ECZEMA

Question 1

what is eczema

Answer 1

Eczema (or dermatitis) is characterized by papules and vesicles on an erythematous base.

There is the presence of some small crusts (suggests weeping/ bleeding). 
Skin thickening (lichenification) with increase of the skin markings due to excessive scratchinh and rubbing

may be seen if chronic. Keep scratching and the skin gets thicker

Small erosions (loss of epidermis) – if linear would be described as excoriations.

Question 2

causes of eczema

Answer 2

IgE mediated response - ass w depressed T cell response

There is no known single cause for atopic eczema. It is a complex condition involving genetic, immunologic, and environmental factors, leading to a dysfunctional skin barrier and immune system dysregulation.

• a positive family history of atopy
  eczema
  asthma, allergic rhinitis
  is often present
• A primary genetic defect in skin barrier function (loss of function variants of the protein filaggrin) appears to underlie atopic eczema
  o Skin barrier dysfunction
   Water loss from the skin – dryness and itching
   Susceptible to allergens – increase IgE
   Predispose skin to infection – STPAH AUREUS
• Exacerbating factors such as infections, allergens (e.g. chemicals, food, dust, pet fur), sweating, heat and severe stress

Question 3

triggers of eczema

Answer 3

soap and detergent, animal dander, house-dust mites, extreme temperatures, rough clothing, pollen, certain foods, and stress, Hormones, dietary factors

Question 4

complications of eczema

Answer 4

bacterial - staph aureus and strep cocci
HSV - eczema herpeticum
molluscum contagiosum
viral warts

Question 5

what is eczema herpeticum

Answer 5

severe primary infection of the skin by herpes simplex virus 1 or 2.

Question 6

presentation of eczema herpeticum

Answer 6

• Extensive crusted papules, blisters and erosions
• Systemically unwell with fever and malaise
• SIGNS – FEVER, LYMPHADENOPATHY AND MALAISE

Question 7

investigations for eczema herpeticum

Answer 7

• Viral culture

- Direct fluorescent antibody stain

Question 8

Management of eczema herpeticum

Answer 8

Antivirals (e.g. aciclovir)
Oral 400-800mg 5 times daily or valaciclovir 1g twice daily, for 10-14 days or until lesions heal
IV aciclovir if patient is too sick to take tablets or deterioration despite medication
● Antibiotics for bacterial secondary infection
- if eyelid or eye is involved call an ophthalmologist

Question 9

complcations of eczema herpeticum

Answer 9

Herpes hepatitis, encephalitis, disseminated intravascular coagulation (DIC) and rarely, death

Question 10

clinical features of eczema

Answer 10

• Itching
• Pattern, time of onset and natural history or rash
• Family or personal history of atopy
• Any treatments and response to treatments
• Possible trigger factors

Question 11

how does eczema look in adults

Answer 11

ADULTS – generalised dryness and itching with exposure to irritants. On the hands primarily.
Diffuse pattern of eczema – drier and lichenified than in children

Question 12

how does eczema look in children or adults with in long term

Answer 12

flexural regions
Can develop pompholyx or vesicular hand/foot dermatitis
‘discoid pattern’ small coin-like areas of eczema scattered around the body can mistake for ringworm
Most it improves ALTHOUGH BARRIER FUNCTION OF THE SKIN IS NEVER ENTIRELY NORMAL

Question 13

how does eczema look in infants

Answer 13

primarily face, scalp, extensor surfaces nappy area spared
Toddlers and pre-schoolers
More localised and thickened

Question 14

differentials for eczema

Answer 14

• Psoriasis
• Allergic contact dermatitis
• Seborrheic dermatitis – red, sharply marginated lesions
• Fungal infection
• Scabies

Question 15

classification of eczema

Answer 15

MILD – areas of dry skin and infrequent itching
MODERATE – areas of dry skin, frequent itching and redness (with or without excoriation and localised skin thickening
SEVERE – widespread areas of dry skin, incessant itching and redness (with or without excoriation, extensive skin thickening, bleeding, oozing, cracking and alteration of pigmentation)

Question 16

treatment for mild eczema

Answer 16

• Emollients – frequent and liberal use
• Areas of red skin prescribe HYDROCORTISONE 1% (topical corticosteroid) should continue treatment 48 hours after the flare has been controlled

Question 17

treatment for moderate eczema

Answer 17

Loads of emollients
Skin is inflamed – MODERATELY POTENT steroid
- Betamethasone valerate 0.025%
- Clobetasone butyrate 0.05%
- 48 hours after flare has been controlled
- Delicate areas – mild – hydrocortisone 1% and increase to moderate if necessary
Severe itch or urticaria – one month trial of a non-sedating anthihistamine
- Cetirizine, loratadine or fexofenadine
Topical calcineurin inhibitors (tacrolimus ad pimecrolimus) SECOND LINE-derm approval
Topical corticosteroids – require reg review 3-6 months

Question 18

treatment for severe eczema

Answer 18

Emollients
Skin is inflamed – potent corticosteroid
- Betamethasone valerate 0.1%
- Delicate areas – betamethasone valerate 0.025% or clobetasone butyrate 0.05% aim for max 5 days use
Severe itch or urticaria – one month trial of a non-sedating anthihistamine
- Cetirizine, loratadine or fexofenadine
Sever itch affecting sleep short course max or 2 weeks sedating antihistamine CHLORPHENAMINE
Severe, extensive eczema causing psych distress – short course of an oral corticosteroid – 30mg prednisolone morning for 1 week

Question 19

examination of eczema herpeticum

Answer 19

grouped vesicles and punched out erosions widespread

Question 20

what is seborrhoeic dermatitis

Answer 20

chronic dermatitis thought to be caused by an inflammatory reaction related to a proliferation of a normal skin inhabitant, a fungus called Malassezia furfur

Question 21

cause of seborrhoeic dermatitis

Answer 21

malssezia furfur

Question 22

features of seborrhoeic dermatitis

Answer 22

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

Question 23

associated conditions of seborrhoeic dermatitis

Answer 23

• HIV

- Parkinson’s disease

Question 24

seborrhoeic dermatitis scalp treatment

Answer 24

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

Question 25

face and body management for seborrhoeic dermatitis

Answer 25

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

Question 26

if someone comes in with infected atopic eczema what do u do

Answer 26

blood cultures
skin swab
oral flucoxacillin
topical emollients
topical moderate potency steroid ointment
dermol 500

Question 27

characteristics of pompholyx eczema

Answer 27

affects hands and feet

acute eruptions of deep-seated vesicles in the palms and fingers, which are followed by scaling and fissuring of the affected areas.
- pruritic - burning sensation

Sweating is a common precipitant of blistering and the condition is therefore associated with hot, humid environments.

Mx
cool compress
emollients
topical steroids

Question 28

general Mx of eczema

Answer 28

● General measures - avoid known exacerbating agents, frequent
emollients +/- bandages and bath oil/soap substitute
● Topical therapies – topical steroids for active areas; topical
immunomodulators (e.g. tacrolimus, pimecrolimus) for
maintenance therapy as steroid-sparing agents
● Oral therapies - antihistamines for symptomatic relief, antibiotics
(e.g. flucloxacillin) for secondary bacterial infections, and
antivirals (e.g. aciclovir) for secondary herpes infection
Inflammatory Skin Conditions
– Atopic eczema

● Phototherapy and immunosuppressants (e.g. azathioprine,
ciclosporin, methotrexate) for severe non- responsive cases, biologic
therapy