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Y4 Lecture Day III > Eczema > Flashcards

Eczema Flashcards

1
Q

Prevalence of eczema in children

A
  • eczema occurs in around 15-20% of children and is becoming more common
  • typically presents before 6 months
  • clears in around 50% of children by 5 years of age and in 75% of children by 10 years of age
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2
Q

Locations of eczema in different age group (in children)

A
  • in infants the face and trunk are often affected
  • in younger children eczema often occurs on the extensor surfaces
  • in older children a more typical distribution is seen, with flexor surfaces affected and the creases of the face and neck
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3
Q

Management of eczema in children

A
  • avoid irritants
  • simple emollients: large quantities should be prescribed (e.g. 250g / week), roughly in a ratio of with topical steroids of 10:1.
  • topical steroids
  • in severe cases wet wraps and oral ciclosporin may be used
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4
Q

How to apply emollients?

A

If a topical steroid is also being used:

  • the emollient should be applied first followed by waiting at least 30 minutes before applying the topical steroid
  • Creams soak into the skin faster than ointments
  • Emollients can become contaminated with bacteria - fingers should not be inserted into pots (many brands have pump dispensers)
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5
Q

What’s 1 finger tip rule?

A

Finger tip rule → for applicaiton of topical steroid

1 finger tip unit (FTU) = 0.5 g, sufficient to treat a skin area about twice that of the flat of an adult hand

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6
Q

The potency of topical steroids

A
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7
Q

Prognostic markers associated with severe disease

A
  • onset at age 3-6 months
  • severe disease in childhood
  • associated asthma or hay fever
  • small family size
  • high IgE serum levels
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8
Q

Pathophysiology of atopic eczema

A
  • TH2 driven inflammation
  • ↑IgE production

*Most children grow-out of it by 13yrs

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9
Q

Causes of atopic eczema

A
  • FH of atopy common
  • Specific allergens
  • House dust mite
  • Animal dander
  • Diet: e.g. dairy products
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10
Q

Presentation of atopic eczema

A

Face: around eyes, cheeks

Flexures: knees, elbows

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11
Q

Associations with atopic eczema

A
  • Asthma
  • Hay fever
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12
Q

Ix for atopic eczema

A
  • ↑ IgE
  • RAST testing: identify specific Ag
  • Irritant → Contact
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13
Q

Management (in general) of eczema

A
  • emollients
  • topical steroids
  • UV radiation
  • immunosuppressants: e.g. ciclosporin, antihistamines and azathioprine
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14
Q

Education for eczema

A

Education

  • Avoid triggers: e.g. soap
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15
Q

What soup substitutes should be used in eczema?

A

Soap Substitute

  • Aqueous cream
  • Dermol cream
  • Epaderm ointment
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16
Q

Name of emoillents

A

Emollients

  • Epaderm
  • Dermol
  • Diprobase
  • Oilatum (bath oil)
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17
Q

Steroid therapy for eczema

A

Topical Therapy with steroids:

  • 1% Hydrocortisone: face, groins
  • Eumovate: can use briefly (<1wk) on face
  • Betnovate
  • Dermovate: very strong, brief use on thick skin (palms, soles)
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18
Q

2nd line therapies for Eczema

A

2nd line Therapies

  • Topical tacrolimus
  • Phototherapy
  • Ciclosporin or azathioprine
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19
Q

What’s eczema herpeticum?

A

Eczema herpeticum

  • a severe primary infection of the skin by herpes simplex virus 1 or 2
  • more commonly seen in children with atopic eczema and often presents as a rapidly progressing painful rash
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20
Q

What can be seen O/E of eczema herpeticum?

A

On examination, monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1–3 mm in diameter are typically seen.

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21
Q

Management of eczema herpeticum

A

it is potentially life-threatening children should be admitted for IV aciclovir

22
Q

Name different types of eczema

A
  • Atopic dermatitis
  • Contact dermatitis
  • Dyshidrotic eczema
  • Nummular eczema
  • Seborrheic dermatitis
  • Stasis dermatitis
23
Q

Two types of contact dermatitis

A

There are two main types of contact dermatitis

  • irritant contact dermatitis: common - non-allergic reaction due to weak acids or alkalis (e.g. detergents). Often seen on the hands.
  • allergic contact dermatitis: type IV hypersensitivity reaction. Uncommon - often seen on the head following hair dyes.
24
Q

Location of contact dermatitis

A

Contact dermatitis usually appears on the hands, or parts of the body that touched the irritant/allergen.

25
Q

The most common irritants in contact dermatitis

A
  • Solvents
  • Industrial chemicals
  • Detergents
  • Fumes
  • Tobacco smoke
  • Paints
  • Bleach
  • Wool
  • Acidic Foods
  • Astringents
  • Skin care products that content alcohol
  • Some soaps and fragrances
  • Allergens (usually animal dander or pollens)
26
Q

Symptoms of contact dermatitis

A
  • Redness and rash
  • Burning or swelling
  • Blisters that may weep or crust over
27
Q

What’s used to diagnose allergic contact dermatitis?

A

Patch testing → to diagnose allergic contact dermatitis.

In this test:

  • selected chemicals put on an adhesive strip, or “patches” and applied to the back, where there are no symptoms
  • the patches are left on for 48 hours. After 48 hours, the doctor removes the patches and looks at the skin for reactions. After two more days, the doctor looks at the patch sites for signs of inflammation. If there is inflammation, the allergy to that particular chemical is confirmed
28
Q

Conservative management of allergic contact dermatitis

A
  • Find out precisely what you are allergic to by having comprehensive patch tests.
  • Carefully study your environment to locate the allergen
  • Wear appropriate gloves to protect hands from touching materials to which you react and remove gloves in the appropriate way.
  • Read labels to avoid the product
29
Q

Medical management of allergic contact dermatitis

A

Active dermatitis is usually treated with:

30
Q
A
31
Q

Another name for dyshidrotic eczema?

A

Dyshidrosis

32
Q

Characteristics/presentation of dyshidrotic eczema (dyshidrosis)

A
  • itchy blisters on the palms of the hands and bottoms of the feet
  • blisters are generally one to two mm in size and heal over three weeks
  • blisters often recur

*redness is not usually present

* Repeated attacks may result in fissures and skin thickening

33
Q

Cause of dyshidrosis (dyshidrotic eczema)

A

The cause is:

  • unknown
  • triggers may include allergens, physical or mental stress, frequent hand washing, or metals
34
Q

Diagnosis of dyshidrosis

A
  • Diagnosis is typically based on what it looks like and the symptoms
  • Allergy testing and culture may be done to rule out other problems

*Other conditions that produce similar symptoms include pustular psoriasis and scabies

35
Q

Management of dyshidrosis

A

​High strength steroid creams may be required for the first week or two

2nd line:

36
Q
A
37
Q

Characteristics and presentation of nummular dermatitis (aka nummular eczema)

A
  • round or oval-shaped itchy lesions
  • chronic or relapsing
  • itchy coin-sized ovoid-shaped red plaques
  • can occur on the trunk, limbs, face, and hands
38
Q

Causes of nummular eczema

A
39
Q

Diagnosis of nummular dermatitis

A
40
Q

Treatment of nummular dermatitis

A
  • s keeping the skin moisturized → lotions, creams, and bath oils may help prevent an outbreak
  • If the condition flares up, a common treatment involves the application of topical corticosteroids
  • Oral antihistamines → lessen itching
  • Avoidance of irritants i
  • More severe cases sometimes respond to ultraviolet light treatment
  • If the condition occurs only during the sun-less winter months then vitamin D supplement might be an effective treatment
41
Q

Pathophysiology of seborrhoeic dermatitis

A
  • a chronic dermatitis
  • caused by an inflammatory reaction related to a proliferation of a normal skin inhabitant, a fungus called Malassezia furfur
42
Q

Features of seborrhoeic dermatitis

A
  • eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds
  • otitis externa and blepharitis may develop
43
Q

Management of seborrhoeic dermatitis on the scalp

A

Scalp disease management

  • over the counter preparations containing zinc pyrithione (‘Head & Shoulders’) and tar (‘Neutrogena T/Gel’) are first-line
  • the preferred second-line agent is ketoconazole
  • selenium sulphide and topical corticosteroid may also be useful
44
Q

Management of seborrhoeic dermatitis on face and body

A

Face and body management

  • topical antifungals: e.g. ketoconazole
  • topical steroids: best used for short periods
  • difficult to treat - recurrences are common
45
Q

What’s seborrhoeic dermatitis in children?

A

Seborrhoeic dermatitis

  • a relatively common skin disorder seen in children
  • it typically affects the scalp (‘Cradle cap’), nappy area, face and limb flexures
46
Q

Characteristics of seborrhoeic dermatitis in children

A

Seborrhoeic dermatitis (aka cradle cap)

  • cradle cap is an early sign which may develop in the first few weeks of life
  • It is characterised by an erythematous rash with coarse yellow scales
47
Q

Management of seborrhoeic dermatitis in children

A

Management depends on severity

  • mild-moderate: baby shampoo and baby oils
  • severe: mild topical steroids e.g. 1% hydrocortisone

Seborrhoeic dermatitis in children tends to resolve spontaneously by around 8 months of age

48
Q

What’s stasis dermatitis?

A
  • skin changes that occur in the leg as a result of “stasis” or blood pooling from insufficient venous return
  • the alternative name of varicose eczema
  • common cause of this being varicose veins
49
Q

Pathophysiology of stasis dermatitis

A
  • Insufficient venous return → increased pressure in the capillaries → both fluid and cells may “leak” out of the capillaries
  • The above → results in red cells breaking down, with iron containing hemosiderin possibly contributing to the pathology
50
Q

Symptoms of stasis dermatitis

A

The skin:

  • appears thin, brown and tissue-like, with possible skin lesions (macule or patches), red spots, superficial skin irritation and/or darkening and/or thickening of the skin at the ankles or legs
  • may be weakened and may ulcerate
  • legs, ankles, or other areas may become swollen
  • open sores, ulcers
  • itching and/or leg pains
  • sometimes pain may persist from swollen tissues and may feel like “stabbing” or “needle pricks”

*The cracks and poor skin condition of this disorder predisposes the patient for the entry of bacterial infection, causing a cellulitis infection in the leg. If the skin condition deteriorates further and breaks down, a venous ulcer (also known as a stasis ulcer) may form.

51
Q

Management of stasis dermatitis

A

Y4 Lecture Day III (9 decks)

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