Eczematous eruptions: Atopic eczema, contact dermatitis, perioral

Question 1

What is atopic eczema?

Answer 1

a chronic inflammatory disorder of the skin characterised by dermal inflammation leading to histological changes in the epidermis such as spongiotic change, acanthosis, hyperkeratosis, and parakeratosis.

Question 2

Presentation of atopic eczema?

Answer 2

itchiness
erythema
oozing
dry, flaky skin
lichenification
sore patches of skin on neck, flexors, surface of limbs, hands

FHx
Atopic conditions -asthma, allergic rhinitis hx

Question 3

How is atopic eczema severity assessed?

Answer 3

Clear
Mild
Moderate
Severe
Infected

Question 4

Diagnosis and management of atopic eczema?

Answer 4

Clinical diagnosis

Emollients
- apply before steroid -helps soothe and hydrate skin

Topical corticosteroid
- reduces inflammation, hence helps with itching, swelling
- START WITH MILD STRENGTH STEROID e.g. hydrocortisone

Antihistamine
- help with itching

Avoid triggers -soaps, perfumes, biological detergents, allergens.

Pt education

Consider referral to derm if optimum tx are not helping.

Consider referral to clinical psychologist -can affect mental health.

Question 5

Ointments vs cream absorption difference?

Answer 5

Ointments take longer to absorb as it contains highest oil content. Preferred for dry skins.

Creams are less oily than ointments but have less moisturising effect, but can absorb within 15-20mins into the skin.

Question 6

What is contact dermatitis?

Answer 6

Skin inflammation reaction of the skin that results from direct contact with an offending agent.

Two types:
IRRITANT CONTACT DERMATITIS
- resulting from direct contact with substances that irritate the skin

ALLERGIC CONTACT DERMATITIS
- provoke an allergic response

Question 7

Causes of ICD and ACD? Diagnosis/IVx?

Answer 7

ICD:
- chemical irritant

ACD:
- an allergen/antigen eliciting a type IV (cell-mediated or delayed) hypersensitivity reaction.

Clinical diagnosis.

Possible IVx:
- patch testing (identify allergen)
- skin biopsy (confirm diagnosis)

Question 8

Irritant contact dermatitis (ICD) presentation?

Answer 8

lesions erythematous
vesicles
crusting
scaling
sharp margins STRICTLY CONFINED to site of exposure

rapid onset (few hrs after exposure)

Question 9

Allergic contact dermatitis (ACD) presentation?

Answer 9

Lesions may be erythematous
pupules
vesicles
erosions
crusts
scaling
itchy

initially sharp margins confined to site of exposure then SPREADING TO PERIPHERY

onset 12-72hrs after exposure

occurs only in sensitised

Question 10

Treatment of contact dermatitis?

Answer 10

Avoid exposure, decontaminate after exposure with soap and water.

For itching relief:
- Aveeno (oatmeal) baths
- Calamine lotion
- Cool compresses
- Oral histamines

Moderate/high potency topical steroids

Consider systemic steroids if severe reaction:
- oral prednisone taper over 7-21days
- tapering too soon can lead to rebound flare.

Question 11

Define perioral dermatitis? Diagnosis/IVx?

Answer 11

Benign eruption that occurs mostly in young, female adults.

Consists of small inflammatory papules and pustules or pink, scaly patches around the mouth.

Clinical diagnosis

Question 12

Presentation of perioral dermatitis?

Answer 12

Nasolabial erythema
Perioral skin (with relative sparing of the lip margins)
Small papules and pustules
erythema
scaling

Question 13

Management of perioral dermatitis?

Answer 13

Wash hands after applying steroids

Avoid alcohol, spicy food (dilates skin blood vessels).

Avoid cosmetics, moisturisers, cleansers.

topical METRONIDAZOLE or ERYTHROMYCIN (mild)

oral abx LYMECYCLINE (if severe case)