Eczema - Atopic Dermatitis Flashcards
Eczema is an inflammatory skin condition that causes dry skin, itchy skin, rashes, scaly patches, blisters and skin infections. Which of the following is the most common form of eczema?
1 - atopic dermatitis
2 - idiopathic eczema
3 - microbial eczema
4 - seborrheic eczema
1 - atopic dermatitis
Chronic disease that causes skin dryness, inflammation, redness, and irritation of the skin
What is the estimated prevalence of atopic dermatitis in children?
1 - 1-3%
2 - 5-10%
3 - 10-30%
4 - 50%
3 - 10-30%
- adults is 2-10%
- overall prevalence is increasing, especially in high income countries
Atopic dermatitis is the most common form of eczema. Where:
- atopic = allergy
- derm = skin
- itis = inflammation
Atopic dermatitis can affect any ages, but what age accounts for 70-90% of all cases?
1 - <5
2 - >10
3 - <15
4 - <20
1 - <5
- around 45% of these cases are in children under 6 months
How many subsets of atopic dermatitis are there based on age?
1 - 6
2 - 4
3 - 3
4 - 2
3 - 3
- Early-onset –first 2 years
- Late onset – after puberty
- Senile onset – after 60
There is a strong genetic risk associated with atopic dermatitis. What is the likelihood of a child having atopic dermatitis if both parents have it?
1 - 80%
2 - 40%
3 - 20%
4 - 5%
1 - 80%
- 60% if only 1 parent has it
Are children with other allergies more likely to suffer with atopic dermatitis?
- yes
What does the term ‘atopic march’ relate to?
1 - marching leads to skin inflammation
2 - skin allergies are due to bacteria from vaginal canal causing allergies
3 - children develop atopic dermatitis, and subsequently develop other allergies
4 - can be all of the above
3 - children develop atopic dermatitis, and subsequently develop other allergies
- food allergies, asthma and allergic rhinoconjunctivitis are examples
Rhinoconjunctivitis
- rhino = nose
conjunct = eyes
The pathophysiology of atopic dermatitis is complex. Which of the following have been identified as a contributor to the development of atopic dermatitis?
1 - Mutations in filaggrin gene epidermal barrier function
2 - Family history
3 - Gene-gene and gene-environment interactions
4 - epidermal barrier dysfunction
5 - Transepidermal water loss
6 - Pruritus – 1L 13
7 - Epicutaneous sensitisation
8 - all of the above
8 - all of the above
- filaggrin = binds keratin fibres together in skin, important for barrier protection
- environmental factors also play an important role
To diagnose a patient with atopic dermatitis, patients much have an itchy skin condition, and how many of the following:
- involvement of skin creases
- personal history of atopy
- dry skin
- visible flexural eczema
- onset under 2 years of age
1 - all of them
2 - >4
3 - >3
4 - >2
3 - >3
Essentially a barrier defect causes water loss and dry skin
Emollients are key
Lotions, creams, gels and ointments
Triple emollient therapy
Does atopic dermatitis affect the flexor or extensor regions of the body more?
- flexor regions
In the acute stage of dermatitis, which of the following do patients typically NOT present with?
1 - erythema
2 - oedema
3 - papules and plaques
4 - vesiculation
5 - oozing and crusting
6 - joint deformities
6 - joint deformities
Image shows how stages eczema goes through from dry skin, to fissures to exudate and eventually lichenification (thickened, hardened area of skin)
Diagnosis of atopic dermatitis can be divided into IgE (allergy associated) or non-IgE form. In the acute stage of dermatitis, which of the following do patients typically present with?
1 - dry skin
2 - pruritus (itchy) skin
3 - crusting with oozing
4 - scaling/lesion formation
5 - skin oedema (swelling)
6 - papule and plaques
7 - all of the above
7 - all of the above
- pruritus is common in acute, subacute and chronic
- Subacute = erythema, scaling and variable crusting
- Chronic = thickened plaques with lichenification (thickened, hardened area of skin)
Can atopic dermatitis cause changes in pigmentation?
- yes
- can be hypo and hyperpigmentation
What type of eczema can we seen in the image below?
1 - extensor eczema
2 - foot eczema
3 - flexor eczema
4 - head and neck eczema
3 - flexor eczema
In infant eczema, which region is NOT typically affected?
1 - cheeks
2 - scalp
3 - neck
4 - extensor extremities
5 - diaper area
5 - diaper area
- typically spares the diaper area
- children tend to rub the skin against the bedding
- skin will be erythematous, papules and papulovesicles
In childhood (2-12 y/o) atopic dermatitis, which region is NOT typically affected?
1 - thighs
2 - head
3 - neck
4 - wrists and ankles
5 - antecubital and popliteal fossa
1 - thighs
- not typically affected
- antecubital and popliteal fossa = referred to as flexor eczema
Childhood (2-12 y/o) atopic dermatitis, typically affects the neck, head, wrists and ankles. Does it typically cause Xerosis?
- yes
- medical term for dry skin
What typically happens to the sin in children (2-12 y/o) with chronic atopic dermatitis?
1 - more exudative
2 - skin becomes lichenified
3 - bleeding
4 - increased plaque formation with scales
2 - skin becomes lichenified
Can also cause pigmentation changes
In atopic dermatitis, once a patients eczema is under control does it stay away?
- no
Generally causes relapses and reoccurs, typically due to some form or skin irritation
In adult (>12 y/o) atopic dermatitis, which region of the body is NOT typically affected?
1 - Flexural
2 - Chronic hand dermatitis
3 - Facial dermatitis
4 - Bum and groinal area
5 - Eyelid involvement
4 - Bum and groinal area
- not commonly affected
Senile atopic dermatitis can cause a number of issues, including ALL of the following EXCEPt which one?
1 - Marked dryness (xerosis)
2 - Delirium
3 - May not have typical lichenified lesions
4 - Sleep disturbances , social isolation
5 - Psychological distress
2 - Delirium
The name of the eczema is typically linked to its location, including:
1 - Chelitis sicca – lips
2 - Lip licker’s eczema
3 - Ear eczema
4 - Eyelid eczema
5 - Head and neck dermatitis
6 - Juvenile plantar dermatosis
7 - Atopic hand eczema
8 - Nipple eczema
Which of the following is NOT a typical feature that is common in atopic dermatitis?
1 - Xerosis –dry skin
2 - Guttate
3 - Icthyosis vulgaris
4 - Keratosis pilaris
5 - Hyperlinearity
6 - Periorbital darkening
2 - Guttate
- happens in psoriasis, where small, round papules that are raised and sometimes scaly appear
All of the following are features of atopic dermatitis, but which is in the image?
1 - Xerosis –dry skin
2 - Icthyosis vulgaris
3 - Keratosis pilaris
4 - Hyperlinearity
5 - Periorbital darkening
3 - Keratosis pilaris
- dry, rough patches and tiny bumps, often on the upper arms, thighs, cheeks or buttocks
- keratosis = hard skin
- pilaris= hair follicle
All of the following are features of atopic dermatitis, but which is in the image?
1 - Xerosis –dry skin
2 - Icthyosis vulgaris
3 - Keratosis pilaris
4 - Hyperlinearity
5 - Periorbital darkening
2 - Icthyosis vulgaris
- excessive dry skin as old skin is not shed
All of the following are features of atopic dermatitis, but which is in the image?
1 - Xerosis –dry skin
2 - Icthyosis vulgaris
3 - Keratosis pilaris
4 - Hyperlinearity
5 - Periorbital darkening
4 - Hyperlinearity
- thickening of the skin on the palms and soles with an increase in the number of lines in the skin.
All of the following are features of atopic dermatitis, but which is in the image?
1 - Xerosis –dry skin
2 - Icthyosis vulgaris
3 - Keratosis pilaris
4 - Hyperlinearity
5 - Periorbital darkening
5 - Periorbital darkening
Impetiginisation is a complication of atopic dermatitis. What is Impetiginisation?
1 - skin infection of eczema patches
2 - infection caused by herpes virus
3 - severe inflammation of the skin
4 - ocular complication
1 - skin infection of eczema patches
- most common cause is Streptococcus or staphylococcus
Impetiginisation is a complication of atopic dermatitis. What is Impetiginisation?
1 - skin infection of eczema patches
2 - infection caused by herpes virus
3 - severe inflammation of the skin
4 - problems with eyes
4 - problems with eyes
Impetiginisation is a complication of atopic dermatitis. What is Erythroderma?
1 - skin infection of eczema patches
2 - infection caused by herpes virus
3 - severe inflammation of the skin
4 - problems with eyes
3 - severe inflammation of the skin
- typically >90% of the skin is affected
- can be life threatening
Impetiginisation is a complication of atopic dermatitis. What is Eczema herpeticum?
1 - skin infection of eczema patches
2 - infection caused by herpes virus
3 - severe inflammation of the skin
4 - problems with eyes
2 - infection caused by herpes simplex virus
- eczema patients typically have impaired immunity and are more susceptible to HSV
Eczema herpeticum is a complication of atopic dermatitis and is caused herpes simplex virus 1 and 2. Where does this typically begin in its presentation?
1 - head and neck
2 - feet and hands
3 - head and feet
4 - neck and hands
1 - head and neck
- can then spread down the body
Eczema herpeticum is a complication of atopic dermatitis and is caused herpes simplex virus 1 and 2. Once contact has been made with someone with HSV, how long before a patient typically presents with Eczema herpeticum?
1 - 1-2 days
2 - 3-5 days
3 - 5-12 days
4 - 7-21 days
3 - 5-12 days
Eczema herpeticum is a complication of atopic dermatitis and is caused herpes simplex virus 1 and 2. Which of the following is the least likely organ to be affected as a complication of eczema herpeticum?
1 - eyes
2 - heart
3 - brain
4 - lung
5 - liver
2 - heart
Eczema herpeticum can be fatal
Eczema herpeticum is a complication of atopic dermatitis and is caused herpes simplex virus 1 and 2. How is this typically be diagnosed?
1 - PCR for viral DNA
2 - positive viral antibodies
3 - culture growth for virus
4 - all of the above
4 - all of the above
- commonly a clinical diagnosis though
Once a patient has been diagnosed with eczema herpeticum, all of the following should be used in the acute setting, EXCEPT which one?
1 - emollient eg 50:50 QDS
2 - aciclovir 200mg x 5 per day for 5 daysOR IV aciclovir 5mg/kg TDS for 5 days, 10mg/kg TDS for 5 days if immunocompromised
3 - topical steroids
4 - abx for secondary bacterial infx
3 - topical steroids
- should be avoided in acute phase due to immunosuppression affect
- eczema should be managed once eczema herpeticum has been treated
Common trigger factors for atopic dermatitis include pollen, dust mites , animal dander, and some foods, such as
eggs, milk, peanut, soy and wheat. Which 2 of the following would help the clinician identify that one the above may be a trigger for the atopic dermatitis?
1 - IgE prick testing
2 - skin biopsy
3 - urine sample
4 - clinical history
1 - IgE prick testing
4 - clinical history
In patients with atopic dermatitis, what type of baths can help reduce the colonisation of staphylococcus?
1 - bubble bath
2 - bleach bath
3 - plain water bath
4 - bath with antibiotics
2 - bleach bath
- Avoid bubble baths and scented salts and oils and reduce the frequency of baths
Which of the following would be the 1st line treatment of choice for atopic dermatitis?
1 - topical steroids
2 - antivirals
3 - light treatment
4 - emollients/ointment /cream/ lotion
4 - emollients/ointment /cream/ lotion
- twice/day
- apply <3 minutes after bath
Non-sedative anti-histamine are also useful to help with itching
If a patient is managing their atopic dermatitis with emollients/ointment /cream/ lotion, what can be given in an acute flair up?
1 - topical steroids
2 - antivirals
3 - light treatment
4 - skin biopsy
1 - topical steroids
- applied before ointments/creams
-provide anti-inflammatory properties
Which of the following steroids can be used on the face?
1 - Hydrocortisone
2 - Dermovate
3 - Eumovate
4 - Betnovate
1 - Hydrocortisone
Patients with atopic dermatitis can be treated with steroids. Typically how long are patients prescribed the steroids for before they need to be reviewed and/or stepped down?
1 - 1 week
2 - 2 weeks
3 - 4 weeks
4 - 8 weeks
2 - 2 weeks
The following are anti-inflammatory treatments for patients with atopic dermatitis in cases of flare-ups.
- Topical corticosteroids- Hydrocortisone butyrate, mometasone furoate
- Topical calcineurin inhibitors -Tacrolimus 0.1% and 0.03% ointment , Pimecrolimus 1%cream
Which body part should these treatments have limited use on?
1 - back and arms
2 - face and skin folds
3 - hands and face
4 - skin folds and hands
2 - face and skin folds
- skin is softer, so easier to damage
- may cause stinging anywhere on the body
- use proactivly twice weekly application to prevent flare ups
How much of a topical steroid should patients typically be advised to use?
1 - enough to completely cover affected area
2 - cover affected area with 1cm thickness
3 - cover affected area with 20mm thickness
4 - finger tip units
4 - finger tip units
- 1 finger tip = 1/2 gram of cream
Which of the following is NOT advice you should give to patients using topical steroids?
1 - Use the lowest potency available
2 - use on affected areas only
3 - Not more than four times daily
4 - Avoid large areas for long periods
5 - Occlusion increases absorption
6 - limit use on sensitive skin
3 - Not more than four times daily
- maximum should be twice daily
- occlusion relates to underneath a dressing
Which of the following can patients use to help treat atopic dermatitis as an adjunct therapy alongside ointments and topical steroids?
1 - Wet wraps (help with dry skin)
2 - Bleach baths (reduce colonisation)
3 - Treatment of associated infections
4 - Probiotics
5 - Modified diets under dietician guidance
6 - all of the above
6 - all of the above
Which of the following can be used to control the inflammation of the skin in atopic dermatitis?
1 - Phototherapy
2 - Immunosuppressives
3 - Antihistamines
4 - Educational programmes
1 - Phototherapy
- ultra violet A and B
Which of the following can be used to help with itching in atopic dermatitis?
1 - Phototherapy
2 - Immunosuppressives
3 - Antihistamines
4 - Educational programmes
3 - Antihistamines
Which of the following could be tried in a child with extensive and/severe eczema?
1 - anti-virals
2 - oral corticosteroids
3 - antibiotics
4 - surgery
2 - oral corticosteroids
Short course and begin at lowest dosage
Which of the following is a common Immunosuppressives used in atopic dermatitis as a last resort typically?
1 - Dupilumab
2 - Methotrexate
3 - Baracinitib
4 - all of the above
2 - Methotrexate
Typically, when is the only time a patient with be started on antibiotics due to their eczema?
1 - severe/extensive outbreak
2 - eczema associated with anaphylaxis
3 - eczema is weeping, crusted, or there are pustules, with fever or malaise
4 - all of the above
3 - eczema is weeping, crusted, or there are pustules, with fever or malaise
Typically means the eczema has become infected cuasing secondary bacterial infection
These children are typically brought to A&E or seen by GP.
What can we seen in the image below?
1 - Gravitational dermatitis (Venous eczema)
2 - Irritant contact dermatitis
3 - Discoid eczema
4 - seborrheic dermatitis
3 - Discoid eczema
Discoid eczema is a common type of eczema/dermatitis defined by scattered, well-defined, coin-shaped and coin-sized plaques of eczema. Which of the following is NOT a treatment option for discoid dermatitis?
1 - Avoid injury
2 - Antivirals
3 - Emollients
4 - Steroids
5 - Phototherapy
2 - Antivirals
What can we seen in the image below?
1 - Gravitational dermatitis (Venous eczema)
2 - Irritant contact dermatitis
3 - Allergic contact dermatitis (ACD)
4 - seborrheic dermatitis
3 - Allergic contact dermatitis (ACD)
Managed by removing the cause of the trigger of the allergy
What can we seen in the image below?
1 - Gravitational dermatitis (Venous eczema)
2 - Irritant contact dermatitis
3 - Allergic contact dermatitis (ACD)
4 - seborrheic dermatitis
2 - Irritant contact dermatitis
What can we seen in the image below?
1 - Gravitational dermatitis (Venous eczema)
2 - Irritant contact dermatitis
3 - Allergic contact dermatitis (ACD)
4 - seborrheic dermatitis
1 - Gravitational dermatitis (Venous eczema)
Treated with:
- Compression, if appropriate
- Emollients
- Steroids under occlusion
