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Clinical lectures: Yr2 > Eczema: Atopic dermatitis > Flashcards

Eczema: Atopic dermatitis Flashcards

Dermatology

1
Q

Define eczema?

A

Chronic condition that causes skin itchiness, inflammation, irritation

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2
Q

Why is eczema used interchangeably with the term dermatitis?

A

Eczema is a form of chronic dermatitis

Dermatitis: Conditions that cause skin inflammation

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3
Q

What are the 9 main types of eczema?

A

Pompholyx
Contact dermatitis
Atopic dermatitis
Venous eczema
Lichen simplex
Gravitational eczema
Irritant dermatitis
Discoid eczema
Seborrheic dermatitis

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4
Q

What is pompholyx?

A

Eczema that affects hands and feet

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5
Q

What is allergic contact dermatitis?

A

Eczema caused by contact with allergen

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6
Q

What is irritant contact dermatitis?

A

Eczema caused by non-specific response contact with physical or chemical irritant

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7
Q

What is the most common form of eczema?

A

Atopic dermatitis

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8
Q

What is the typical onset age of atopic dermatitis?

A

Childhood (before 5 yrs old) but can occur at any age

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9
Q

What kind of conditions are usually associated with atopic dermatitis?

A

Other atopic conditions eg. asthma, hay fever

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10
Q

What kind of history does a patient with atopic dermatitis usually present with?

A

Family history of atopy

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11
Q

How does presentation of atopic dermatitis typically change with age?

A

Affects more flexural surfaces, less extensor surfaces

As age increases

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12
Q

What 3 types of skin abnormalities does atopic dermatitis commonly present as?

A

Plaques

Patches

Papules

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13
Q

Describe how plaques, patches or papules caused by atopic dermatitis typically present?

A

Pruritic (incessant and causes poor sleep)

Erythematous

Flaky, crusty, dry (xerosis)

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14
Q

What is the typical distribution of atopic dermatitis in infants?

A

Face, scalp, neck, trunk and extensor surfaces

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15
Q

What is the typical distribution of atopic dermatitis in children?

A

Flexor surfaces with residue on face, neck

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16
Q

What is the typical distribution of atopic dermatitis in adults?

A

Flexor surfaces

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17
Q

How is the diagnosis of atopic dermatitis confirmed?

A

Clinical diagnosis confirmed by patient history (particularly family history)

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18
Q

What FBC finding can indicate atopic dermatitis?

A

Elevated eosinophil count

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19
Q

What is xerosis?

A

Dry, flaky skin

20
Q

How can you investigate if eczema is causing infection?

A

Skin swab to confirm if a viral or bacterial infection has caused it, can also guide treatment

21
Q

Why can a patch test be useful in diagnosing eczema?

A

Patch test to confirm if a particular substance/allergen is causing it

22
Q

Give 2 examples of scoring tools used to measure the severity of eczema?

A

Eczema Area and Severity Index (EASI)

Dermatology Life Quality Index (DLQI)

23
Q

What types of emollients are used to treat atopic dermatitis?

A

Lotion, cream, ointments

24
Q

Which 4 topical steroids are used to treat atopic dermatitis?

A

1% hydrocortisone cream: Mildly potent so is used for infants with face, mild eczema and eyelids

Eumovate cream: Mild-moderately potent so is used for infants with body eczema, face

Elocon 0.1% cream: Moderately potent so is used for body

Dermovate cream: Very potent so is used for severe body eczema

25
Q

How does a patient measure how much topical steroid to used for eczema?

A

Finger Tip Unit (FTU): (about 500mg) is the amount needed to squeeze a line from the tip of an adult finger to the first crease of the finger

Various estimates for body surface area and the number of FTUs required

26
Q

How often should a patient use topical steroid to treat eczema?

A

Daily use for 2-4 weeks then reduce to alternate days, then to 1/2 times weekly

27
Q

When are topical calcineurin inhibitors indicated for treatment of eczema?

A

Alternative to topical steroids

28
Q

How old must patients be for licensed use of topical calcineurin inhibitors, to treat eczema?

A

2 yrs old and older

29
Q

What is the most important side effect of oral calcineurin inhibitors for treatment of eczema?

A

Increase risk of lymphoma/skin malignancy

30
Q

When is phototherapy indicated for treatment of eczema?

A

Moderate-severe eczema that won’t respond to topical treatments alone

31
Q

What kind of phototherapy is used for body eczema?

A

UVB

32
Q

What kind of phototherapy is used for hands and feet eczema?

A

PUVA (psoralen and ultraviolet A)

33
Q

How often does a patient receive phototherapy to treat eczema?

A

Several appointments at hospital per week, for a few weeks

34
Q

Give 2 examples of biologics that can be used to treat eczema?

A

Monoclonal antibodies

JAK inhibitors

35
Q

Can DMARDs be used to treat eczema?

A

Yes

36
Q

What are the 3 main factors that make up the pathophysiology of eczema?

A

Genetic

Environmental

Immunological

37
Q

What is the correlation between individuals with atopic dermatitis and infections?

A

Individuals with AD more likely to develop viral, bacterial, fungal infections

38
Q

What is the genetic factor that causes epidermal dysfunction and leads to eczema?

A

Mutation causing filaggrin deficiency (faulty epithelial differentiation genes on chromosome 1), which bind keratin in the epidermis

39
Q

Which 2 epidermal layers are most affected by eczema?

A

Stratum granulosum: Comprises keratinocytes that have matured to the point where they are beginning to produce the large amounts of keratin

Stratum corneum: Contains keratinocytes that are shedding keratin

40
Q

What do epithelial differentiation genes code for, and how can mutations cause eczema?

A

Code for lipids, enzymes, proteins (eg. filaggrin) to provide stability to epidermis

Unstable structure which allows penetration of allergens and microbes

41
Q

What causes dry skin in eczema?

A

Less natural moisture in skin due to reduced lipids

42
Q

What mechanical stress can contribute to eczema?

A

Itching skin

43
Q

What is the combined result of mechanical stress, unstable epidermal structure and penetration of irritants on eczema?

A

Weakens epidermal barrier more, exacerbates eczema

44
Q

What is excoriation?

A

Uncontrollable skin-picking which can cause irritation and scarring

45
Q

What is lichenification?

A

Thick leathery skin with exaggerated skin markings caused by sudden itching

Clinical lectures: Yr2 (10 decks)

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