ECZEMA Flashcards
what is eczema
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.
causes of eczema
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
triggers of eczema
soap and detergent, animal dander, house-dust mites, extreme temperatures, rough clothing, pollen, certain foods, and stress, Hormones, dietary factors
complications of eczema
bacterial - staph aureus and strep cocci
HSV - eczema herpeticum
molluscum contagiosum
viral warts
what is eczema herpeticum
severe primary infection of the skin by herpes simplex virus 1 or 2.
presentation of eczema herpeticum
- Extensive crusted papules, blisters and erosions
- Systemically unwell with fever and malaise
- SIGNS – FEVER, LYMPHADENOPATHY AND MALAISE
investigations for eczema herpeticum
- Viral culture
- Direct fluorescent antibody stain
Management of eczema herpeticum
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
complcations of eczema herpeticum
Herpes hepatitis, encephalitis, disseminated intravascular coagulation (DIC) and rarely, death
clinical features of eczema
- 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
how does eczema look in adults
ADULTS – generalised dryness and itching with exposure to irritants. On the hands primarily.
Diffuse pattern of eczema – drier and lichenified than in children
how does eczema look in children or adults with in long term
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
how does eczema look in infants
primarily face, scalp, extensor surfaces nappy area spared
Toddlers and pre-schoolers
More localised and thickened
differentials for eczema
- Psoriasis
- Allergic contact dermatitis
- Seborrheic dermatitis – red, sharply marginated lesions
- Fungal infection
- Scabies
classification of eczema
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)
treatment for mild eczema
- 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
treatment for moderate eczema
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
treatment for severe eczema
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
examination of eczema herpeticum
grouped vesicles and punched out erosions widespread
what is seborrhoeic dermatitis
chronic dermatitis thought to be caused by an inflammatory reaction related to a proliferation of a normal skin inhabitant, a fungus called Malassezia furfur
cause of seborrhoeic dermatitis
malssezia furfur
features of seborrhoeic dermatitis
- eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds
- otitis externa and blepharitis may develop
associated conditions of seborrhoeic dermatitis
- HIV
- Parkinson’s disease
seborrhoeic dermatitis scalp treatment
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
face and body management for seborrhoeic dermatitis
- topical antifungals: e.g. ketoconazole
- topical steroids: best used for short periods
- difficult to treat - recurrences are common
if someone comes in with infected atopic eczema what do u do
blood cultures skin swab oral flucoxacillin topical emollients topical moderate potency steroid ointment dermol 500
characteristics of pompholyx eczema
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
general Mx of eczema
● 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
