Eczema

Question 1

THis lesion is extremly itchy and located on the legs -> give the diagnosis

Answer 1

Discoid eczema

Question 2

What are the key features of discoid eczema?

Answer 2

Coin shaped
Extremities
Extremly itchy
Central clearing can give a similar appearance to tinea corporis
Higher risk of bacterial infection

Question 3

What is atopic dermatitis?

Answer 3

Eczema
Chronic inflmmatory skin condition with pruritus and xerosis
Genetic predisposition, immune dysregulation and epidermal barrier dysfunction

Question 4

What more conservative management is offered for eczema?

Answer 4

Avoid irritants/allergens
Gentle skin care routines - sentless, for gently skin, avoid over washing/drying hands

Question 5

What is the guidance around the use of emollients to treat eczema?

Answer 5

All plans -> regardless of severity
REgular and generous use to hydrate and restore barrier
Ointments -> lotions -> cream for effectiveness but reverse for patient preference
Often recommend ointment at night and lotion/cream during the day

Question 6

What topical steroids are recommended in eczema?

Answer 6

Mild - hydrocortisone 1%
Moderate - betamethasone valreate 0.025% or clobetasone butyrate
Severe - betamethasone valerate 0.1%

Question 7

What is the purpose of topical calcineurin inhibitors in eczema treatment?

Answer 7

Suitable for sensitive skin
Reduce inflammation
Tacrolimus and pimecrolimus

Question 8

What and what systemic therapies may be beneficial in eczema?

Answer 8

Used in severe or unresponsive cases
Oral corticosteroids - acute severe exacerbations
Immunosuppresants - ciclosporin, methotrexate, azathiopurine
Biologics - dupilumab

Question 9

What is the purpose of phototherapy for eczema treatment?

Answer 9

Extensive eczema cases -> effectiveness varies

Question 10

What are the key factors affecting the prognosis of eczema?

Answer 10

Severe disease:
Onset at 3-6months
Severe disease in childhood
Other atopy - asthma or hay fever
Small family size
high IgGe serum levels

Question 11

What should the amount of steroid cream used in eczema be calculated?

Answer 11

One fingertip for two palm sizes -> 0.5 g per two palm sixes

Question 12

What doesage of steroids can be used in certain areas over 2 weeks for eczema treatment?

Answer 12

Face, neck, hands, scalp groin and genitals - 15 to 30g
Legs and trunk - 100g
Both arms 30-60g.

Question 13

Define eczema herpeticulum?

Answer 13

Primary infection the skin by HSV1/2
Common presents as a rapidly progressive painful rash in children with eczema

Question 14

Name the diagnosis:
Rapidly progressive rash, generally unwell and feverish, background of eczema

Answer 14

Eczema herpeticulum

Question 15

What is the management for eczema herpeticulum?

Answer 15

Oral or IV aciclovir

Question 16

What is the typical presentation of eczema in children?

Answer 16

Itchy erythematous rash - typically before 2 years
Trunk affected or extensory surfaces