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Eczema or eczematous dermatitis is an inflammatory response of the epidermis and may be acute, subacute or chronic in nature. Acute dermatitis is characterised by erythema, oedema and blistering – histology reveals spongiosis and inflammatory cells. Chronic dermatitis is characterised by skin thickening and dryness – histology reveals acanthosis and parakeratosis without much inflammation.
Combinations and overlap of different type of eczema are common – for example, lichen simplex may complicate atopic eczema; irritant hand dermatitis predisposes to allergic contact dermatitis; asteatotic and venous eczema may lead to discoid eczema and autosensitisation; and pompholyx may become infected and spread more widely.
General management of eczema should include identifying and minimising causal or aggravating factors, reducing exposure to irritants, liberal use of emollients, and intermittent use of topical steroids of appropriate potency.
For each of the fourteen cases, study the image(s) and then answer the questions. You can click on the image to view a larger version if required.
Each case should take approximately 2 minutes to complete. There is a list of suggested further reading material at the end of the quiz.
What kind of eczema does this patient have?
Pompholyx
Describe the features
Pompolyx presents as crops of intensely itchy sago grain-like vesicles on the palms and sides of the fingers, and sometimes on the soles of the feet. It often appears to be a stress reaction, but can arise as a dermatophytide, i.e., eczema in response to the presence of an inflammatory tinea infection somewhere (usually the feet). Vesicular hand eczema may also be due to or aggravated by contact irritants and/or allergens.