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A. Block B Dermatology > Eczema - Atopic Dermatitis > Flashcards

Eczema - Atopic Dermatitis Flashcards

1
Q

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

A

1 - atopic dermatitis

Chronic disease that causes skin dryness, inflammation, redness, and irritation of the skin

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2
Q

What is the estimated prevalence of atopic dermatitis in children?

1 - 1-3%
2 - 5-10%
3 - 10-30%
4 - 50%

A

3 - 10-30%

  • adults is 2-10%
  • overall prevalence is increasing, especially in high income countries
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3
Q

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

A

1 - <5
- around 45% of these cases are in children under 6 months

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4
Q

How many subsets of atopic dermatitis are there based on age?

1 - 6
2 - 4
3 - 3
4 - 2

A

3 - 3
- Early-onset –first 2 years
- Late onset – after puberty
- Senile onset – after 60

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5
Q

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%

A

1 - 80%
- 60% if only 1 parent has it

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6
Q

Are children with other allergies more likely to suffer with atopic dermatitis?

A
  • yes
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7
Q

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

A

3 - children develop atopic dermatitis, and subsequently develop other allergies

  • food allergies, asthma and allergic rhinoconjunctivitis are examples

Rhinoconjunctivitis
- rhino = nose
conjunct = eyes

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8
Q

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

A

8 - all of the above

  • filaggrin = binds keratin fibres together in skin, important for barrier protection
  • environmental factors also play an important role
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9
Q

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

A

3 - >3

Essentially a barrier defect causes water loss and dry skin

Emollients are key

Lotions, creams, gels and ointments

Triple emollient therapy

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10
Q

Does atopic dermatitis affect the flexor or extensor regions of the body more?

A
  • flexor regions
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11
Q

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

A

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)

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12
Q

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

A

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)
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13
Q

Can atopic dermatitis cause changes in pigmentation?

A
  • yes
  • can be hypo and hyperpigmentation
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14
Q

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

A

3 - flexor eczema

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15
Q

In infant eczema, which region is NOT typically affected?

1 - cheeks
2 - scalp
3 - neck
4 - extensor extremities
5 - diaper area

A

5 - diaper area
- typically spares the diaper area

  • children tend to rub the skin against the bedding
  • skin will be erythematous, papules and papulovesicles
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16
Q

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

A

1 - thighs
- not typically affected

  • antecubital and popliteal fossa = referred to as flexor eczema
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17
Q

Childhood (2-12 y/o) atopic dermatitis, typically affects the neck, head, wrists and ankles. Does it typically cause Xerosis?

A
  • yes
  • medical term for dry skin
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18
Q

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

A

2 - skin becomes lichenified

Can also cause pigmentation changes

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19
Q

In atopic dermatitis, once a patients eczema is under control does it stay away?

A
  • no

Generally causes relapses and reoccurs, typically due to some form or skin irritation

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20
Q

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

A

4 - Bum and groinal area
- not commonly affected

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21
Q

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

A

2 - Delirium

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22
Q

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

A
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23
Q

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

A

2 - Guttate
- happens in psoriasis, where small, round papules that are raised and sometimes scaly appear

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24
Q

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

A

3 - Keratosis pilaris
- dry, rough patches and tiny bumps, often on the upper arms, thighs, cheeks or buttocks

  • keratosis = hard skin
  • pilaris= hair follicle
25
Q

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

A

2 - Icthyosis vulgaris
- excessive dry skin as old skin is not shed

26
Q

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

A

4 - Hyperlinearity
- thickening of the skin on the palms and soles with an increase in the number of lines in the skin.

27
Q

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

A

5 - Periorbital darkening

28
Q

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

A

1 - skin infection of eczema patches
- most common cause is Streptococcus or staphylococcus

29
Q

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

A

4 - problems with eyes

30
Q

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

A

3 - severe inflammation of the skin
- typically >90% of the skin is affected

  • can be life threatening
31
Q

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

A

2 - infection caused by herpes simplex virus

  • eczema patients typically have impaired immunity and are more susceptible to HSV
32
Q

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

A

1 - head and neck
- can then spread down the body

33
Q

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

A

3 - 5-12 days

34
Q

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

A

2 - heart

Eczema herpeticum can be fatal

35
Q

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

A

4 - all of the above
- commonly a clinical diagnosis though

36
Q

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

A

3 - topical steroids
- should be avoided in acute phase due to immunosuppression affect

  • eczema should be managed once eczema herpeticum has been treated
37
Q

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

A

1 - IgE prick testing
4 - clinical history

38
Q

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

A

2 - bleach bath

  • Avoid bubble baths and scented salts and oils and reduce the frequency of baths
39
Q

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

A

4 - emollients/ointment /cream/ lotion
- twice/day
- apply <3 minutes after bath

Non-sedative anti-histamine are also useful to help with itching

40
Q

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

A

1 - topical steroids
- applied before ointments/creams
-provide anti-inflammatory properties

41
Q

Which of the following steroids can be used on the face?

1 - Hydrocortisone
2 - Dermovate
3 - Eumovate
4 - Betnovate

A

1 - Hydrocortisone

42
Q

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

A

2 - 2 weeks

43
Q

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

A

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

44
Q

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

A

4 - finger tip units
- 1 finger tip = 1/2 gram of cream

45
Q

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

A

3 - Not more than four times daily
- maximum should be twice daily

  • occlusion relates to underneath a dressing
46
Q

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

A

6 - all of the above

47
Q

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

A

1 - Phototherapy
- ultra violet A and B

48
Q

Which of the following can be used to help with itching in atopic dermatitis?

1 - Phototherapy
2 - Immunosuppressives
3 - Antihistamines
4 - Educational programmes

A

3 - Antihistamines

49
Q

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

A

2 - oral corticosteroids

Short course and begin at lowest dosage

50
Q

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

A

2 - Methotrexate

51
Q

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

A

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.

52
Q

What can we seen in the image below?

1 - Gravitational dermatitis (Venous eczema)
2 - Irritant contact dermatitis
3 - Discoid eczema
4 - seborrheic dermatitis

A

3 - Discoid eczema

53
Q

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

A

2 - Antivirals

54
Q

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

A

3 - Allergic contact dermatitis (ACD)

Managed by removing the cause of the trigger of the allergy

55
Q

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

A

2 - Irritant contact dermatitis

56
Q

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

A

1 - Gravitational dermatitis (Venous eczema)

Treated with:
- Compression, if appropriate
- Emollients
- Steroids under occlusion

57
Q
A
58
Q
A

A. Block B Dermatology (33 decks)

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