Eczema & Dermatitis

Question 1

The simplified pathophysiology is that eczema is

Answer 1

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.

Question 2

Eczema occurs in around ?% of children and is becoming more common.

Answer 2

Eczema occurs in around 15-20% of children and is becoming more common.

Question 3

Eczema typically presents?

Answer 3

before 6 months

Question 4

When does eczema typically clear?

Answer 4

clears in around 50% of children by 5 years of age and in 75% of children by 10 years of age

Question 5

Features of eczema?

Answer 5

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

Question 6

Management of eczema in children?

Answer 6

avoid irritants
simple emollients
topical steroids
in severe cases wet wraps and oral ciclosporin may be used

Question 7

How should emollients be prescribed for eczema?

Answer 7

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.

Question 8

Creams soak into the skin faster than ointments.

Answer 8

true

Question 9

Emollients can become contaminated with bacteria

Answer 9

true

fingers should not be inserted into pots (many brands have pump dispensers)

Question 10

Eczema - Prognostic markers associated with severe disease include?

Answer 10

onset at age 3-6 months
severe disease in childhood
associated asthma or hay fever
small family size
high IgE serum levels

Question 11

Management of eczema in adults?

Answer 11

emollients
topical steroids
UV radiation
immunosuppressants: e.g. ciclosporin, antihistamines and azathioprine

Question 12

In Eczema Use weakest steroid cream which controls patients symptoms

Answer 12

true

Question 13

Mild steroid?

Answer 13

Hydrocortisone 0.5-2.5%

Question 14

Moderate steroid?

Answer 14

Betamethasone valerate 0.025% (Betnovate RD)

Clobetasone butyrate 0.05% (Eumovate)

Question 15

Potent Steroid

Answer 15

Fluticasone propionate 0.05% (Cutivate)

Betamethasone valerate 0.1% (Betnovate)

Question 16

Very potent steroid?

Answer 16

Clobetasol propionate 0.05% (Dermovate)

Question 17

What is the finger tip rule?

Answer 17

1 finger tip unit (FTU) = 0.5 g, sufficient to treat a skin area about twice that of the flat of an adult hand

Question 18

Topical steroid doses for eczema in adults

Area of skin & Fingertip units per dose

Answer 18

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

Question 19

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:

Answer 19

15 to 30 g for Face and neck, Both hands, Scalp, groin & genitalia

Both arms 30 to 60 g

100g for both legs & trunk

Question 20

What is Pompholyx?

Answer 20

Pompholyx is a type of eczema which affects both the hands (cheiropompholyx) and the feet (pedopompholyx). It is also known as dyshidrotic eczema.

Question 21

Pompholyx eczema may be precipitated by

Answer 21

humidity (e.g. sweating) and high temperatures.

Question 22

Pompholyx eczema sx

Answer 22

small blisters on the palms and soles
pruritic
often intensely itchy
sometimes burning sensation
once blisters burst skin may become dry and crack

Question 23

mx pompholyx?

Answer 23

cool compresses
emollients
topical steroids

Question 24

What is Eczema herpeticum?

Answer 24

describes a severe primary infection of the skin by herpes simplex virus 1 or 2.

Question 25

Eczema herpeticum is more commonly seen in?

Answer 25

children with atopic eczema

Question 26

Eczema herpeticum often presents with?

Answer 26

rapidly progressing painful rash
On examination, monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1–3 mm in diameter are typically seen.

Question 27

Eczema herpeticum mx

Answer 27

As it is potentially life-threatening children should be admitted for IV aciclovir.

Question 28

Causes of a napkin (‘nappy’) rash include the following

Answer 28

Irritant dermatitis
Candida dermatitis
Seborrhoeic dermatitis
Psoriasis
Atopic eczema

Question 29

There are two main types of contact dermatitis:

Answer 29

irritant contact dermatitis

allergic contact dermatitis

Question 30

Describe irritant contact dermatitis

Answer 30

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

Question 31

Describe allergic contact dermatitis?

Answer 31

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

Question 32

Frequent cause of contact dermatitis?

Answer 32

Cement
The alkaline nature of cement may cause an irritant contact dermatitis whilst the dichromates in cement also can cause an allergic contact dermatitis

Question 33

What is Dermatitis herpetiformis?

Answer 33

Dermatitis herpetiformis is an autoimmune blistering skin disorder associated with coeliac disease. It is caused by deposition of IgA in the dermis.

Question 34

Features dermatitis herpetiformis?

Answer 34

itchy, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks)

Question 35

Diagnosis dermatitis herpetiformis

Answer 35

skin biopsy: direct immunofluorescence shows deposition of IgA in a granular pattern in the upper dermis

Question 36

Mx dermatitis herpetiformis

Answer 36

gluten-free diet

dapsone

Question 37

Nickel dermatitis diagnosis?

Answer 37

diagnosed by a skin patch test

Question 38

Nickel is a common cause allergic contact dermatitis and is an example of a
? hypersensitivity reaction

Answer 38

type IV hypersensitivity reaction