Eczema Flashcards
What are the classical signs of eczema
erythema
skin scaling
skin dryness
usually in flexural areas
what may the acute form of eczema have
vesicles/blisters
what occurs in more serious eczema
skin fissures
lichenification
whats the pathology of acute eczema
dermal vessel dilation causing epidermoid oedema and separation of keratinocytes (spongiosis) with inflammation of the dermis and epidermis
whats the pathology of subacute eczema
less spongiosis (keratinocyte separation)
thickening of epidermis (acanthosis)
increased keratin production
hyperkeratosis and parakeratosis
all this leds to more scaling
what is the pathology of chronic eczema
marked acanthosis, hyperkeratosis and parakeratosis
persistent vessel dilation and inflammation
what are types of endogenous eczema
atopic
serborrhoeic
what are types of exogenous eczema
irritant infective allergic contact asteatotic gravitational/varicose discoid
what are two broad classifications of eczema
exogenous
endogenous
where is irritant contact dermatitis most common
dorsum of hand and in the finger webs
what is the reason for irritant contact dermatitis
irritants destroying skin barriers
what occupations are at increased risk for irritant contact dermatitis
chefs hairdressers housewives cleaners nurses
what kind of reaction is allergic contact dermatitis
type 4 cell mediated reaction
what are common sources for allergic contact dermatitis
nickel jewellry hair dye plants topical medications fragrance occupational
how do you confirm an allergic contact dermatitis
patch/spot testing
how long is a patch left on during patch testing
48 hours
how are results collected for patch testing
area is examined 10 minutes after removing the patch, then 96 hours (4 days) after that
0 = no reaction \+/- = doubtful reaction \+ = weak reaction (erythema) \++ = strong reaction (erythema,odema,vesicles) \+++ = extreme reaction (erythema + bullous) IR = irritatn reaction (varicble but well circumscribed with a glazed appearance)
when does atopic eczema come on most commonly
<2 years old onset
how does atopic eczema change with age
decrease in severity with age
50% grow out of it by 2, 80% by adolescence
what is discoid eczema
well demarcated discrete plaques that can occur at any site at any age
what is discoid eczema most commonly associated with
infection
what is varicose eczema
eczema occuring around varicose veins/chronic venous disease
what is a helpful treatment adjunct for varicose eczema
compression
what is asteatotic eczema
a decrease in skin fat content (usually in elderly) leading to ‘crazy paving’ looking dry skin
whats the treatment for asteatotic eczema
topical steroids with long term emmolients
advice to now over-wash as it dries skin out
what is pompholytic eczema
eczema provoked by heat/emotion/nickel allergy
what are features of pompholytic eczema
recurrent bouts of vesicles/arge blisters on palms, finggers and soles lasting for a few weeks at itrregular intervals
what are common complications of pompholytic eczema
secondary infection
lymphangitis
what are some useful treatments for acute eczema in a hospital setting
antibiotics if bacterial infection suspected
aluminium acetate/potassium permanganate soaks with very potent corticosteroids is also helpful
who is more likely to get seborrhoeic eczema
middle aged adults
alcoholics
what superinfection is seborrheic eczema associated with
pitryosporum yeast species
what is the first line management for atopic eczema
avoid exacerbating facotr s
PRN emmolient
active eczema areas (erythematous/painful areas) should be treated with topical steroids
what form are steroids given in for eczema and why
ointments, as they have greater efficacy and decreased chance of allergy than creams
whats the reccomended application routine for steroids
1-2 times a day in bursts, with days off inbetween
what are secondary treatment options for atopic eczema
topical immunomodulators (tacrolimus) bandagin/wet wraps systemic treatment (UV light, oral pred, cyclosporine, azathioprine)
what are the main side effects of topical steroids
telangeictasa perioral dermatitis eye prpblems striae glaucoma cataracts pigmentation
