Eczema & Dermatitis Flashcards
The simplified pathophysiology is that eczema is
efects in the barrier that the skin provides. Tiny gaps in the skin barrier provide an entrance for irritants, microbes and allergens that create an immune response, resulting in inflammation and the associated symptoms.
Eczema occurs in around ?% of children and is becoming more common.
Eczema occurs in around 15-20% of children and is becoming more common.
Eczema typically presents?
before 6 months
When does eczema typically clear?
clears in around 50% of children by 5 years of age and in 75% of children by 10 years of age
Features of eczema?
in infants the face and trunk are often affected
in younger children eczema often occurs on the extensor surfaces
in older children a more typical distribution is seen, with flexor surfaces affected and the creases of the face and neck
Management of eczema in children?
avoid irritants
simple emollients
topical steroids
in severe cases wet wraps and oral ciclosporin may be used
How should emollients be prescribed for eczema?
large quantities should be prescribed (e.g. 250g / week), roughly in a ratio of with topical steroids of 10:1. If a topical steroid is also being used the emollient should be applied first followed by waiting at least 30 minutes before applying the topical steroid.
Creams soak into the skin faster than ointments.
true
Emollients can become contaminated with bacteria
true
fingers should not be inserted into pots (many brands have pump dispensers)
Eczema - Prognostic markers associated with severe disease include?
onset at age 3-6 months severe disease in childhood associated asthma or hay fever small family size high IgE serum levels
Management of eczema in adults?
emollients
topical steroids
UV radiation
immunosuppressants: e.g. ciclosporin, antihistamines and azathioprine
In Eczema Use weakest steroid cream which controls patients symptoms
true
Mild steroid?
Hydrocortisone 0.5-2.5%
Moderate steroid?
Betamethasone valerate 0.025% (Betnovate RD)
Clobetasone butyrate 0.05% (Eumovate)
Potent Steroid
Fluticasone propionate 0.05% (Cutivate)
Betamethasone valerate 0.1% (Betnovate)
Very potent steroid?
Clobetasol propionate 0.05% (Dermovate)
What is the finger tip rule?
1 finger tip unit (FTU) = 0.5 g, sufficient to treat a skin area about twice that of the flat of an adult hand
Topical steroid doses for eczema in adults
Area of skin & Fingertip units per dose
Hand and fingers (front and back) 1.0 A foot (all over) 2.0 Front of chest and abdomen 7.0 Back and buttocks 7.0 Face and neck 2.5 An entire arm and hand 4.0 An entire leg and foot 8.0
The BNF makes recommendation on the quantity of topical steroids that should be prescribed for an adult for a single daily application for 2 weeks:
15 to 30 g for Face and neck, Both hands, Scalp, groin & genitalia
Both arms 30 to 60 g
100g for both legs & trunk
What is Pompholyx?
Pompholyx is a type of eczema which affects both the hands (cheiropompholyx) and the feet (pedopompholyx). It is also known as dyshidrotic eczema.
Pompholyx eczema may be precipitated by
humidity (e.g. sweating) and high temperatures.
Pompholyx eczema sx
small blisters on the palms and soles pruritic often intensely itchy sometimes burning sensation once blisters burst skin may become dry and crack
mx pompholyx?
cool compresses
emollients
topical steroids
What is Eczema herpeticum?
describes a severe primary infection of the skin by herpes simplex virus 1 or 2.
Eczema herpeticum is more commonly seen in?
children with atopic eczema
Eczema herpeticum often presents with?
rapidly progressing painful rash
On examination, monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1–3 mm in diameter are typically seen.
Eczema herpeticum mx
As it is potentially life-threatening children should be admitted for IV aciclovir.
Causes of a napkin (‘nappy’) rash include the following
Irritant dermatitis Candida dermatitis Seborrhoeic dermatitis Psoriasis Atopic eczema
There are two main types of contact dermatitis:
irritant contact dermatitis
allergic contact dermatitis
Describe irritant contact dermatitis
common - non-allergic reaction due to weak acids or alkalis (e.g. detergents). Often seen on the hands. Erythema is typical, crusting and vesicles are rare
Describe allergic contact dermatitis?
type IV hypersensitivity reaction. Uncommon - often seen on the head following hair dyes. Presents as an acute weeping eczema which predominately affects the margins of the hairline rather than the hairy scalp itself. Topical treatment with a potent steroid is indicated
Frequent cause of contact dermatitis?
Cement
The alkaline nature of cement may cause an irritant contact dermatitis whilst the dichromates in cement also can cause an allergic contact dermatitis
What is Dermatitis herpetiformis?
Dermatitis herpetiformis is an autoimmune blistering skin disorder associated with coeliac disease. It is caused by deposition of IgA in the dermis.
Features dermatitis herpetiformis?
itchy, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks)
Diagnosis dermatitis herpetiformis
skin biopsy: direct immunofluorescence shows deposition of IgA in a granular pattern in the upper dermis
Mx dermatitis herpetiformis
gluten-free diet
dapsone
Nickel dermatitis diagnosis?
diagnosed by a skin patch test
Nickel is a common cause allergic contact dermatitis and is an example of a
? hypersensitivity reaction
type IV hypersensitivity reaction
