Eczema

Question 1

What are the classical signs of eczema

Answer 1

erythema
skin scaling
skin dryness
usually in flexural areas

Question 2

what may the acute form of eczema have

Answer 2

vesicles/blisters

Question 3

what occurs in more serious eczema

Answer 3

skin fissures

lichenification

Question 4

whats the pathology of acute eczema

Answer 4

dermal vessel dilation causing epidermoid oedema and separation of keratinocytes (spongiosis) with inflammation of the dermis and epidermis

Question 5

whats the pathology of subacute eczema

Answer 5

less spongiosis (keratinocyte separation)
thickening of epidermis (acanthosis)
increased keratin production
hyperkeratosis and parakeratosis

all this leds to more scaling

Question 6

what is the pathology of chronic eczema

Answer 6

marked acanthosis, hyperkeratosis and parakeratosis

persistent vessel dilation and inflammation

Question 7

what are types of endogenous eczema

Answer 7

atopic

serborrhoeic

Question 8

what are types of exogenous eczema

Answer 8

irritant 
infective 
allergic contact
asteatotic
gravitational/varicose
discoid

Question 9

what are two broad classifications of eczema

Answer 9

exogenous

endogenous

Question 10

where is irritant contact dermatitis most common

Answer 10

dorsum of hand and in the finger webs

Question 11

what is the reason for irritant contact dermatitis

Answer 11

irritants destroying skin barriers

Question 12

what occupations are at increased risk for irritant contact dermatitis

Answer 12

chefs
hairdressers
housewives
cleaners
nurses

Question 13

what kind of reaction is allergic contact dermatitis

Answer 13

type 4 cell mediated reaction

Question 14

what are common sources for allergic contact dermatitis

Answer 14

nickel jewellry
hair dye 
plants
topical medications
fragrance 
occupational

Question 15

how do you confirm an allergic contact dermatitis

Answer 15

patch/spot testing

Question 16

how long is a patch left on during patch testing

Answer 16

48 hours

Question 17

how are results collected for patch testing

Answer 17

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)

Question 18

when does atopic eczema come on most commonly

Answer 18

<2 years old onset

Question 19

how does atopic eczema change with age

Answer 19

decrease in severity with age

50% grow out of it by 2, 80% by adolescence

Question 20

what is discoid eczema

Answer 20

well demarcated discrete plaques that can occur at any site at any age

Question 21

what is discoid eczema most commonly associated with

Answer 21

infection

Question 22

what is varicose eczema

Answer 22

eczema occuring around varicose veins/chronic venous disease

Question 23

what is a helpful treatment adjunct for varicose eczema

Answer 23

compression

Question 24

what is asteatotic eczema

Answer 24

a decrease in skin fat content (usually in elderly) leading to ‘crazy paving’ looking dry skin

Question 25

whats the treatment for asteatotic eczema

Answer 25

topical steroids with long term emmolients advice to now over-wash as it dries skin out

Question 26

what is pompholytic eczema

Answer 26

eczema provoked by heat/emotion/nickel allergy

Question 27

what are features of pompholytic eczema

Answer 27

recurrent bouts of vesicles/arge blisters on palms, finggers and soles lasting for a few weeks at itrregular intervals

Question 28

what are common complications of pompholytic eczema

Answer 28

secondary infection | lymphangitis

Question 29

what are some useful treatments for acute eczema in a hospital setting

Answer 29

antibiotics if bacterial infection suspected aluminium acetate/potassium permanganate soaks with very potent corticosteroids is also helpful

Question 30

who is more likely to get seborrhoeic eczema

Answer 30

middle aged adults alcoholics

Question 31

what superinfection is seborrheic eczema associated with

Answer 31

pitryosporum yeast species

Question 32

what is the first line management for atopic eczema

Answer 32

avoid exacerbating facotr s PRN emmolient active eczema areas (erythematous/painful areas) should be treated with topical steroids

Question 33

what form are steroids given in for eczema and why

Answer 33

ointments, as they have greater efficacy and decreased chance of allergy than creams

Question 34

whats the reccomended application routine for steroids

Answer 34

1-2 times a day in bursts, with days off inbetween

Question 35

what are secondary treatment options for atopic eczema

Answer 35

``` topical immunomodulators (tacrolimus) bandagin/wet wraps systemic treatment (UV light, oral pred, cyclosporine, azathioprine) ```

Question 36

what are the main side effects of topical steroids

Answer 36

``` telangeictasa perioral dermatitis eye prpblems striae glaucoma cataracts pigmentation ```