Eczema Flashcards
Define eczema
Inflammatory skin condition characterised by dry, pruritic skin with a chronic relapsing course
Describe atopic eczema and how it presents
Type I/IV hypersensitivity
IgE mediated
Seen at flexures and on the face
Describe contact eczema and how it presents
Type IV hypersensitivity after contact exposure to allergen or irritant
Area of exposure is affected, may spread
Often due to nickel, latex detergents etc.
Describe discoid eczema and how it presents
Coin-shaped plaques
Seen in middle-aged/elderly patients
Describe dishydrotic eczema and how it presents
Known as pompholyx
Acute itchy/painful blisters seen on the palms and plantars
Describe eczema herpeticum
Medical emergency - high risk of dissemination
Superimposed HSV-1 infection
It is more commonly seen in children with atopic eczema and often presents as a rapidly progressing painful rash.
On examination, monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1–3 mm in diameter are typically seen.
As it is potentially life-threatening children should be admitted for IV aciclovir.
Describe seborrhoeic eczema
Yellow, greasy, scaly rash
Intermittent papulous skin condition
Due to yeast (pityrosporun, Malassezia)
Affects scalp, paranasal area, eyebrows
Infants - cradle cap
Aetiology of eczema
Combination of genetic susceptibility e.g. filaggrin mutation and environmental factors
Breaks in the epidermal layer allow increased exposure and sensitisation
Triggered by soaps, shampoos, food, pollen, pets, dust mites etc.
Risk factors for eczema
Age <5 years Family history Allergic rhinitis, hayfever Asthma Food allergies Urban areas, smaller families, high socio-economic class
Epidemiology of Eczema
Usually presents in childhood
45% diagnosed by 6 months, 70% by 5 years
Remission in 60-70% at 15 years
Prevalence increasing
Children exposed to less hygienic environments
Presenting symptoms of eczema
Pruritus
Xerosis
Red, scaling rash
Chronic: Thickened epidermis, skin lichenification, fissures, change in pigmentation.
Signs of eczema
Xerosis Erythema Vesicles Papules Keratosis pilaris Excoriations Lichenification Hypopigmentation
Common distributions of eczema
Infants: cheeks, forehead, scalp, extensor surfaces
Children: flexures, particularly the wrists, ankles, antecubital and popliteal fossa
Chronic: neck, upper back, arms, hands and feet
Investigations for eczema
Clinical diagnosis
Allergy testing, IgE levels, skin biopsy
