitis?

A
  • emmolients
  • topical corticosteroids
  • avoidance of the allergen
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17
Q

What is an allergen vs irritant?

A

irritant is non-allergic

allergy = involves a damaging hypersensitivity immune response by the body to a substance (types 1-4)

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18
Q

What is a type 1 allergic reaction?

A

Immediate Hypersensitivity (Anaphylactic Reaction)

These allergic reactions are systemic or localized, as in allergic dermatitis (e.g., hives, wheal and erythema reactions)

antigen + membrane IgE of mast cell/basophil

= H2, platelet activating factor, PG and leukotrienes released

19
Q

What is a type 2 allergic reaction?

A

Cytotoxic Reaction (Antibody-dependent)

Ab –> ag to induce cell lysis

IgG and IgM mediated e.g. Rh incompatibility

20
Q

What is a type 3 hypersensitivity reaction?

A

immune complex reaction

IgG and IgM bind Ag –> PMN releasing tissue damaging enzymes

–> e.g. SLE & chonic infectious diseases e.g. leprosy

21
Q

What is a type 4 hypersensitivity reaction?

A

Cell-mediated (delayed hypersensitivity)

reaction initated by T lymphocytes + Ag –> mediated by effector T cells (CD4+ and CD8+) –> 48-72hrs later = cytokines

22
Q

Which is the most common eczema/dematitis?

A

Atopic eczema

~15% children

23
Q

aczema / atopic dermatitis is caused by food allergy

true or false

A

False

NB: if there is a true food allargy e.g. egg allergy –> immediate peri-oral syx on contact with egg, it is not uncommon for eczema to FLARE up (e.g. its pre-existing eczema) several hours after the allergic reaction

24
Q

what gene mutations is eczema associated with?

A

filaggrin gene mutations

[encodes protein that facilitated terminal differentiation of the epidermis and formation of the skin barrier]

25
Q

What is eczema?

A
  • chronic skin condition
  • assoc. w/filaggrin gene mutations
  • ==> causes poor barrier function of the skin
  • ==> allows IgE sensitisation to air allergens (aero-allergens)
  • via the THINNER, PERMEABLE epidermis
26
Q

What 4 factors can aggrevate eczema & cause a “flare-up”?

A
  1. infections
  2. chemical irritation
  3. allergy - particularly aero-allergens
  4. other
27
Q

What is included in the “other” category for eczema aggravating factors?

A
  • hot or cold temperatures
    • heat
    • humidity
    • sweat / perspiration from exercising
  • food
  • stress
  • hormones
28
Q

Sort of infections can cause eczema exacerbations?

A
  • general infection
  • or skin infection often induced by scratching
    • certain bacteria e.g. staph aureus
    • viruses or certain fungi
29
Q

What sort of chemical irritants can cause eczema exacerbation?

A
  • soap, detergents
  • disinfectants (chlorine),
  • contact with: chemicals, fumes on job
    • juices from:
      • fresh fruits
      • meats
      • vegetables
30
Q

What kind of allergens can cause eczema flares?

A
  • house dust mites
  • animal dander e.g. pets - cats, dogs
  • pollens (seasonal)
  • moulds
  • dandruff
31
Q

What is the cause of atopic eczema?

A

multifactorial:

  • epidermal barrier impairment
  • genetic component - filaggrin gene
  • & parts of immune system dysfunctional
  • & environmental factors e.g. exposure to allergens in utero or in childhood
32
Q

What are the clinical features of atopic eczema?

A
  • 1st 6 months of life
  • dry itchy rash –> excoriation (abrasion) & linchenfication (leathery-thickening)
  • Fhx or Hx of atopy or eczema
33
Q

Some age groups get atopic eczema most commonly in different parts.

1) extensors, face & trunk
2) flexors

which groups get (1) or (2)?

A

older children get eczema on flexors

infants get eczema on extensors, face, trunk

34
Q

What are the complications of eczema and why?

A

Bacterial infection from the chronic epidermal barrier impairment (filaggrin etc) –> staph aureus infection (lives on skin)

viral infection - due to altered T cell function…

35
Q

What viral infections can you get due to eczema and what conditions do they cause?

A

Pox virus –> molluscum contagiosum

Herpes Simplex –> eczema herpeticum (can be FATAL)

36
Q

What is this?

A

molluscum contagiosum

(pox virus)

37
Q

What is this?

A

Eczema herpeticum

(HSV infection, can be fatal via organ failure if virus spreads to brain, lungs & liver)

38
Q

How do you diagnose atopic eczema?

A
  • clinical (ask Hx of triggers too)
  • plama IgE levels often raised
39
Q

Why must allergy (oral etc) testing in eczema be based on the clinical history?

A

if not targeted based on clinical hx:

  • you get false positive specific IgE results
  • as this is common in eczema & asthma
  • this simply reflects exposure and IgE sensitisation in an atopic individual
  • TF does not necesserily predict clinical allergy
40
Q

How many children go onto have eczema in adolescence?

A

1/3rd

  • 2/3rds of children with eczema will recover by adolescence
41
Q

What are the general measures of management for eczema?

A
  1. short nails,
  2. avoid known exacerbating agents,
    • oil/soap substitute
  3. frequent emollients +/- bandages (with zinc/tar paste/diluted steroids)
42
Q

What are the topical therapies given for eczema flares?

A
  • topical corticosteroids
  • NB: ointment is more effective than cream but messier
43
Q

What are the oral therapies for eczema flares?

A
  • antihistamines (symptomatic relief)
  • Infection Rx:
    • abx e.g. flucloxacillin for 2o bacterial infection
    • antivirals e.g. aciclovir for 2o herpes
  • ?exclusion diet -
    • food allergies may EXACERBATE/flare eczema so investigate and trial an exclusion diet (not cause it, exacerbate)

Paediatrics (16 decks)

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