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Dermatology Week 2 2017/18 > 7: Dermatitis / atopic eczema > Flashcards

7: Dermatitis / atopic eczema Flashcards

1
Q

What is another name for dermatitis?

A

Eczema

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2
Q

What is another name for eczema?

A

Dermatitis

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3
Q

What is papillomatosis?

A

Irregular epithelial thickening

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4
Q

What is the characteristic histological feature of eczema?

A

Spongiosis (oedema between keratinocytes)

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5
Q

Which immune cells infiltrate the epidermis in eczema?

A

Neutrophils

Lymphocytes

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6
Q

What is the common symptom for all types of eczema?

A

Pruritus (itching)

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7
Q

What are the two phases of an eczema reaction?

A

Acute phase

Chronic phase

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8
Q

What happens in the acute phase of an eczema reaction?

A

Rapid acute inflammation

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9
Q

What does eczema look like in the acute phase?

A

Papulovesicular

Erythematous

Spongiotic

Oozing / scaly / crusty

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10
Q

What does eczema look like in the chronic phase?

A

Thickened (lichenification)

Elevated patches –> PLAQUES

Even scalier

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11
Q

What are the four defining morphological features of eczema?

A

Itchy

Ill-defined

Erythematous

Scaly

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12
Q

What type of eczema is brought about by a Type IV hypersensitivity reaction?

A

Contact allergic eczema

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13
Q

What type of eczema reaction is brought about by substances which aren’t allergens?

A

Contact irritant eczema

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14
Q

Give two examples of substances which cause contact irritant eczema.

A

Soap

Water

Urine

Faeces

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15
Q

What is atopic eczema?

A

Inflammation of the skin due to genetic and environmental factors versus allergens or irritants

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16
Q

Which types of hypersensitivity reactions occur in drug-related eczema?

A

Type I

Type IV

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17
Q

Which immune cells are seen in drug-related eczema?

A

Eosinophils

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18
Q

What is the histological feature common to ALL types of eczema?

A

Spongiosis (oedema between keratinocytes)

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19
Q

If a patient has eczema on sun-exposed areas only, which type of eczema may they have?

A

Photosensitive eczema

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20
Q

What is lichen simplex eczema?

A

Inflammation due to scratching

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21
Q

What is stasis dermatitis?

A

Skin inflammation due to hydrostatic pressure in legs with poor circulation (see also: varicose veins)

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22
Q

Which cells leak into the extracellular compartment and cause inflammation in stasis dermatitis?

Why?

A

Red blood cells

Increase in capillary hydrostatic pressure (in turn due to decreased venous circulation, e.g heart failure or peripheral vascular disease)

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23
Q

Give some examples of allergens which cause contact allergic dermatitis.

A

Chemicals

Drugs (e.g penicillin)

Nickel!!!!

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24
Q

Where is nickel commonly found which can cause contact allergic dermatitis?

A

Belt buckles, buttons

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25
Q

Why do people tend to get worse contact allergic reactions on the dorsal surfaces of their hands?

A

The skin is thinner

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26
Q

Which substance, increasingly found in the air, can cause contact allergic reactions on the face?

A

Perfume

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27
Q

What is typically seen in the acute phase of eczema?

A

Weeping blisters (due to rapid severe spongiosis)

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28
Q

Which cells, found in the epidermis, bind to antigens on the skin?

A

Langerhans cells

29
Q

Where do Langerhans cells take antigens for transport to T cells?

A

Lymphatic vessels

30
Q

Which cells do Langerhans cells present antigen to?

A

T cells

31
Q

Which immune cells are responsible for spongiosis in the epidermis upon contact with an allergen?

A

Lymphocytes

32
Q

Which cells trigger dermatitis?

A

Lymphocytes

33
Q

What are the two main histological features of contact allergic eczema?

A

Lymphocyte infiltration

Spongiosis

34
Q

Which investigation allows you to figure out which allergens a patient is allergic to?

A

Patch testing

35
Q

If the patient is allergic to one of the substances in a patch test, what will be seen in that battery 96 hours later?

A

Contact allergic eczema

36
Q

Irritant contact eczema is a (specific / non-specific) reaction to a substance.

A

non-specific

37
Q

Why do people wearing rings develop dermatitis even though they aren’t allergic to the metal in them?

A

Soap is trapped under the ring during hand washing

37
Q

Name five clinical features of severe hand dermatitis.

A

Oedema

Erosions

Lichenification

Fissures

Scales

Nail dystrophy

38
Q

What kind of eczema is “nappy rash”?

A

Contact irritant eczema

39
Q

Why may a patient have irritant dermatitis around their lips?

A

They’ve been licking them i.e saliva

40
Q

Which kind of eczema is associated with asthma and hayfever?

A

Atopic eczema

41
Q

What is the main symptom of atopic eczema in children?

A

Pruritus

42
Q

What is a major quality of life impact of pruritus?

A

Sleep disturbance > Fatigue > Poor school/work/life performance

43
Q

Apart from itching, what are other signs and symptoms of atopic eczema?

A

Ill-defined erythema

Scales

Dry skin

44
Q

On which surfaces is atopic eczema seen?

A

Flexural surfaces

45
Q

Apart from flexural surfaces, where else is atopic eczema found?

A

Face

Groin

Bit below ear

46
Q

If a child has a patch of dermatitis below the fold in their ear, what do they probably have?

A

Atopic eczema

47
Q

What are skin changes seen in chronic atopic eczema?

A

Lichenification

Excorciation (erosion caused by scratching)

Secondary infection

48
Q

What commensal bacteria are seen in far greater numbers in people with atopic eczema, and may contribute to secondary infection?

A

Staph. aureus

Staph. epidermidis

49
Q

What does crusting (golden/yellow) indicate in a patient with atopic eczema?

A

Staph. aureus

50
Q

What infection does eczema herpeticum (rash on the buttocks) indicate?

A

Herpes simplex

51
Q

How would you describe eczema herpeticum?

A

Monomorphic punched-out lesions

52
Q

How should eczema herpeticum be treated?

A

Oral acyclovir

53
Q

Is eczema herpeticum a one-off infection?

A

No, tends to recur

54
Q

What should be used to address dryness in patients with eczema?

A

Emollients

55
Q

Which products should be avoided in patients with eczema?

A

Irritants - e.g shampoos and soaps

56
Q

If emollients and antigen/irritant avoidance don’t work, how can you treat eczema?

A

Topical steroids

Phototherapy (UVB)

Immunosuppression

57
Q

When should topical steroid be stopped?

A

When the eczema dies down

58
Q

What are biologic agents?

A

Monoclonal antibodies used to treat skin conditions (e.g psoriasis, eczema)

59
Q

The gene for which protein is important in the genetic cause of atopic eczema?

A

Filaggrin

60
Q

Round, scaly, WELL-DEFINED eczema found on the extensor aspects of the arms is…

A

Discoid eczema

61
Q

What is the difference between discoid eczema and psoriasis?

A

Discoid eczema produces PATCHES

Psoriasis produces PLAQUES

62
Q

A patient has a cut-off of their eczema at the collar line. What type of eczema do they have?

A

Photosensitive eczema

63
Q

What can trigger photosensitive eczema in a patient who isn’t normally photosensitive?

A

Drugs

64
Q

What are some examples of drugs which cause photosensitivity in some patients?

A

Antibiotics (tetracyclines)

NSAIDs (ibuprofen)

Diuretics

Retinoids

65
Q

What type of eczema is found around swollen varicose veins?

A

Stasis eczema

66
Q

What is another name for cradle cap?

A

Seborrhoeic dermatitis

67
Q

What is the name for a sub-type of eczema where the oedema can’t escape and instead forms itchy vesicles on the palms and fingers?

A

Pompholyx

68
Q

What is the pathomechanism of lichen simplex eczema?

A

Scratching

Dermatology Week 2 2017/18 (8 decks)

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