Eczema and related dermatitis Flashcards
aetiology of eczema
mutlifactorial both genetic and environmetal factors
-50% of severe cases have a mutationin the filaggrin gene
-this gene forms part of the strattum corneum which helps form the skin barrier
how is eczema diagnosed 2
clinically
-although total and specific IgE may be raised and aid diagnosis
diagnostic criteria for eczema 4
flexural rash
development before the age of 2 (seen in 80%)
FHx
dry skin
allergic sensitation (total and specific IgE)
chief characterisitic of eczema 1
itch
-can be unbearable leeding to sleep loss,s tress and depression
prinicples of eczema management
restoring the skin barrier
avoiding irritant and allergens
reducing inflammation
trying to reduce itch
what can itching in eczema lead to 3
excoriation (which further disrupts the skin barrier)
infection
lichenifiication (thickening of the skin)
barrier protection managemnt in eczema
bathe daily
use the greasiest emolloient tollerated (ointments)
-generally use a greasy emollient at night and cream during the day
-if greasy ointments are felt to be too messy for day time
overview of priniciples of eczema managemnt 4
improving barrier
avoiding irritants and allergens
reducint in itch and scratchin
topical steroids
prinicples of avoiding irritatns and allergens in eczema
these aggrevate eczema
-include soap perfumes and individualised allergens
heat and sweating aggrevates eczema so child and bedroom should be kept cool
prinicples of reduction in itch and scratcing for eczema 4
dryness will contribute to itch so ensure well moisturied
sedative anti-histamines
cotton garmnets/scratch mits
keep nails schort
-scratching will cause release of histamiens and other chemicals into the skin which causes further ithcing (itch scratch cycle)
when should topical steroids be used in eczema 2
for the following steroid potentencies give an example
mild
moderate
potent
very potent
short burts for active areas
-either flares only or additionally twice weekly if there are chronic pathces that do not clear
steroid potency
mild-hydrocortison (0.5-2.5%)
moderate betamethasone 0.025
potent Fluticasone 0.05
v potent clobetasol PROPIONATE 0.05
topical steroid regime for body in eczema
medium potency for 7 day for flares
-then 2-3 times weekly in chronic areas
*-if not controlled increase strength to a potent steroid again for short burts for flates then twice weekly for chronic patches- (if over 1yo)
what is safe topical steroid amounts for long term use in eczema
moderate and potetn topical steroids twice weekly
topical steroid regime for eczema of the face
1% hydrocort safe for daily use
-except eyelids when use should be limited to 3 nights weekly
three day bursts of moderately potent steroids shouild be safe for occasionaly flares
side effects of topical steroids in eczema 4
if used twice weekly moderate potency no side effects seen
fear of adverse affects has led to under use
others:
-systemic -cushings
-local- thinning, striae, telengectasia
-eyelids
-periorifical dermatitis
-steroid rosacea
-pustular psoriasis
most common skin problem of infancy
irritant contact napkin dermatitis
what causes irritant contact napkin dermatitis
moisture and friction disrups the skin barrier allowing penetration of irritants from urine and faeces
-contributed to by candida and bacterial overgrowth
characteristic appearance of irritant contact napkin dermatitis 3
glazed eryhtmea that spares the skin folds
-can ulcerate if left untreated or when diarrhoea causes a sevee form
develops a wrinkled appearnace and scaling when it resolves
treatment of mild irritant contact napkin dermatitis 2
frequent nappy changes w avoidiance of soap and wips
greasy emollients help repair skin barrier and a thick barrrier preparartion applied at each nappy change to prevenet prenetration of irritatns
treatment of very inflamed irritant contact napkin dermatitis
topical steroid/antifungal cream to settle inflammation
try mild potency then moderate
use for 5-7days then repeat if flares <2x per mnth
if flares >2x mnth use twice weekly to chronic areas
treatment of irritant contact napkin dermatitis if candidal infection develops
add topical antiyest - clotrimazole
CONTINUE USE OF STEROIDS
appearnace of candida infected irritant contact napkin dermatitis
satellite papules and pusutles which spread to the flexures
who gets vulvitis
young prepubertal girls
-represents localsied eczema
usually seen in atopic children (though may not have eczema elsewhere)
*-note prepubertal girls cannot develop candidiasis
appearance of vulvitis
itch
eryhtmea
discharge
sting/buring passing urine
managemnt of vulvitis
same as for napkin dermaitis
+
cotton underwear
avoidance of tights
define discoid eczema
localised form of eczema
appears in well demarcated circular plaques
-often crusted and weeping due to bacterial superinfection
management of discoid eczema 2
-potent steroid use is common
-usually start with medium strenght dependent on severeity
-use for 7-10 days to settle flairs
management of discoid eczema 2
-potent steroid use is common
-usually start with medium strenght dependent on severeity
-use for 7-10 days to settle flairsr
managment of discoid eczema if crusted/ weeping
if crusted/weeping
-topical steroid combinded with an antibacterial agent
define lip lick dermatitis
peri-oral eczema caused by drying of the lips in atopic chldren
-causes them to lick them which then irriatets skin-> eczema-> viscouc cycle
usually worse in winter
managemtn of lip lick dermatitis 3
greasy emollients
if red-> topical steroid with an anti yeast
-daktacort (weak steroid) for 7 days
trimovate (moderate steroid) for 2 days for flares
if requirng trimovate more than once per month-> consider tacrolimus
appearance pityriasis alba
usually asain children
hypopigmentation
-usualy with dry rough skin on cheekcs of atopic children 4-12 years
-seen mainly in non-caucasian skin
genetrally patchy and poorly demarcated inconrast to vitligo
Management of pityriasis alba 3
use of emollients
topical streoids to areas of erythema
and sunscreen to prevent surrouding skin tannign whichc makes it more obvious
who gets juvenile plantar dermatosis
affects anterior planter surface of children (mainly boys)
aged 4-7
flares intermittently continues until puberty then settles spontaneously
main trigger is sweating
-variety of factors contribute
-wearing of sports shoes with rubebr soles and syntehtic nylon (football) socks or tights whichc cause occulsion and maceration
risk factors for juvenile plantar dermatosis 2
repeated friction
atopic dermatitis
-worse in winter
where on the foot is affeected by juvenile plantar dermatosis (more specific)
-appearance 3
plantar surface of the anterior third of the foot and occasionally the first toe
-plantar arch is always spared
-erythema
-hyperkeratosis
-fissuring
-characteristic glazed appearanc
(itch is not a feature)
investigations for juvenile plantar dermatosis
clinical diagnosis
patch testing- though ont routinely recommened
rubber allergy- may affect soles and palms but is usually itchy and generally causes blisters- JPD does not
treatment for juvenile plantar dermatosis 5
avoid occlusive footwear and synthetic socks
wear 2 pairs of cotton socks or thick toweling socks to imrpove aborption of sweat
aluminium hydrochldoird powder may help reduce sweating
urea based emollients may help hyperkeratosis and fissusing
topical steroids for flares
