Eczema

Question 1

Clinical features of eczema?

Answer 1

• Itching
• Erythema + Oedema
• Worse Winter (cold) + Summer (hot)
• Papules /Vesicles /Exudation
• Flexor surfaces (thin skin)
• Diffuse, ill-defined patches

Question 2

Additional clinical features of chronic eczema?

Answer 2

• Less oedema
• Epidermal thickening
• +/- lichenification

Question 3

Exogenous forms of eczema?

Answer 3

• Primary irritant contact dermatitis
• Allergic contact dermatitis
• Photodermatitis

Question 4

Endogenous forms of eczema>

Answer 4

• Atopic eczema
• Seborrhoeic dermatitis
• Discoid eczema
• Varicose / status eczema
• Endogenous eczema of palms and soles
• Asteatotic eczema
• Pompholyx

Question 5

Atopic eczema model?

Answer 5

Genetic predisposition (filaggrin mutation) leads to reduced barrier function. Environmental triggers thus precipitate eczema.

Question 6

What is discoid eczema?

Answer 6

Eczema in scattered, well-demarcated annular patches. Mimics psoriasis and tinea.

Question 7

Discoid eczema treatment?

Answer 7

Potent topical steroids

Question 8

Pathophysiology of asteatotic eczema?

Answer 8

Decreasing lipid content of stratum corneum with increasing age. Susceptible to ‘degreasing agents’.

Question 9

Distribution of asteatotic eczema?

Answer 9

Front of legs.

May also affect lower abdomen / arms

Question 10

Pattern of asteatotic eczema?

Answer 10

Crazy paving pattern

Question 11

Rx asteatotic eczema.

Answer 11

• Trial emollient

- Often need mild topic steroid ointment

Question 12

What is pompholyx?

Answer 12

Vesicular eczema of hand and foot. very itchy, often related to sweating).

Question 13

What precipitates pompholyx?

Answer 13

Excessive washing and sweating

Question 14

Rx pompholyx?

Answer 14

• Potent topical steroid
• Avoidance of soaps and irritants
• Regular emollients

Question 15

What is diffuse erythrodermic eczema?

Answer 15

Severe eczema (>90% BSA).
Significant morbidity.

Question 16

Treatment diffuse erythrodermic eczema?

Answer 16

Intense topical steroids and systemic immunosuppression

Question 17

What are the complications of eczema?

Answer 17

• Bacterial superinfection
• Eczema herpeticum
• Allergic Contact dermatitis

Question 18

Why is eczematous skin predisposed to bacterial superinfection?

Answer 18

Eczematous skin lacks naturally occurring antibacterial peptides.

Question 19

Rx bacterial infection of eczema?

Answer 19

Systemic anti-staph ABx (generally infected with Staph aureus).

Question 20

What is eczema herpeticum?

Answer 20

Secondary infection by HSV virus. MEDICAL EMERGENCY due to risk of corneal scarring.

Question 21

Clinical features of eczema herpeticum?

Answer 21

Sudden onset worsening of pre-existing eczema with painful vesicles and “punched out” erosions.

Question 22

Mx eczema herpeticum?

Answer 22

• Assessment by opthalmologist

- Systemic antiviral treatment

Question 23

How is allergic contact dermatitis diagnosed?

Answer 23

Patch testing

Question 24

Pathophysiology of allergic contact dermatitis?

Answer 24

Delayed hypersensitivity reaction to an external allergen.

Question 25

General measures to treat eczema?

Answer 25

- Avoid irritants: soap, allergens, pets - Regular emollient (mainstay Rx) - topical steroids when appropriate - Warm showers (not hot)

Question 26

Specific treatment atopic eczema?

Answer 26

- Topical steroid to inflamed areas - Mild steroid for face, NSAICream (e.g. pimecrolimus) - Treat infection if suspected

Question 27

Treatment options for severe eczema?

Answer 27

- Dermatology referral - Wet dressings - Phototherapy with UVB - Systemic immunomodulators: - -short term = prednisolone - -long term = azathioprine, cyclosporin, methotrexate

Question 28

What is required for diagnosis of atopic eczema?

Answer 28

Itch + 3 of: | -flexural dermatitis (or cheeks if

Question 29

What are the acute signs of dermatitis?

Answer 29

Signs of acute inflammation - Erythema - Oedema / papules - Ooze/ crust - Vesiculation - Excoriations

Question 30

Chronic signs dermatitis?

Answer 30

- Lichenification - Dryness - Scale - Fissuring / cracking - Post-inflamm hypo/hyper pigmentation

Question 31

Functional assessment dermatitis impact?

Answer 31

- Sleep - Self esteem - Bullying - Career - Cost - Time - Parental stress

Question 32

What is Koebnerisation?

Answer 32

Propensity for lesion or rash to occur in area of previous trauma (e.g. psoriasis, warts, lichen planus)