2: Inflammatory Skin Conditions: Acne, Eczema, Psoriasis Flashcards
1
Q
What is acne
A
Inflammatory condition of pilosebaceous follicles
2
Q
When is acne more common
A
Adolescence
3
Q
In which gender is acne more common
A
Males during adolescences and then females during adulthood
4
Q
Where is acne more common
A
Areas with more sebaceous glands:
- Face
- Back
- Upper chest
- Shoulders
5
Q
Explain grading of acne
A
Acne is graded into mild, moderate and severe forms
6
Q
What is mild acne
A
- Open and closed comedones
- Less than 20 comedones
- Less than 15 inflammatory lesions
- Less than 30 total lesions
7
Q
What identifies moderate acne
A
- Pustules
- 20-100 Comedones
- 15-50 Inflammatory lesions
- 30 - 125 total lesions
8
Q
What are the features of severe acne
A
Cysts
- > 5 pseudocysts
- > 100 comedones
- > 50 inflammatory lesions
- > 125 total lesions
9
Q
What is a good way to remeber if mild, moderate or severe acne
A
Oliver Couldn’t Please Carol
Open and Closed Comedones = Mild
Pustules = Moderate
Cysts = Severe
10
Q
What is a comedones
A
Dilation of pilosebaceous gland. If top is open = blackhead. If top is closed = white head
11
Q
What is a pustule
A
Irritants released from over-flow of pilosebaceous gland trigger an inflammatory response
12
Q
What is a pseudocyst
A
Chronic inflammation
13
Q
What is the sequence of scarring forming acne
A
Icepick scars then develop into hypertrophic scars
14
Q
What are 3 contributing factors to acne
A
- Increased sebum
- Abnormal follicular keratinisation
- Colonisation with propionibacterium acnes
15
Q
What is conservative advice for acne
A
- Do not wash skin more than twice daily
- Use make-up remover with pH close to skin
- Do not squeeze or pick spots
- Healthy diet
16
Q
What is first line for mild acne
A
Topical benzyl peroxide
17
Q
What is second line for mild acne
A
Benzyl peroxide and topical clindamycin
18
Q
What should be offered for moderate acne or failure of topical treatment
A
Oral doxycycline or limecycline
19
Q
What time frame should oral doxycycline be trialled for before deeming it is not effective
A
3m
20
Q
What other medication should be tried in women with acne
A
dianette
21
Q
What is used to manage severe acne
A
Isoretinoin
22
Q
Explain the clinical presentation of acne rosacea
A
- Early symptoms including flushing of nose, cheeks and forehead.
- With associated telangiectasia
- Will then develop into persistent erythema and pustules
- With rhinopehyma and blepharitis
23
Q
What is used for patients with mild symptoms of acne rosecea
A
Oral metronidazole
24
Q
What is used for patients with flushing but no telangiectasia in acne rosacea
A
Topical bromonidine gel
25
What is used to manage severe acne rosacea
Oral oxytetracycline
26
What is eczema
Chronic inflammatory skin condition
27
When does eczema usually manifest
Early childhood (3-6m)
28
What will 70 of patients with eczema also have
Other atopic conditions: hay fever, asthma.
29
Give 5 triggers for eczema
```
Stress
Infection
Corrosive substances
Dry or Humid Climate
Heat
Dust
```
30
How will eczema in an infant likely present
- Face, Cheek, Head
| - Extensor surfaces
31
What may infantile eczema start as
Seborrheic dermatitis
32
What is the common name for seborrheic dermatitis
Cradle cap
33
How will cradle cap present
Yellow, Scaly, Greasy Lesions of the scalp
34
What fold may be present in infantile eczema
Dennie-Morgan Fold
35
What is a dennie-morgan fold
Increase fold below lower eyelid
36
Where will childhood eczema present
Flexor surfaces
37
What are some examples of flexor creases
Popliteal Fossa
| Antecubital Fossa
38
What is a classic feature of eczema in children
Lichenificaiton - from where they have been scratching
39
How will adult eczema present clinically
Flexor surfaces
40
What is a nail feature of eczema
Nail pitting
41
What type of hypersensitivity reaction is eczema
type I hypersensitivity reaction
42
How is eczema diagnosed
clinically
43
What should be assessed each clinical visit with eczema
severity AND impact of eczema on the person's life
44
How can severity of eczema be divided
1. Mild
2. Moderate
3. Severe
4. Infected
45
What defines mild eczema
Infrequent itching with or without redness
46
What defines moderate eczema
Frequent itching, with redness.
| With/or without excoriations and localised skin thickening
47
What defines severe eczema
Incessant itching, redness, excoriations. With or without extensive skin thickening, bleeding, oozing, cracking and change in pigmentation
48
What indicates infected eczema
Weeping and crusting of a lesion
| Or, Fever and general malaise
49
What can be used to determine the impact of eczema on a patients life
Adult dermatology quality of life index (ADLQI)
50
What is first-line for managing eczema
Advice
51
What advice should be offered to someone with eczema
- Avoid triggers (irritants, heat, pets, stress)
- Cut nails short and do not scratch. Offer scratch mittens to infants
- Frequent emollient use
52
What is first-line management for mild eczema
1. Emolients
| 2. Mild topical corticosteroid such as Hydrocortisone
53
What is first-line management for moderate eczema
1. Emolients
| 2. Potent topical corticosteroid - such as betamethasone. Use mild corticosteroid on the face
54
If individual has itching in moderate eczema what can be given
Non-sedating antihistamine such as certrizine or loranitidine
55
How is severe eczema managed
Emolients
Potent topical corticosteroids
Non-sedating anti-histamines
56
If itching is impacting sleep what can be given
Sedating anti-histamines (Chlorphenamine)
57
If eczema causing psychological distress what may be offered first-line
1W course oral prednisolone. Then given maintenance topical corticosteroids or topical calcineurin inhibitors (tacrolismus) to prevent flares
58
If a secondary bacterial infection what will be given in eczema
Flucloxacillin
59
If eczema herpeticum is suspected what will be offered in eczema
Acyclovir
60
How will secondary bacterial infection present
oozing of the lesion
61
How will secondary viral infection with molluscm contagious present
pearly papules with central umbilication
62
What is eczema herpeticum
infection of eczema with HSVI (or less commonly 2)
63
In which population is eczema herpeticum more common
children with atopic eczema
64
How does eczema herpeticum present
rapidly progressing painful rash with monomorphic punched-out erosions
65
What is a complication of eczema herpeticum
oozing
66
What is dermatitis
Group of conditions that causes of inflammation of the dermis
67
What is eczema
Vesicles seen in acute eczema
68
What is the problem with dermatitis and eczema as terms
Often used interchangeably
69
What may be ordered for individuals with eczema
Allergy testing
70
What method of allergy testing is used for eczema/dermatitis
Skin Patch Testing
71
Explain skin patch testing
Several allergens are placed on the patch. Which is then placed on the skin and reaction observed.
72
What are two types of emollients
- Liquid paraffin
| - Aqueous cream
73
What are indications for emollients
Dry Skin
Eczema
Psoriasis
74
How do emollients work
Replace water content in dry skin
75
What are three side effects of emollients
1. Greasy skin - poorly tolerated
2. Exacerbate acne
3. Exacerbate folliculitis
76
What is a contraindication to emollients
Highly flammable
77
Describe application of emollients
Should be applied last after topical corticosteroids
78
Name two topical corticosteroids
Hydrocortisone
| Betamethasone
79
What are two complications of prolonged topical corticosteroid use
Skin thinning
| Striae
80
If used on the face what can topical corticosteroids cause
Peri-oral dermatitis
| Exacerbate acne
81
What is psoriasis
Chronic inflammatory skin condition that presents with well-circumscribed red patches and associated scaling. Caused by hyper-proliferation of keratinocytes
82
What is the most common type of psoriasis
Chronic plaque psoriasis
83
How does chronic plaque psoriasis present
Erythematous plaques with silver scales
84
What population is psoriasis more common in
Middle-age females
85
Which age group does psoriasis occur in
20-40
86
What genes is psoriasis associated with
HLAB13
| HLAB17
87
What can trigger psoriasis
- Infections
- Trauma
- Medications
- Alcohol
88
What bacteria is known to exacerbate psoriasis
Group A streptococcus
89
What medications may exacerbate psoriasis
ACEi, B-blockers, Lithium, Chloroquine, NSAIDs
90
How will chronic plaque psoriasis present
- Well-demarcated erythematous plaques with white scaling. That initially start as separate lesions and then become confluent.
- Commonly over extensor surfaces
- Pruritus
91
What are four nail-features of chronic plaque psoriasis
- Oil drop
- Brittle
- Onycholysis
- Nail pitting
92
What is the oil-drop sign
Well circumscribed yellow-red discolouration of the nail
93
What is koebner phenomenon
Individual has trauma to the skin it will cause lesions to appear representative of underlying condition
94
What is aupitz sign
bleeding on scaling of of flakes
95
What two signs are seen in psoriasis
Koebner phenomenon
| Aupitz sign
96
How is psoriasis diagnosed
Clinically
97
What advice is offered to improve psoriasis
- Smoking cessation
- Reduce alcohol intake
- Weight loss
98
What is first-line to manage chronic plaque psoriasis
- Regular Emollients
| - Topical corticosteroid and vitamin-D analogue
99
How long is the topical corticosteroid and vitamin-D analogue applied
4W
100
If vitamin D and corticosteroid are ineffective for psoriasis what is offered
Coal Tar
101
What is the MOA of coal tar
Inhibits DNA synthesis
102
How long do NICE recommend a topical corticosteroid should be used for
8W if potent. 4W if very potent
103
in secondary care, what may be offered to manage psoriasis
1. Phototherapy
| 2. Oral methotrexate
104
What is oral methotrexate particularly effective management strategy
Psoriatic arthritis
105
What % of individuals with psoriasis may develop psoriatic arthritis
10%
106
What is first-line for managing chronic plaque psoriasis
Topical emollients
107
Aside from emollients what else is given for chronic plaque psoriasis
Topical corticosteroids and vitamin D
108
How long should individual take topical corticosteroid and topical vitamin D before review
4W
109
If topical corticosteroids and topical vitamin D are ineffective after 4W what should be done
Continue both for a further 4W. Or continue just vitamin D for a further 8W.
110
If topical corticosteroids and topical vitamin D are ineffective after 8W what should be done
Continue potent corticosteroid for 4W or coal tar
111
If individual does not respond to corticosteroid, coal tar or vitamin D what should be done
Refer to dermatologist for narrow-band UVB phototherapy
112
How often is narrow-band UVB phototherapy offered
2-3 times per week
113
What is offered if phototherapy is ineffective
Methotrexate
114
If methotrexate is ineffective hat may be offered
Biologics
115
What biological treatments are offered
TNFa inhibitors
116
What are two TNFa inhibitors
Adalilumab
| Entarnacept
117
What should be given to males AND females on methotrexate
contraception during taking methotrexate and for at least 3 months afterwards
118
How long should males and females continue to use contraception after stopping methotrexate
3 months
119
Why is methotrexate teratogenic
anti-folate can prevent closure of the neural tube
120
How long after taking methotrexate should a women avoid getting pregnant for
6m
121
What blood tests are required for monitoring methotrexate
FBC
LFT
U+E
122
What should be prescribed with methotrexate
Folic acid 5mg
123
What drug should methotrexate not be prescribed with and why
Co-trimoxazole and trimethoprim as it increases risk of bone marrow aplasia
124
Why should methotrexate not be prescribed with high-dose aspirin
NSAID - increases risk of methotrexate toxicity secondary to reduced renal excretion
125
What should females take alongside isoretinoin
two methods of contraception
126
What is the problem with isoretinion
causes foetal retinoid syndrome
