Ch 3.1 - Eczema & Acne

Question 1

Describe an eczema rash

Answer 1

Typically presents as
dry/flaky skin that may be inflamed and have small red spots
skin may be cracked and weepy & sometimes thickened.

Rash is irritating and extremely itchy

Question 2

How can age/race affect the distribution of the rash?

Answer 2

Infants - present around the nappy area, neck, back of scalp, face, limb creases and backs of wrists.

White children - behind the knees, inside elbow joints, around wrists, hands, ankles, neck and around eyes.

Black/Asian children - often on exterior surface of joints and have a more follicular appearance.

Adults - neck, back of hands, groin, around anus, ankles and feet

Question 3

What is atopic eczema?

Answer 3

eczema associated with hayfever and or/ asthma.

Question 4

What can aggravate eczema/dermatitis?

Answer 4

Hay fever season
House dust
Animal danders
Soaps/Detergents
Certain clothing - woollen material

Question 5

What medications can cause allergic dermatitis? Should be careful

Answer 5

Local anaesthetics
Antihistamines
Antibiotics
Antiseptics

Question 6

When would you refer for eczema/dermatitis?

Answer 6

1. Evidence of infection (weeping, crusting, spreading)
2. Severe condition, badly cracked skin, bleeding
3. Failed medication
4. No identifiable cause
5. Duration of longer than 2 weeks

Question 7

What management options are there for eczema?

Answer 7

1. Emollients
2. Topical corticosteroids
3. Antipruritics

Question 8

How do emollients work?

Answer 8

they are medically inert cream and ointments which can help to:
soothe the skin 
reduce irritation
prevent skin drying 
act as protective layer 
used as soap substitute

Question 9

Give two examples of topical corticosteroids?

Answer 9

Hydrocortisone cream/ointment

Clobetasone 0.05%

Question 10

When can OTC hydrocortisone cream be used and when can it NOT be used?

Answer 10

CAN be used for
Irritant and allergic dermatitis
Insect bites
Mild/Moderate eczema

For children over 10 & adults only. 1 week max use.

CANNOT/contraindicated:
where skin is infected (e.g.g athlete’s foot, cold sores)
Acne
Face and anogenital areas

Question 11

When is Topical clobetasone 0.05% (P med) used?

Answer 11

Short term treatment and control of patches of eczema and dermatitis in people aged 12 and over

Question 12

What are some examples of antipruritics used in eczema? Since the itch is not histamine related. Anti-histamines used for sedation purposes.

Answer 12

Aqueous calamine cream can be used and adding 1%
menthol gives additional antipruritic and cooling actions.

Crotamiton

Question 13

Which medications can induce acne?

Answer 13

Lithium, phenytoin and the progestogens,

levonorgestrel and norethisterone

Question 14

When should you refer for acne?

Answer 14

1. Severe acne
2. Failed medication
3. Suspected drug-induced acne
4. Not responded to treatment within 8 weeks

Question 15

What is the first line OTC treatment for inflammatory and non-inflammatory acne?

Answer 15

Benzoyl peroxide has both antibacterial and anticomedogenic
actions.

It has a keratolytic action, which increases the turnover
of skin cells, helping the skin to peel.

Start with 2.5% or 5% then increase to 10% if needed

Question 16

Name the second line treatments for acne?

Answer 16

Other keratolytics include potassium hydroxyquinoline sulphate, sulphur,
resorcinol and salicylic acid.

Question 17

Which antibacterials can be used and how are they helpful for acne?

Answer 17

Soap/washes containing antiseptics e.g. chlorhexidine. Help degreasing skin and reducing skin flora.
combination product available - benzoyl peroxide + miconazole

Question 18

What are the antibiotics choices available for acne?

Answer 18

Oral - tetracyclines, erythromycin (high resistance) and trimethoprim (unlicensed but used when resistance to others)

Topical - alternative but not as effective as oral.
Erythromycin + benzyol peroxide