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what is eczema?
an inflammatory dermatosis
what are the 3 main features that characterise eczema?
what are the 9 types of eczema?
- atopic: most common, genetic, asthma & hayfever
- contact allergic
- contact irritant
- pompholyx: blistering hands and feet (stress)
- lichen simplex chronicus
what is seborrheic eczema? who and where?
- babies - cradle
- t zones, nasolabial folds, groin
what is atopy?
predisposition to develop asthma, allergic rhinitis and atopic eczema
what are the blood signs of atopy?
- increased IgE response
how is atopy diagnosed?
- don't need to do blood tests
- clinical diagnosis
who is atopic eczema common in?
what % of atopic eczema have FHpositive?
where does eczema affect on children?
what are the main exacerbating factors for atopic dermatitis?
- topical irritants: detergents, soap (as people with eczema don't have same barrier function)
- secondary infection: bacterial (staph-impetigo), eczema herpeticum, molluscum
- (house dust mite and food allergies)
what is the prognosis of atopic dermatitis?
- 50% clear by 3 years
- 66% clear by 6 years
- 90% clear by 20 years
how would you describe eczema herpeticum?
- 2 mm
what can happen to skin if keep itching?
- linear excoriations
- lichenification: generalised thickening of skin, becomes rough and tough, can see skin markings
what are the 5 main aspects to treatment of atopic dermatitis?
- 1. avoid provoking factors eg soap
- 2. reduce dryness: bath oils, soap substitutes, emollients
- 3. topical corticosteroids: for active inflammation
- 4. anti-histamines (make sleepy) /bandaging (stop scratching)
- 5. Rx secondary infections
which is the strongest steroid cream for eczema?
what are the 3 SE from steroid creams?
- 1. potential systemic absorption
- 2. skin atrophy (prominence of bv, skin fragile)
- 3. acne/perioral dermatitis
if first line Rx don't work for atopic dermatitis, then what are next line Rx?
- topical tacrolimus: calcineurin inhibitor, immune modulator, use if too many SE of steroids or need too high dose of steroids
- phototherapy: PUVA or UVB (immune suppressant)
- systemic therapy: systemic steroids, azathioprine, cyclosporin A
what are the main SE of ciclosporin
- immune suppress - so cancer risk
what is contact dermatitis?
- inflammation due to interaction of external agent and the skin
- usually well demarcated/confined to area of contact
what are the 2 types of contact dermatitis?
- non-immunological = IRRITANT (80%)
- immunological = ALLERGIC (20%)
who gets irritant contact dermatitis?
- new nurse or new mum
- the irritant leads to inflammation when applied to the skin or most normal people
who gets allergic contact dermatitis?
people with type 4 or delayed cell mediated hypersensitivity
give an eg of an acute and a chronic allergic contact dermatitis?
- acute: phytodermatosis
- chronic: ie nickel, fragrances, hair dye
what reasons would make you suspect contact dermatitis?
- acute/chronic eczema not responding/aggravated by Rx
- work related - nurse(latex gloves), hairdresser hair dye
how do you make the diagnosis of allergic contact dermatitis?
- clinical features
- history of allergen exposure
- patch testing
what is the Rx for allergic contact dermatitis?
what is pompholyx eczema?
- vesiculobullous disorder
where does pomphloyx eczema occur?
get tiny blisters on fingers > soles
what is the Rx of pompholyx eczema?
- potent topical steroids
describe the vesicles of pomphloyx eczema?
- may be painful
what are the lesions of nummular/discoid eczema like?
- coin shaped lesions
- may be vesicular and colonised with staph aureus
where does nummular/discoid eczema occur?
what is Rx of num/discoid eczema?
- often difficult to Rx
- potent topical steroids
- +/- occlusion
who does seborrheic eczema affect?
- infants 2-10 weeks
- adults: puberty
where in infants does seb eczema come?
- cradle cap
- 'nappy rash'
- intertriginous areas - where 2 surfaces come together eg groin, neck fold, armpits
where in adults does seb eczema affect?
- medial eyebrows
- nasolabial folds
- intertriginous areas
describe the rash of seborrheic eczema?
- erythemaous papules
what is the Rx of seborrheic eczema?
- anti-fungal shampoo
- topical steroids + scalp application
- oral ketoconazole/itraconazole
what is erythroderma?
when >90% of the body is affected by erythema and scaling
what are the 4 causes of erythroderma to consider?
- drug allergy
what is the Rx of erythroderma?
- bed rest
- fluid balance
- topical steroids
- treat secondary infection
- treat underlying causes if known
what is differential diganosis of eczema?
- inflammation: seborrheic dermatitis, irritant dermatitis
- infection: candida, strep/staph, tinea cruris