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Dermatology Diploma > Itchy Skin & Eczema > Flashcards

Itchy Skin & Eczema Flashcards

1
Q

What is Yamamoto’s Sign?

A

Atopic Eczema (AE) that spares the tip of the nose and forehead.

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2
Q

What are the most common sites of involvement in childhood?

A

Felxures of the arms and legs.

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3
Q

As one gets older the face is more commonly affected.

Why is this?

A

It is thought to be due to Malassezia Furfur Overgrowth. (seborrheic eczema)

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4
Q

Genetically, what causes the dry skin of eczema sufferers?

A

Filaggrin (the skin barrier protein) isn’t produced as well and therefore Skin barrier function is impaired.

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5
Q

What occurs due to the reduced skin barrier function?

A

Transepidermal water loss and dehydration of the skin.

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6
Q

In Type 5 and 6 Fitzpatrick patients, how can eczema present? (2 ways)

A

In a follicular pattern. (like turkey skin)

OR

as Pityriasis Alba-Hypopigmented patches typically on the face.

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7
Q

What is this?

What is it called if this is a chronic problem with the skin?

A

Lichenification of the skin (Acanthosis/Thickening of the epidermis of the skin)

Lichen Simplex Chronicus

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8
Q

What is the prognosis of childhood eczema?

A

50% of patients have outgrown it by the age of 5 years.

90% by the age of 14 years.

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9
Q

What is the differential diagnoses of Atopic Eczema (AE)?

A
  • Scabies
  • Contact dermatitis - unusual in children.
  • Impetigo
  • Cutaneous T Cell Lymphoma (CTCL Mycosis Fungoides) - eczematous looking patches but they don’t itch.
  • Langerhans Cell Histiocytosis (LCH) - ecchymosis with yellow brown papules in intertiginous areas.
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10
Q

What are some complications of Atopic Eczema?

A
  • Secondary bacterial or viral infection.
  • Eczema Herpeticum
  • Molluscum Contagiosum
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11
Q

What is the commonest bacterial cause of infection Eczema?

A

Staph Aureus.

90% of patients will have Staph colonization.

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12
Q

If someone has a staph infection on eczema what does it look like?

A

Impeitginous (yellow crusts etc)

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13
Q

What is the management protocol for Eczema patients who continually get Staph Super Infections (PVL)?

A
  • Nasal Mupirin for 5 days TDS to each nostril.
  • Antibacterial soap Substitute (e.g. Benzylkonium Chloride)
  • Bleach Baths Twice Weekly
    • 150ml of Milton Sterilising Fluid - bath to 10cm depth once weekly.
      • Similar to swimming pool - which reduces infection rates.
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14
Q

Similar to Asthma, what is the approach to managing Eczema

A
  1. Relieve
  2. Prevent

Getting it Better and Keeping it Better

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15
Q

What are some lifestyle changes for preventing Eczema?

A
  • Avoid wool or man made fibers.
  • Avoid hot rooms at night.
  • Prescription undergarments - Dermasilk.
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16
Q

What are the 3 categories of topical therapy in Eczema?

A
  1. Emollients
  2. Soap Substitutes
  3. Anti-Inflammatories
    1. Steroids
    2. Non-Steroids - Calcineurin Inhibitors
17
Q

Why should Sodium Lauryl Sulphate not be used in Eczema?

A

They activate proteases that encourage trans-epidermal waterloss by reducing the skin barrier function.

18
Q

Are emollients used for relief or maintenance?

A

Maintenance

19
Q

If a patient has weepy skin how would you manage it?

A

With Potassium permanganate soaks.

20
Q

What soap substitutes are recommend for the bath?

A

Aqeous Cream or Unguentum Merck.

21
Q

Why is avoiding soaps etc important in eczema?

A

It can lead to protease activation and thus reduce epidermal barrier function.

22
Q

What is first line for acute flares of eczema?

A

Topical Steroids.

23
Q

What are the instructions on using potassium Permanganate soaks?

A
  • Dilute to pale pink.
  • Use an old plastic bowl because it stains.
  • Apply on gauze and leave on for 20mins 3 times daily.
24
Q

What is second line for flare ups of eczema?

A

Tacrolimus or Picrolimus

(But they can be used for maintenance aswell.)

25
Q

What is a common side effect of Tacrolimus or Pimecrolimus?

A

It can initially sting but this settles with use.

26
Q

How often per week are calcineurin inhibitors licensed for use as maintenance therapy?

A

3 times weekly

27
Q

Why are Calcineurin Inhibitors useful when compared to steroids?

A

They can be used in facial eczema without thinning the skin.

28
Q

How can steroids be used as maintenance?

A

Mometasone once weekly as maintenance

ONLY for body sites.

29
Q

What are 3 useful behavioural therapies that can help with the itch of eczema?

A
  1. Biofeedback - scratch counters.
  2. Hypnosis (limited evidence)
  3. Acupuncture (less evidence)
30
Q

What are some scoring systems that can be used to assess Eczema severity?

A

SCORAD

Real Life Severity Score

DLQI (Dermatology Life Quality Index)

31
Q

If all these fail - what are the second line options that can be used in hospitals?

A
  • Oral steroids - 6 week reducing course of steroids for adults.
  • Cyclopsorin
  • Azathioprine
  • Methotrexate
  • Mycofenolate Mofetil
  • IVIG for severe adult cases
32
Q

What are the 6 other types of eczema?

A
  1. Contact/Irritant Eczema
  2. Venous (Gravitational) Eczema
  3. Seborrhoeic Eczema
  4. Pompholyx Eczema
  5. Discoid Eczema
  6. Erythrodermic Eczema
33
Q

What is this?

A

Palmar Pomphylyx

Treat with potent steroids

If dry - use emollients. (50/50)

If wet - use permanganate soaks 3 times weekly.

34
Q

What is this?

A

Discoid eczema

Treat with high dose steroids +/- antibiotics if impetiginised.

35
Q

What is this?

A

Erythromdermic Eczema

Secondary care treatment needed urgently.

36
Q

What are some systemic causes of pruritus?

A
  • Chronic renal disease
  • Cholestasis – intra and extra hepatic cholestasis
  • Iron deficiency.
  • Malignancy; especially haematological malignancy such as polycythaemia rubra vera, lymphomas.
  • Endocrine abnormality (thyrotoxicosis, hypothyroidism, T1DM).
  • Skin diseases especially atopic eczema, contact dermatitis, dermatitis herpetiformis, psoriasis (don’t forget that psoriasis and eczema can coexist), lichen planus other lichenoid skin disorders.
  • Urticaria related disorders
  • Infection and infestation, scabies, lice (pediculosis infestation)
  • HIV related chronic itch.
37
Q

What is often the first manifestation of lypmhoma?

A

Itch

The first presentation of lymphoma may often be itch which can precede overt disease by years.

38
Q

What should be the investigations for systemic causes of chronic itch?

A
  • First line:
    • Bloods
      • U&Es, LFTs, TFTs, Random Glucose, Iron and Ferritin.
      • FBC (Haematological malignancies)
      • Protein electrophoresis (Myeloma screen)
    • Chest Xray
  • Second:
    • ANA - Lupus screen.
    • Skin biopsy
    • Serology for dermatitis herpetiformis, HIV etc.

Dermatology Diploma (39 decks)

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