Eczema

Question 1

How many children are diagnosed with eczema

Answer 1

24%

Atopic eczema prevalence is rising

Question 2

What is atopic eczema

Answer 2

Its an inflammatory skin condition most commonly seen in flexural areas. (usually caused by a barrier dysfunction)

Question 3

What is the pathophysiology of atopic eczema

Answer 3

The skin barrier is disrupted, antigens get into the dermis which activates T cells - this gives inflammation, itch and redness

Question 4

How many adults have eczema

Answer 4

60-75% of eczema has cleared by the time patients reach adulthood
overall 4% of adults in western countries

Question 5

Definition of atopic eczema

Answer 5

An itchy skin condition in the last 12 months with 3 of: onset before 2yrs, flexural involvement, general dry skin, history of other atopic disease, history in 1st degree relatives if <4yrs.

Question 6

Which gene is effected in eczema

Answer 6

Filaggrin gene (plays a key role in barrier function of epidermis).

Question 7

What is spongiosis

Answer 7

intercellular oedema within the epidermis

Question 8

what is acanthosis

Answer 8

thickening of the epidermis (due to persistent scratching)

Question 9

features of Acute eczema on histology

Answer 9

intercellular oedema and infiltration of lymphocytes, neutrophils, histiocytes and eosinophils

Question 10

Features of chronic eczema on histology

Answer 10

the level of oedema is low but the levels of acanthosis (thickening of epidermis) is high, there might also be fibrosis

Question 11

Acute eczema signs

Answer 11

itch, erythema (redness), scales, papule, exudate, crusting

Question 12

Chronic eczema signs

Answer 12

Thickening of the skin, plaque formation, fissuring (deep cracks in skin) - leaks exudate fluid and risks infection

Question 13

Most common sign in eczema

Answer 13

Pruritis

Question 14

Where will you see eczema on children

Answer 14

in flexural areas and around the mouth/face due to drooling

Question 15

What is allergic contact dermatitis

Answer 15

its different from atopic eczema because its not chronic. Only occurs when in contact with allergen.
Type 4 hypersensitivity

Question 16

Causes of allergic contact dermatitis

Answer 16

friction, cold, metals, water, detergents, acids, often Brought on by occupation (eg cleaner)

Question 17

how to assess allergic contact dermatitis AND eczema

Answer 17

allergen patch testing

Question 18

What is seborrhoeic dermatitis in infants

Answer 18

an excessive discharge of sebum which crusts up.

often clears within weeks of treatment. Child is happy as there is no associated itch.

Question 19

What is seborrhoeic dermatitis in adults

Answer 19

a type of chronic dermatitis usually due to a yeast imbalance on the skin - causes seborrheic dermatitis.
In places with rich sebaceous glands (scalp, face)

Question 20

How should seborrhoeic eczema be treated

Answer 20

with anti yeasts (ketoconazole). Consider HIV testing.

Question 21

What is discoid eczema

Answer 21

circular plaques of eczema in middle aged patients (often had eczema as a child)

Question 22

What is pompholyx/vesicular eczema

Answer 22

eczema on the palms and soles with water blisters

Question 23

What is asteatotic eczema

Answer 23

very dry skin that gives a cracked and scaly appearance. Associated with older skin as your skin ages - it dries and thins. (excessive washing - strips natural oils from skin)

Question 24

What is venous eczema

Answer 24

eczema usually in the lower leg when their is insufficiency of blood blow

Question 25

What is eczema herpeticum

Answer 25

A viral infection due to herpes simplex 1 and 2. Fever and unwell. Causes itchy clusters of blisters and erosions.

Question 26

Treatment of eczema in general

Answer 26

1. avoid exacerbating factors
2. use emollients
3. use soap substitutes
4. topical steroids (for inflammation) - hydrocortisone
5. Antihistamines
6. Calcineurin inhibitors (good in chronic eczema)

Question 27

Treatment of severe eczema

Answer 27

UV light, immunosuppression, biologics