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Questions and Answers
What is the primary meaning of the term 'dermatitis'?
What is the primary meaning of the term 'dermatitis'?
It refers to inflamed skin.
Distinguish between exogenous and endogenous eczema.
Distinguish between exogenous and endogenous eczema.
Exogenous eczema is caused by external factors like irritants, while endogenous eczema originates from internal factors, such as genetic predisposition.
Describe the acute stage of eczema.
Describe the acute stage of eczema.
The acute stage of eczema is characterized by erythema, edema, oozing, and papulovesicular eruption.
Identify the components involved in the pathogenesis of atopic dermatitis.
Identify the components involved in the pathogenesis of atopic dermatitis.
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What management step focuses on skin care and education for eczema patients?
What management step focuses on skin care and education for eczema patients?
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What are common aggravating factors for atopic dermatitis?
What are common aggravating factors for atopic dermatitis?
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Where does seborrheic dermatitis commonly appear on the body?
Where does seborrheic dermatitis commonly appear on the body?
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What type of treatment is recommended for mild to moderate seborrheic dermatitis?
What type of treatment is recommended for mild to moderate seborrheic dermatitis?
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What morphological changes differentiate chronic eczema from acute eczema?
What morphological changes differentiate chronic eczema from acute eczema?
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Explain the role of genetic factors in the pathogenesis of atopic dermatitis.
Explain the role of genetic factors in the pathogenesis of atopic dermatitis.
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How do environmental factors exacerbate eczema symptoms?
How do environmental factors exacerbate eczema symptoms?
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What is the significance of the Atopic Triad in relation to eczema?
What is the significance of the Atopic Triad in relation to eczema?
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Describe the typical skin appearance involved in seborrheic dermatitis.
Describe the typical skin appearance involved in seborrheic dermatitis.
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What strategies are involved in the management of flare-ups in eczema patients?
What strategies are involved in the management of flare-ups in eczema patients?
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What features characterize infantile atopic dermatitis?
What features characterize infantile atopic dermatitis?
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Identify how the immune system is involved in the pathogenesis of eczema.
Identify how the immune system is involved in the pathogenesis of eczema.
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What role do emollients play in the management of eczema?
What role do emollients play in the management of eczema?
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What are the preferred sedating antihistamines for children with eczema and why?
What are the preferred sedating antihistamines for children with eczema and why?
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Describe the 'itch-scratch cycle' in relation to eczema.
Describe the 'itch-scratch cycle' in relation to eczema.
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Identify one key characteristic of atopic dermatitis compared to other forms of eczema.
Identify one key characteristic of atopic dermatitis compared to other forms of eczema.
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What topical treatment is specifically used to manage nummular eczema alongside emollients?
What topical treatment is specifically used to manage nummular eczema alongside emollients?
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What is the significance of using the weakest topical corticosteroids in eczema treatment?
What is the significance of using the weakest topical corticosteroids in eczema treatment?
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What role do antihistamines play in the treatment of eczema?
What role do antihistamines play in the treatment of eczema?
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What is a common exacerbating factor in eczema and how should it be managed?
What is a common exacerbating factor in eczema and how should it be managed?
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In the context of eczema, describe the pathogenesis of allergic contact dermatitis.
In the context of eczema, describe the pathogenesis of allergic contact dermatitis.
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How does exogenous eczema differ from endogenous eczema in terms of triggers?
How does exogenous eczema differ from endogenous eczema in terms of triggers?
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Explain the relationship between chronic scratching and neurodermatitis.
Explain the relationship between chronic scratching and neurodermatitis.
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List two treatment options for managing flare-ups in eczema patients.
List two treatment options for managing flare-ups in eczema patients.
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What characterizes the typical progression of a papule in nummular eczema?
What characterizes the typical progression of a papule in nummular eczema?
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What is a common secondary infection associated with diaper dermatitis, and what is its treatment?
What is a common secondary infection associated with diaper dermatitis, and what is its treatment?
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What is the significance of phototherapy in eczema treatment?
What is the significance of phototherapy in eczema treatment?
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In managing the itch-scratch cycle associated with eczematous conditions, what is a key strategy?
In managing the itch-scratch cycle associated with eczematous conditions, what is a key strategy?
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What treatment options are typically recommended for managing acute eczema symptoms?
What treatment options are typically recommended for managing acute eczema symptoms?
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In what ways does atopic dermatitis prevalence differ among different age groups?
In what ways does atopic dermatitis prevalence differ among different age groups?
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What strategies can be employed to interrupt the itch-scratch cycle associated with eczema?
What strategies can be employed to interrupt the itch-scratch cycle associated with eczema?
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Describe the pathogenesis of eczema concerning environmental and immune factors.
Describe the pathogenesis of eczema concerning environmental and immune factors.
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How are the stages of eczema classified, and what features distinguish acute from chronic stages?
How are the stages of eczema classified, and what features distinguish acute from chronic stages?
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What role do eosinophils play in the chronic stage of eczema?
What role do eosinophils play in the chronic stage of eczema?
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What morphological characteristics distinguish allergic contact dermatitis from other types of eczema?
What morphological characteristics distinguish allergic contact dermatitis from other types of eczema?
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Discuss how the concept of barrier dysfunction relates to the management of eczema.
Discuss how the concept of barrier dysfunction relates to the management of eczema.
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Study Notes
Eczema (Dermatitis)
- Eczema is the same as dermatitis, meaning inflamed skin.
- It is classified as exogenous or endogenous.
- Exogenous includes irritant contact dermatitis & allergic contact dermatitis.
- Endogenous includes atopic dermatitis & seborrheic dermatitis.
- Eczema typically progresses through stages:
- Acute: Erythema (redness), edema (swelling), oozing, and papulovesicular eruption (small bumps).
- Sub-acute: Less erythema & edema, scaling, and crusting.
- Chronic: Dryness, thickening, and lichenification (thickened skin).
Atopic Dermatitis
- Multifactorial condition influenced by:
- Genetics
- Impaired epidermal barrier (decreased filaggrin protein).
- Environmental factors.
- Immune dysregulation (TH1-TH2 imbalance).
- Characterized by the "Atopic Triad," which includes atopic dermatitis, asthma, and allergic rhinitis.
- Aggravating factors include contact allergens (nickel, fragrances, soaps), food allergies (eggs, milk, nuts), environmental triggers (dust mites, pet dander), and climate (cold, dry air).
- Presents in distinct stages:
- Infantile: 2 months to 2 years old.
- Childhood: 2 years to 10 years old.
- Adult: Adolescence to adulthood.
Management of Atopic Dermatitis
-
Step 1:
- Complete emollient therapy (moisturizers) to restore the skin barrier.
- Educate patients about the condition and its management.
-
Step 2:
- Identify and avoid allergens and triggers.
-
Step 3:
- Treat flares with topical corticosteroids or calcineurin inhibitors (medications that reduce inflammation).
Seborrheic Dermatitis
- Primarily affects hairy areas, often presenting with characteristic greasy yellowish scales.
- Common locations include:
- Interscapular areas (between shoulder blades).
- Intertriginous lesions (folds of skin, like armpits and umbilicus).
- Face, particularly the inner thirds of the eyebrows and nasolabial folds (lines around the nose).
- Etiology (causes):
- Pityrosporum ovale (Malassezia furfur) yeast.
- Increased sebaceous gland activity.
- More common in patients with Parkinson's disease and HIV.
Treatment of Seborrheic Dermatitis
-
Mild to Moderate Cases:
- Topical steroids (creams/ointments).
- Anti-dandruff shampoos:
- Tar.
- 2% selenium sulfide.
- Ketoconazole.
- Ciclopirox olamine.
- Pyrithione zinc.
-
Topical Antifungals (creams):
- Cotrimazole.
- Micanazole.
-
Severe Cases:
- Systemic antifungals (oral medications):
- Itraconazole.
- Fluconazole.
- Systemic antifungals (oral medications):
Eczema: Definition and Classification
- Eczema is a general term for skin inflammation.
- Also known as dermatitis
- Etymology of "eczema": Greek origin meaning "over", "out", and "boiling" to describe the appearance of inflamed skin.
Eczema Classification:
-
Exogenous: External agents causing inflammation
- Irritant contact dermatitis: Caused by direct irritation from substances like soaps, detergents, and chemicals.
- Allergic contact dermatitis: Caused by an allergic reaction to substances like poison ivy, nickel, and fragrances.
-
Endogenous: Internal factors causing inflammation
- Atopic dermatitis: A common, chronic inflammatory skin condition driven by genetic factors and environmental triggers.
- Seborrheic dermatitis: Characterized by oily, scaly patches, often in areas with many sebaceous glands.
Morphology and Stages of Eczema
- Morphology: The visual characteristics of eczema lesions.
-
Stages: Reflect the progression and severity of eczema
- Acute: Redness, swelling, oozing, and small blisters
- Sub-acute: Less redness and oozing, with scaling and crusting.
- Chronic: Dryness, thickening, and roughening of the skin called "lichenification".
Atopic Dermatitis:
- Multifactorial: Multiple factors contribute to development.
- Genetic Factors: Strong genetic predisposition.
- Impaired Epidermal Barrier: Defective skin barrier caused by lower levels of filaggrin protein.
- Environmental Factors: Triggers like allergens, irritants, and changes in temperature and humidity.
- Immune Dysregulation: Imbalance in the immune system, particularly with the T helper 1 (TH1) and T helper 2 (TH2) cells.
Atopic Triad:
- A set of three conditions often seen together in individuals with atopic dermatitis:
- Atopic dermatitis (eczema)
- Allergic rhinitis (hay fever)
- Asthma
Atopic Dermatitis: Aggravating Factors
- Triggers: Irritants, allergens, infections, stress, and some types of food.
Atopic Dermatitis: Stages
- Infantile: 2 months to 2 years
- Childhood: 2 years to 10 years
- Adult: Adolescence to adulthood
Atopic Dermatitis: Management
- Step 1: Complete Emollient Therapy and Education: Daily use of emollients to hydrate the skin and prevent dryness.
- Step 2: Identification and Avoidance of Allergen Triggers: Identifying and eliminating triggers specific to the individual.
- Step 3: Treatment of Flare-Ups: Topical corticosteroids and calcineurin inhibitors are used to manage inflammation during flares.
Seborrheic Dermatitis
- Characteristics: Affects hairy areas of the body, often showing yellowish, oily scales.
- Common Sites: Interscapular areas, armpits, umbilicus, inner parts of eyebrows, and nasolabial folds.
Seborrheic Dermatitis: Etiology
- Pityrosporum Ovale (Malassezia Furfur): A type of yeast that may play a role.
- Sebaceous Gland Activity: Increased activity of sebaceous glands may contribute.
- Associations: More common in Parkinson's disease and HIV-infected individuals.
Seborrheic Dermatitis: Treatment
- Mild to Moderate Cases: Topical corticosteroids.
- Shampoo: Tar, selenium sulfide, ketoconazole, ciclopirox olamine, and pyrithione zinc shampoos.
- Topical Antifungals: Cotrimazole and miconazole creams.
- Severe Cases: Systemic antifungal medications (itraconazole and fluconazole).
Eczema Herpeticum
- Typical vesicular lesions on the hand, around the eye, and on the face
- Management includes complete emollient therapy, identification and avoidance of allergen triggers, and education
- Treatment of flares includes topical corticosteroids, calcineurin inhibitors, and sedating antihistamines for children
General Eczema Management
- The first step is to break the "itch-scratch cycle" - to avoid triggers, control exacerbating factors in the environment, restore skin barrier function, and hydrate the skin with emollients
Eczema Treatment Options
- Topical corticosteroids
- Topical immunosuppressants
- Topical calcineurin inhibitors (TCI) have anti-inflammatory effects without the side effect profile of topical corticosteroids
- Treatment principles for topical corticosteroids: Use the weakest strength that controls the eczema, review use regularly, consider calcineurin inhibitors in children with long-term treatment
Types of Eczema
- Atopic dermatitis
- Seborrheic dermatitis
- Nummular eczema
- Dyshidrosis
- Lichen simplex chronicus (Neurodermatitis)
- Asteatotic dermatitis
- Stasis Eczema (Gravitational)
- Pityriasis alba
- Juvenile plantar dermatitis
Lichen Simplex Chronicus
- Chronic repetitive rubbing, scratching, and picking of the skin
- Skin thickens (lichenification)
- Itching becomes a habit
- Round or coin-shaped, erythematous, scaly plaques, often with minute fissures, round erosions, or crusts located within
- Plaques may begin as papules or vesicles that then coalesce
- The dorsum of the hand, forearm, feet, and legs are sites of predilection
Nummular Eczema
- Well-defined and scaly
Nummular Eczema Treatments
- Emollients
- Topical steroids
- Topical calcineurin inhibitors
- Phototherapy
- Antihistamines
- Antibiotics if it is an infectious reaction
Diaper Dermatitis
- Erythematous, papulovesicular dermatitis
- Irritation caused by bacteria, change in the environment (moisture, higher or lower PH, feces)
- Candida albicans occurs as a secondary infection
- Treatment is by zinc-rich ointments, low-potent topical steroid, antifungals, change of diaper, or no diaper
Exogenous Eczema
- Contact dermatitis: irritant, allergic, phototoxic, allergic contact dermatitis
Contact Dermatitis
- The generic term applied to acute and chronic inflammatory reactions to substances that come in contact with the skin
Irritant Contact Dermatitis
- An inflammatory reaction in the skin resulting from exposure to a substance that causes an eruption in most people who come in contact with it
Allergic Contact Dermatitis
- An acquired delayed sensitivity to various substances that produce inflammatory reactions in only those who have been previously sensitized to the allergen
- It is a type 4 hypersensitivity reaction
### Irritant Contact Dermatitis Pathogenesis
- Irritants cause cell damage if applied for sufficient time and in adequate concentration
Eczema and Dermatitis
- Eczema and dermatitis are the same thing
- Dermat(o): refers to skin
- -itis: inflamed
- Therefore, it is inflamed skin
- It is classified as a non-papulosquamous skin disorder, accounts for 25% of dermatological cases
Eczema Stages
- Acute: erythema, edema, oozing, and papulovesicular eruptions
- Sub-acute: less erythema, edema, and oozing with scaling and crusting
- Chronic: dryness and thickening (lichenification)
Eczema Histology
- Acute Stage: Spongiosis, intraepidermal vesicles, blisters
- Chronic Stage: Less spongiosis, increased thickening of the epidermis (acanthosis, hyperkeratosis, and parakeratosis)
- Eosinophils may be seen
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Description
This quiz covers essential information about eczema and atopic dermatitis, including their classification, stages, and influencing factors. Explore the differences between exogenous and endogenous eczema, as well as the characteristics of atopic dermatitis and its aggravating factors.