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what is eczema?
an inflammatory dermatosis
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what are the 3 main features that characterise eczema?
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what are the 9 types of eczema?
- atopic: most common, genetic, asthma & hayfever
- contact allergic
- contact irritant
- pompholyx: blistering hands and feet (stress)
- nummular/discoid
- seborrhoeic
- lichen simplex chronicus
- varicose
- erythroderma
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what is seborrheic eczema? who and where?
- babies - cradle
- t zones, nasolabial folds, groin
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what is atopy?
predisposition to develop asthma, allergic rhinitis and atopic eczema
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what are the blood signs of atopy?
- increased IgE response
- eosinophilia
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how is atopy diagnosed?
- don't need to do blood tests
- clinical diagnosis
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who is atopic eczema common in?
children
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what % of atopic eczema have FHpositive?
70%
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where does eczema affect on children?
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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)
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what is the prognosis of atopic dermatitis?
- 50% clear by 3 years
- 66% clear by 6 years
- 90% clear by 20 years
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how would you describe eczema herpeticum?
- erosions
- multiple
- monomorphic
- erythematous
- 2 mm
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what can happen to skin if keep itching?
- linear excoriations
- lichenification: generalised thickening of skin, becomes rough and tough, can see skin markings
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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
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which is the strongest steroid cream for eczema?
dermovate
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what are the 3 SE from steroid creams?
- 1. potential systemic absorption
- 2. skin atrophy (prominence of bv, skin fragile)
- 3. acne/perioral dermatitis
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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
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what are the main SE of ciclosporin
- BP
- kidney
- immune suppress - so cancer risk
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what is contact dermatitis?
- inflammation due to interaction of external agent and the skin
- usually well demarcated/confined to area of contact
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what are the 2 types of contact dermatitis?
- non-immunological = IRRITANT (80%)
- immunological = ALLERGIC (20%)
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who gets irritant contact dermatitis?
- new nurse or new mum
- the irritant leads to inflammation when applied to the skin or most normal people
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who gets allergic contact dermatitis?
people with type 4 or delayed cell mediated hypersensitivity
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give an eg of an acute and a chronic allergic contact dermatitis?
- acute: phytodermatosis
- chronic: ie nickel, fragrances, hair dye
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what reasons would make you suspect contact dermatitis?
- acute/chronic eczema not responding/aggravated by Rx
- site
- work related - nurse(latex gloves), hairdresser hair dye
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how do you make the diagnosis of allergic contact dermatitis?
- clinical features
- history of allergen exposure
- patch testing
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what is the Rx for allergic contact dermatitis?
allergen avoidance
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what is pompholyx eczema?
- EPISODIC
- vesiculobullous disorder
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where does pomphloyx eczema occur?
get tiny blisters on fingers > soles
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what is the Rx of pompholyx eczema?
- emollients
- potent topical steroids
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describe the vesicles of pomphloyx eczema?
- small
- firm
- itchy
- may be painful
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what are the lesions of nummular/discoid eczema like?
- coin shaped lesions
- may be vesicular and colonised with staph aureus
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where does nummular/discoid eczema occur?
on legs
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what is Rx of num/discoid eczema?
- often difficult to Rx
- potent topical steroids
- +/- occlusion
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who does seborrheic eczema affect?
- infants 2-10 weeks
- adults: puberty
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where in infants does seb eczema come?
- cradle cap
- 'nappy rash'
- intertriginous areas - where 2 surfaces come together eg groin, neck fold, armpits
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where in adults does seb eczema affect?
- dandruff
- medial eyebrows
- nasolabial folds
- chest
- intertriginous areas
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describe the rash of seborrheic eczema?
- greasy
- erythemaous papules
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what is the Rx of seborrheic eczema?
- anti-fungal shampoo
- topical steroids + scalp application
- oral ketoconazole/itraconazole
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what is erythroderma?
when >90% of the body is affected by erythema and scaling
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what are the 4 causes of erythroderma to consider?
- eczema
- psoriasis
- drug allergy
- lymphoma
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what is the Rx of erythroderma?
- admit
- bed rest
- fluid balance
- emollients
- topical steroids
- treat secondary infection
- treat underlying causes if known
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what is differential diganosis of eczema?
- inflammation: seborrheic dermatitis, irritant dermatitis
- infection: candida, strep/staph, tinea cruris
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