Lecture 8: Eczema

Question 1

Other than Atopic Eczema, what are the main types?

Answer 1

Exogenous Causes:

• Contact Dermititis
• Lichen Simplex
• Photoallergic Eczema

Endogenous Causes:

• Discoid
• Venous
• Seborhoeaic
• Pompholyx
• Juvenile Plantar Dematitis

Question 2

How would you spot photoallergic eczema?

Answer 2

It shows a distribution around light exposed areas

I.e. Face, Sleeve lines, neck line etc.

Question 3

Explain how Contact Dermatitis works

Answer 3

Comes in 2 Forms:

• Allergic (Type 4 hypersensitivity reaction)
• Irritant (Friction, cold, long water exposure or chemicals e.g. detergent)

Question 4

What occupations get a lot of contact dermatitis?

Answer 4

• Hairdressers (lots of washing & water)
• NHS staff (Constantly washing hands)
• Cleaners (Detergents and acids)
• Babies (not an occupation, but get a lot of contact nappy rash)

Question 5

Explain what discoid eczema is?

Answer 5

Circular plaques of eczema. Mainly at sites of irritation

Question 6

If you find eczema on an infants scalp, proximal flexures and trunk what do you think it is?

Answer 6

Seborrhoeic Eczema

Because it targets areas where there’s lots of sebaescous glands like the scalp, armpits and chest

Question 7

So what causes Seborrhoeic Eczema and how do you treat it?

Answer 7

Usually a Malassezia Yeast infection

Topical Ketoconazole

Question 8

You might get more patients during the winter months coming in with very dry skin thats cracked an scaly, mostly on thier shins. Why is that?

Answer 8

They have asteatotic eczema.

It occurs when the skin becomes very dry such as:

• In hot climates
• Excessive soap washing
• Cold months (people spend a lot of time indoors with dry heating)

Question 9

A patient presents with intensely itchy sudden crops of vesicles appearing on their hands and feet along with redness and flaking?

Answer 9

Probably Pompholyx (aka vesicular dermatitis)
A form of eczema involving formation of blisters on the hands/feet

Question 10

Explain how venous eczema occurs?

Answer 10

Increased venous pressure (mostly legs)
Causes oedema
Body reacts to oedema triggering eczema

So it presents with the classic red, flaky, itchy eczema. Possibly plus:

• Varicose Veins
• Brown/red discolouration
• Swelling
• Pain
• Hardened/tight skin (lipodermatosclerosis)
• White “scars” (atrophie blanche)

Question 11

Finally what happens if a patient with eczema gets a disseminated HSV infection?

Answer 11

Eczema Herpeticum!

Question 12

How does Eczema Herpeticum present?

Answer 12

Painful eczema getting rapidly worse
Clusters of blisters and ‘punched-out’ erosions
Fever, lethargy and malaise

Question 13

How would we treat venous eczema?

Answer 13

Other than standard eczema treatments:

compression stocking - Reduce the oedema, reduce the reaction

Question 14

How would we treat Eczema Herpeticum?

Answer 14

Antiviral Aciclovir to clear the HSV
Mild topical steroid (e.g. hydrocortisone) to lessen the eczema

Get an ophthalmology consult if there’s periocular disease

Question 15

A chronic inflammatory T-Cell mediated condition of the skin in response to environmental allergensIts very common

Answer 15

Define Atopic Eczema?

Question 16

Spongiosis - Intercellular Oedema Acanthosis - Thicking of Epidermis Inflammation

Answer 16

What are the parts of eczema pathology?

Question 17

Flexures Neck Face Eyelids Hands & Feet

Answer 17

What are the common places to find atopic eczema?

Question 18

StressCold or HeatAllergens e.g. pollen

Answer 18

What can trigger/worsen atopic eczema?

Question 19

Red, scaly patches sometimes with papules, vesicles, exudate and crusting/It itches

Answer 19

How does Eczema present?

Question 20

Lichenification - Leathering Fissures Large plaque lesions

Answer 20

what does chronic eczema lead to?

Question 21

• Topical Steroids- Systemic Immunosuppression- Education (Causative/exacerbating factors)- Emollients/Soap susbstitutes- Anti-histamines- Anti-microbials- UV light

Answer 21

Quick overview of the main eczema treatments:

Question 22

Some patients with eczema can contract infections through the damaged skin

Answer 22

When are anti-microbials necessary for eczema?

Question 23

They serve to diminish the inflammation & Itching

Answer 23

How do anti-histamines help eczema?

Question 24

Hydrocortisone - low potency Betamethasone - High potency

Answer 24

What topical steroids could be used for Eczema?

Question 25

Azithioprine Ciclosporin Methotrexate Calcineurin inhibitors e.g. Tacrolimus

Answer 25

What re the types of systemic immunosuppression for Eczema

Question 26

They inhibit calcineurina protein involved in T cell activation. Since T cells mediate Atopic eczema they serve to inhibit the whole disease

Answer 26

How do calcineurin inhibitors work?

Question 27

Many are involved but the Filaggrin gene is the primary one

Answer 27

Main gene involved in atopic eczema?