eczema r

Question 1

what is eczema

Answer 1

chronic atopic condition

Question 2

pathophysiology of eczema

Answer 2

barrier defect allows irritants and allergens to enter the skin
skin becomes inflamed

Question 3

risk factors for eczema

Answer 3

FH
filaggrin protein mutations
autoimmune disease e.g. asthma

Question 4

presentation of eczema

Answer 4

red dry itchy skin
flare ups
Hyperlinearity in filaggrin deficiency

Question 5

where does the rash usually appear in eczema

Answer 5

flexor surfaces
face
neck

Question 6

common triggers for eczema

Answer 6

illness
stress
teething
cold air
central heating

Question 7

characteristics of atopic eczema

Answer 7

wide spread diffuse scaly red eruption
very itchy
early onset

Question 8

when should you be more concerned about atopic eczema

Answer 8

when it presents earlier than 3months old

Question 9

discoid eczema characteristics

Answer 9

scattered circular patches that recur in the same place

very stubborn to treat

Question 10

specific treatment for discoid eczema

Answer 10

topical steroid for 14 days then twice a week to maintain

Question 11

characteristics of seborrheic dermatitis

Answer 11

mainly on scalp and face
proliferation of commensals
very scaly

Question 12

how would you use topical steroids in eczema

Answer 12

once a day for 1-2 weeks
reduce use if it improves
use once a week on stubborn areas
return to daily use in flare up

Question 13

what other basic treatments can be used in eczema

Answer 13

emollients
soap substitutes
fitted physical barriers to present scratching

Question 14

what should you consider if topical steroids don’t work

Answer 14

consider allergy 
phototherapy 
protopic ointment 
immunosuppressants 
biologics 
oral corticosteroids

Question 15

what immunosuppressants are used

Answer 15

methotrexate
ciclosporin
azathioprine

Question 16

what biologic can be used in eczema

Answer 16

dupilomab

Question 17

order of topical steroid ladder from least to most potent

Answer 17

HEBD
hydrocortisone 
eumovate 
betnovate 
dermovate

Question 18

how should steroids be used on the face

Answer 18

try and limit it as much as possible - especially around eyes
use for 3-5 days then stop
repeat when needed

Question 19

what should you introduce if the patient needs to use steroids on their face regularly

Answer 19

topical tacroliums for 14 days then twice a week

Question 20

what is eczema herpecticum

Answer 20

viral skin infection caused by HSV or VZV

Question 21

presentation of eczema herpeticum

Answer 21

widespread painful vesicular rash 
monomorphic punched out lesions
systemic symptoms - fever, lethargy, irritability, reduced oral intake 
lymphadenopathy 
history of eczema

Question 22

investigation in eczema herpeticum

Answer 22

viral swab of rash

Question 23

management of eczema herpeticum

Answer 23

aciclovir - IV in severe cases
withhold topical steroids for 24hrs
analgesics
opthamology review if near eyes