Itchy rash, eczema, and urticaria Flashcards
Where does atopic eczema present at different ages?
Non mobile infant: cheeks, face and scalp
Crawling infant: extensor surfaces
Older children: flexures
What is the DLQI score?
Dermatology Life Quality Index
- Adapted to cDLQI for children
How can eczema be scored?
- Dermatology Life Quality Index (DLQI)
- Patient Orientated Eczema Measure (POEM)
- Eczema Assessment Severity Index (EASI)
What food allergies can trigger eczema?
Milk, egg, wheat, soy, and peanut in 75% of cases
Can allergens pass through breast milk?
Yes
So breastfeeding mothers should avoid allergens
What are the management options for atopic eczema?
- Treat all atopic problems- including hay fever, food allergy, asthma
- Education
- Emollients/ bath oils
- Topical immunomodulators (Steroids/ Calcineurin inhibitors)
- Phototherapy (severe disease)
- Systemic immunomodulators (severe disease)
- Antihistamines
What are the different types of eczema?
- Atopic dermatitis
- Contact dermatitis: itchy rash caused by direct contact
- Dyshidrotic eczema (pompholyx): causes itchy, leaky papules on hands and feet
- Hand eczema
- Neurodermatitis: chronic itching or scaling causing a patch. not widespread
- Nummular eczema: circular, raised spots on the skin (chronic)
- Stasis (varicose) dermatitis: caused poor circulation
How do Calcineurin Inhibitors work for eczema?
They’re anti-inflammatories used when topical steroids have been ineffective or for vulnerable sites like the face
What are the systemic treatment option for atopic eczema?
- Phototherapy
- Oral prednisolone
- Systemic immunomodulators (ciclosporin, methotrexate, azathioprine)
- Biologics (dupilumabm, tralokinumab)
- JAK inhibitors
What impetigo?
A contagious skin infection usually presenting in children
Causes: staph aureus or strep pyogenes
Treatment: flucloxacillin
What is seborrheic eczema?
- Reaction to yeast Malassezia (pityrosporum
ovale)
Affects parts with increased sebum
production (scalp, ears, medial eyebrows,
upper eyelids, nasolabial folds) and major
body folds
If severe or recalcitrant, test for HIV
What is the difference between atopic and seborrheic eczema?
Seborrhoeic eczema has:
* Earlier onset, weeks after birth
* Different distribution
* Less intense inflammation
* Absence of pruritus, irritability and sleeplessness
* Infants usually feed well and are content
What is urticaria?
An immune mediated reaction
Pseudoallergic: stinging nettle, opiates, NSAID’s
What are wheals in urticaria?
Swellings on the surface of the skin into red- or skin-coloured welts
What does angioedema without wheals suggest?
- Drug reaction
- Hereditary angioedema
- ACEi (induced angioedema)
What needs to be covered in an urticaria history?
- How quickly does it come and go (urticaria comes up and resolves within 24 hrs)
- Was there a trigger?
- Is there a personal /Fhx of autoimmune disease
- Does it heal with bruising (differential: urticarial vasculitis)
What are the treatment options for chronic urticaria?
1st line: antihistamine, then add montelukast
Can offer steroids and biological therapies courses but may need to repeat
What is pruritus?
Itchy skin
What conditions have pruritus and dermatosis?
- Dry skin
- Eczema
- Urticaria
- Scabies
- Prebullous pemphigoid
- Cutaneous T Cell Lymphoma
Which conditions cause pruritis without dermatosis?
- Systemic illness: iron deficiency, uraemia, renal failure, haem disorders, infections, elderly skin, neuro disorders
- Meds: opioids, chloroquine, ACE inhibitors, statins
- Psychogenic (delusions)
