Eczematous eruptions

Question 1

Define macule

Answer 1

Circumucised lesion with change to skin colour
Not elevated or depressed

Question 2

Define papule

Answer 2

Solid, elevated lesion with no visible fluid <0.5mm in diameter

Question 3

Define vesicle

Answer 3

Elevated vesicle with clear fluid <5mm in diameter

Question 4

Define plaque

Answer 4

Elevated area of skin 2cm or more in diameter

Question 5

Define lichenification

Answer 5

Thick leathery skin in certain areas as a result of regular scratching / rubbing

Question 6

Presentation of atopic eczema

Answer 6

Distribution - dry skin on neck, flexors of limbs (behind knees, inside elbows), hands
Itchy
Excoriation marks from scratching
Lichenification if too much scratching causing scarring (needs steroids to break it down)

Question 7

Treatment for eczema

Answer 7

Emollients - applied before steroids at least twice a day in direction of hair growth - can also use as soap alternatives

Topical corticosteroids - depending on severity
mild = hydrocortisone
moderate - strong = betamethasone
v. severe = clobetasol propionate and derm referral

Non drowsy Antihistamine (fexofenadine OTC for the itching, chloramphenamin if struggling to sleep, loratedine)

Avoid triggers
Signpost for infected eczema

Question 8

Instructions for applying steroids for eczema

Answer 8

One adult finger tip unit (FTU) on area of skin
Do not overuse

Question 9

What is contact dermatitis

Answer 9

Inflammatory reaction of skin that results from direct contact with an offending agent

Irritant contact dermatitis - cause by chemical irritant
Allergic contact dermatitis - caused by allergen causing immune mediated hypersensitivity reaction

Question 10

Difference in clinical presentation between irritant contact dermatitis and allergic contact dermatitis

Answer 10

ICD
erythematous, vesicles, crusting, scaling
SHARP MARGINS STRICTLY CONFINED TO SITE OF EXPOSURE
RAPID ONSENT - FEW HOURS OF EXPOSURE
Occurs in anyone

ACD
erythematous, papules, vesicles, erosions, crusts, scaling
INITIAL SHARP MARGINS CONFINED TO SITE OF EXPOSURE THEN SPREADING TO PERIPHERIES
ONSET AFTER 12-72 HRS OF EXPOSURE
only in sensitised people

Question 11

Things that can cause contact dermatitis

Answer 11

Neomycin
Bacitracin
Balsam
Nickel
Gold
Cobalt
Latex
Rubber
Formaldehyde
Quaternium 15
Thimerosal

Question 12

Contact dermatitis treatment

Answer 12

Prevent exposure - decontaminate with soap and water if exposed

Itch relief - aveeno/oatmeal baths, calamine lotion, cool compresses, oral antihistamines

Moderate topical steroids if really bad
High topical steroids - if really bad and nothing else works
Systemic steroids if severe reaction - oral prednisolone tapered over 7-21 days

Question 13

Presentation of perioral eczema

Answer 13

Erythematous papules, pusyles, papulovesicles
Females - 20-45 yrs
Associated with topical steroid use

Question 14

Management of perioral eczema

Answer 14

Wash hands after applying steroids
Avoid alcohol and spicy foods
Avoid cosmetics, moisturisers and cleansers

Topical metronidazole or erythomycin if mild
Oral abx (lymecycline) if severe

Question 15

Nummular eczema presentation

Answer 15

Discoid eczema
MULTIPLE COIN SHAPED LESIONS
vesicles and papules which fuse/turn into plaques
Itchy

Question 16

Treatment of nummular eczema

Answer 16

Moisturise
Hydrocortisone
Sedating antihistamine if extreme itching disturbing sleeping

Question 17

What is venous stasis eczema

Answer 17

Hyperpigmented plaques on lower legs with erythema, ulcers or oedema due to venous insufficiency with poor circulation

Question 18

Prediposing factors of venous stasis eczema

Answer 18

Varicose veins
Cardiac failure
Thrombophlebitis
Trauma / surgery to limb
Age over 50

Question 19

Venous stasis eczema treatment

Answer 19

Compression, elevation (above heart level) and walking for venous return

Topical steroids if itchy
Abx if infected - high risk of infection due to blood stasis
Treat ulcers if present

Question 20

Eczema herpeticum presentation

Answer 20

Caused by HSV 1
atopic eczema is a risk factor (for virus to get in)
Signs appear 5-12 days after contact with infected individual
- Fever
- swollen lymph nodes
- extremely painful blisters

Question 21

Eczema herpeticum treatment

Answer 21

Clinical diagnosis
Oral aciclovir
Admit if child is under 2 yrs
Send to A+E if blisters around eye areas

Question 22

Cause of infected eczema

Answer 22

Staphylococcal or streptococcal bacteria due to breaks in the skin and reduced immunity in skin due to eczema

Question 23

Infected eczema presentation

Answer 23

Painful
Red
Weepy red crusting
Already has atopic eczema

Question 24

Infected eczema treatment

Answer 24

Flucloxacillin
Macrolide (if penicillin allergic)

Question 25

What is actinic keratosis / solar keratosis

Answer 25

Sun induced premalignant lesions that grow with age

may turn into squamous cell carcnimoa over years in some ppl

Question 26

Actinic keratosis presentation

Answer 26

Isolated red / brown macule/papule with yellow / rown scale over it
Dry, flaky rash
Not itchy
In areas exposed to sun

Question 27

Actinic keratosis treatment

Answer 27

Cryotherapy / surgical removal
Diclofenac gel (NSAID gel) for 8 weeks only on affected area (if applied on healthy skin it will blister)

If no improvement around 4 week mark = referral

Tretinoin
Sunscreen - regular use
Acid peels (alpha hydroxy acids)