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Dermatology > 2: Inflammatory Skin Conditions: Acne, Eczema, Psoriasis > Flashcards

2: Inflammatory Skin Conditions: Acne, Eczema, Psoriasis Flashcards

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Dermatology Board Prep flashcards
1
Q

What is acne

A

Inflammatory condition of pilosebaceous follicles

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2
Q

When is acne more common

A

Adolescence

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3
Q

In which gender is acne more common

A

Males during adolescences and then females during adulthood

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4
Q

Where is acne more common

A

Areas with more sebaceous glands:

  • Face
  • Back
  • Upper chest
  • Shoulders
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5
Q

Explain grading of acne

A

Acne is graded into mild, moderate and severe forms

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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
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7
Q

What identifies moderate acne

A
  • Pustules
  • 20-100 Comedones
  • 15-50 Inflammatory lesions
  • 30 - 125 total lesions
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8
Q

What are the features of severe acne

A

Cysts

  • > 5 pseudocysts
  • > 100 comedones
  • > 50 inflammatory lesions
  • > 125 total lesions
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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

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10
Q

What is a comedones

A

Dilation of pilosebaceous gland. If top is open = blackhead. If top is closed = white head

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11
Q

What is a pustule

A

Irritants released from over-flow of pilosebaceous gland trigger an inflammatory response

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12
Q

What is a pseudocyst

A

Chronic inflammation

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13
Q

What is the sequence of scarring forming acne

A

Icepick scars then develop into hypertrophic scars

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14
Q

What are 3 contributing factors to acne

A
  • Increased sebum
  • Abnormal follicular keratinisation
  • Colonisation with propionibacterium acnes
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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
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16
Q

What is first line for mild acne

A

Topical benzyl peroxide

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17
Q

What is second line for mild acne

A

Benzyl peroxide and topical clindamycin

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18
Q

What should be offered for moderate acne or failure of topical treatment

A

Oral doxycycline or limecycline

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19
Q

What time frame should oral doxycycline be trialled for before deeming it is not effective

A

3m

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20
Q

What other medication should be tried in women with acne

A

dianette

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21
Q

What is used to manage severe acne

A

Isoretinoin

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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
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23
Q

What is used for patients with mild symptoms of acne rosecea

A

Oral metronidazole

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24
Q

What is used for patients with flushing but no telangiectasia in acne rosacea

A

Topical bromonidine gel

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25
Q

What is used to manage severe acne rosacea

A

Oral oxytetracycline

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26
Q

What is eczema

A

Chronic inflammatory skin condition

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27
Q

When does eczema usually manifest

A

Early childhood (3-6m)

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28
Q

What will 70 of patients with eczema also have

A

Other atopic conditions: hay fever, asthma.

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29
Q

Give 5 triggers for eczema

A 
Stress
Infection
Corrosive substances
Dry or Humid Climate 
Heat 
Dust
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30
Q

How will eczema in an infant likely present

A
  • Face, Cheek, Head

- Extensor surfaces

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31
Q

What may infantile eczema start as

A

Seborrheic dermatitis

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32
Q

What is the common name for seborrheic dermatitis

A

Cradle cap

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33
Q

How will cradle cap present

A

Yellow, Scaly, Greasy Lesions of the scalp

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34
Q

What fold may be present in infantile eczema

A

Dennie-Morgan Fold

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35
Q

What is a dennie-morgan fold

A

Increase fold below lower eyelid

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36
Q

Where will childhood eczema present

A

Flexor surfaces

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37
Q

What are some examples of flexor creases

A

Popliteal Fossa

Antecubital Fossa

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38
Q

What is a classic feature of eczema in children

A

Lichenificaiton - from where they have been scratching

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39
Q

How will adult eczema present clinically

A

Flexor surfaces

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40
Q

What is a nail feature of eczema

A

Nail pitting

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41
Q

What type of hypersensitivity reaction is eczema

A

type I hypersensitivity reaction

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42
Q

How is eczema diagnosed

A

clinically

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43
Q

What should be assessed each clinical visit with eczema

A

severity AND impact of eczema on the person’s life

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44
Q

How can severity of eczema be divided

A
  1. Mild
  2. Moderate
  3. Severe
  4. Infected
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45
Q

What defines mild eczema

A

Infrequent itching with or without redness

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46
Q

What defines moderate eczema

A

Frequent itching, with redness.

With/or without excoriations and localised skin thickening

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47
Q

What defines severe eczema

A

Incessant itching, redness, excoriations. With or without extensive skin thickening, bleeding, oozing, cracking and change in pigmentation

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48
Q

What indicates infected eczema

A

Weeping and crusting of a lesion

Or, Fever and general malaise

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49
Q

What can be used to determine the impact of eczema on a patients life

A

Adult dermatology quality of life index (ADLQI)

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50
Q

What is first-line for managing eczema

A

Advice

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51
Q

What advice should be offered to someone with eczema

A
  • Avoid triggers (irritants, heat, pets, stress)
  • Cut nails short and do not scratch. Offer scratch mittens to infants
  • Frequent emollient use
52
Q

What is first-line management for mild eczema

A
  1. Emolients

2. Mild topical corticosteroid such as Hydrocortisone

53
Q

What is first-line management for moderate eczema

A
  1. Emolients

2. Potent topical corticosteroid - such as betamethasone. Use mild corticosteroid on the face

54
Q

If individual has itching in moderate eczema what can be given

A

Non-sedating antihistamine such as certrizine or loranitidine

55
Q

How is severe eczema managed

A

Emolients
Potent topical corticosteroids
Non-sedating anti-histamines

56
Q

If itching is impacting sleep what can be given

A

Sedating anti-histamines (Chlorphenamine)

57
Q

If eczema causing psychological distress what may be offered first-line

A

1W course oral prednisolone. Then given maintenance topical corticosteroids or topical calcineurin inhibitors (tacrolismus) to prevent flares

58
Q

If a secondary bacterial infection what will be given in eczema

A

Flucloxacillin

59
Q

If eczema herpeticum is suspected what will be offered in eczema

A

Acyclovir

60
Q

How will secondary bacterial infection present

A

oozing of the lesion

61
Q

How will secondary viral infection with molluscm contagious present

A

pearly papules with central umbilication

62
Q

What is eczema herpeticum

A

infection of eczema with HSVI (or less commonly 2)

63
Q

In which population is eczema herpeticum more common

A

children with atopic eczema

64
Q

How does eczema herpeticum present

A

rapidly progressing painful rash with monomorphic punched-out erosions

65
Q

What is a complication of eczema herpeticum

A

oozing

66
Q

What is dermatitis

A

Group of conditions that causes of inflammation of the dermis

67
Q

What is eczema

A

Vesicles seen in acute eczema

68
Q

What is the problem with dermatitis and eczema as terms

A

Often used interchangeably

69
Q

What may be ordered for individuals with eczema

A

Allergy testing

70
Q

What method of allergy testing is used for eczema/dermatitis

A

Skin Patch Testing

71
Q

Explain skin patch testing

A

Several allergens are placed on the patch. Which is then placed on the skin and reaction observed.

72
Q

What are two types of emollients

A
  • Liquid paraffin

- Aqueous cream

73
Q

What are indications for emollients

A

Dry Skin
Eczema
Psoriasis

74
Q

How do emollients work

A

Replace water content in dry skin

75
Q

What are three side effects of emollients

A
  1. Greasy skin - poorly tolerated
  2. Exacerbate acne
  3. Exacerbate folliculitis
76
Q

What is a contraindication to emollients

A

Highly flammable

77
Q

Describe application of emollients

A

Should be applied last after topical corticosteroids

78
Q

Name two topical corticosteroids

A

Hydrocortisone

Betamethasone

79
Q

What are two complications of prolonged topical corticosteroid use

A

Skin thinning

Striae

80
Q

If used on the face what can topical corticosteroids cause

A

Peri-oral dermatitis

Exacerbate acne

81
Q

What is psoriasis

A

Chronic inflammatory skin condition that presents with well-circumscribed red patches and associated scaling. Caused by hyper-proliferation of keratinocytes

82
Q

What is the most common type of psoriasis

A

Chronic plaque psoriasis

83
Q

How does chronic plaque psoriasis present

A

Erythematous plaques with silver scales

84
Q

What population is psoriasis more common in

A

Middle-age females

85
Q

Which age group does psoriasis occur in

A

20-40

86
Q

What genes is psoriasis associated with

A

HLAB13

HLAB17

87
Q

What can trigger psoriasis

A
  • Infections
  • Trauma
  • Medications
  • Alcohol
88
Q

What bacteria is known to exacerbate psoriasis

A

Group A streptococcus

89
Q

What medications may exacerbate psoriasis

A

ACEi, B-blockers, Lithium, Chloroquine, NSAIDs

90
Q

How will chronic plaque psoriasis present

A
  • Well-demarcated erythematous plaques with white scaling. That initially start as separate lesions and then become confluent.
  • Commonly over extensor surfaces
  • Pruritus
91
Q

What are four nail-features of chronic plaque psoriasis

A
  • Oil drop
  • Brittle
  • Onycholysis
  • Nail pitting
92
Q

What is the oil-drop sign

A

Well circumscribed yellow-red discolouration of the nail

93
Q

What is koebner phenomenon

A

Individual has trauma to the skin it will cause lesions to appear representative of underlying condition

94
Q

What is aupitz sign

A

bleeding on scaling of of flakes

95
Q

What two signs are seen in psoriasis

A

Koebner phenomenon

Aupitz sign

96
Q

How is psoriasis diagnosed

A

Clinically

97
Q

What advice is offered to improve psoriasis

A
  • Smoking cessation
  • Reduce alcohol intake
  • Weight loss
98
Q

What is first-line to manage chronic plaque psoriasis

A
  • Regular Emollients

- Topical corticosteroid and vitamin-D analogue

99
Q

How long is the topical corticosteroid and vitamin-D analogue applied

A

4W

100
Q

If vitamin D and corticosteroid are ineffective for psoriasis what is offered

A

Coal Tar

101
Q

What is the MOA of coal tar

A

Inhibits DNA synthesis

102
Q

How long do NICE recommend a topical corticosteroid should be used for

A

8W if potent. 4W if very potent

103
Q

in secondary care, what may be offered to manage psoriasis

A
  1. Phototherapy

2. Oral methotrexate

104
Q

What is oral methotrexate particularly effective management strategy

A

Psoriatic arthritis

105
Q

What % of individuals with psoriasis may develop psoriatic arthritis

A

10%

106
Q

What is first-line for managing chronic plaque psoriasis

A

Topical emollients

107
Q

Aside from emollients what else is given for chronic plaque psoriasis

A

Topical corticosteroids and vitamin D

108
Q

How long should individual take topical corticosteroid and topical vitamin D before review

A

4W

109
Q

If topical corticosteroids and topical vitamin D are ineffective after 4W what should be done

A

Continue both for a further 4W. Or continue just vitamin D for a further 8W.

110
Q

If topical corticosteroids and topical vitamin D are ineffective after 8W what should be done

A

Continue potent corticosteroid for 4W or coal tar

111
Q

If individual does not respond to corticosteroid, coal tar or vitamin D what should be done

A

Refer to dermatologist for narrow-band UVB phototherapy

112
Q

How often is narrow-band UVB phototherapy offered

A

2-3 times per week

113
Q

What is offered if phototherapy is ineffective

A

Methotrexate

114
Q

If methotrexate is ineffective hat may be offered

A

Biologics

115
Q

What biological treatments are offered

A

TNFa inhibitors

116
Q

What are two TNFa inhibitors

A

Adalilumab

Entarnacept

117
Q

What should be given to males AND females on methotrexate

A

contraception during taking methotrexate and for at least 3 months afterwards

118
Q

How long should males and females continue to use contraception after stopping methotrexate

A

3 months

119
Q

Why is methotrexate teratogenic

A

anti-folate can prevent closure of the neural tube

120
Q

How long after taking methotrexate should a women avoid getting pregnant for

A

6m

121
Q

What blood tests are required for monitoring methotrexate

A

FBC
LFT
U+E

122
Q

What should be prescribed with methotrexate

A

Folic acid 5mg

123
Q

What drug should methotrexate not be prescribed with and why

A

Co-trimoxazole and trimethoprim as it increases risk of bone marrow aplasia

124
Q

Why should methotrexate not be prescribed with high-dose aspirin

A

NSAID - increases risk of methotrexate toxicity secondary to reduced renal excretion

125
Q

What should females take alongside isoretinoin

A

two methods of contraception

126
Q

What is the problem with isoretinion

A

causes foetal retinoid syndrome

Dermatology (6 decks)

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