DERM - common dermatological conditions Flashcards
Describe atopic eczema
- appearance
- atopic triad
- Px
- Erythematous, ill defined, scaly, patches in flexures
- Triad: asthma + hayfever + eczema
Px: •Itchy ++ •Erythematous •Diffuse •Flexural- thinnest skin •Worse in winter (dry) •Worse in summer (heat)
What are the risk factors for eczema?
Genetic:
- Filaggrin mutation (reduced barrier function)
Environmental: •Irritants (soaps etc) •Allergy •Heat •Infection (Staph.) •“Itch-scratch cycle” •Stress and anxiety
(2) Cx of eczema
- Bacterial Superinfection
- Eczematous skin lacks naturally occuring antibacterial peptides
- Often superinfected with Staphylococcus aureus producing a “golden crust”
- Successful treatment requires systemic anti-staph antibiotics
- Eczema Herpeticum
- Secondary infection by HSV virus
- Sudden onset, worsening of pre-existing eczema with painful vesicles and “punched out” erosions
- Medical emergency, risk of corneal scarring
- Needs assessment by ophthalmologist and systemic antiviral treatment
Rx of atopic eczema
General measures
•Avoid soap ( use soap substitute, non detergent)
•Regular emollient (eg sorbolene cream)
•Warm, not hot showers
Specific measures
•Topical steroid to inflamed areas eg potent steroid to body;
•Mild steroid for face, or non steroid anti inflammatory creams (pimecrolimus)
•Treat infection if suspected with systemic antibiotics
- Wet dressings
- Phototherapy with UVB
- Systemic immunosuppression with oral prednisolone, methotrexate etc
Describe psoriasis
- appearance
- Px
- age of onset
- Risk factor
Appearance: •Well demarcated plaques •Extensor surfaces •Very erythematous/salmon pink •Silvery Scaly +++
Px: •Extensor rash •Symmetrical •Silvery scale •Well demarcated •Can be itchy, but not like eczema
Age of onset: 20s & 50s (bimodal)
Genetic predisposition (30% FMHx)
Describe post-streptococcal guttate psoriasis
- Occurs 1-2 weeks after Streptococcus URTI/tonsillitis
- Sudden generalised onset of small plaque psoriasis
- Most will clear with treatment but recurs if Strep. infection again
- Very responsive to phototherapy
Describe generalised pustular psoarisis
- Acute pustular flare of psoriasis is often accompanied by systemic symptoms of fever and chills.
- Leads to loss of barrier function, thermoregulation, protein loss.
- Risk of pre-renal impairment, high output cardiac failure, sepsis.
- Needs hospital admission to stabilize.
A medical emergency!
Describe psoriatic arthritis
Affects 10% of psoriasis patients
•More common if nail psoriasis •Various types; - Oligoarthritis - Distal symmetrical polyarthritis - Ankylosing Spondylitis - Rheumatoid-like - Arthritis mutilans
Rx of psoriasis
- Topical – steroids, tars, calcipotriol, dithranol, keratolytics, emollients
- Phototherapy – Narrowband UVB treatment, (PUVA)
- Systemic – oral acitretin, methotrexate, cyclosporin A, biologic treatments.
Often used in combination.
Describe acne
- disorder of which unit
- how common in post-pubertal
- Disorder of pilosebaceous unit
- Common- Occurs in approx 80% of post-pubertal individuals
- Moderate to severe in 15-20% of cases
- Teenage disease, but can persist into adulthood
What are the causes of acne?
- Starts in adolescence with increasing sebum production
- Strong genetic component
- Can be flared by hormonal factors (menstruation), picking, emotional stress
- Medications: Lithium, anabolic steroids, topical corticosteroids (steroid acne)
- Topical occlusion – “oily” makeup, moisturisers, headwear and hairstyling
What are the 4 components of acne?
- Abnormal keratinization of sebaceous duct
- Colonization with bacteria
- Propionobactrium acnes - Increase in androgen levels leading to increased sebum production
- Inflammation
Describe hormonal acne
Adult onset acne in female
•Premenstrual flare
•Mainly on lower face
•Treatment: Anti-androgenic OCP +/- anti-androgen
•If associated with other signs of androgenisation – eg hirsutism, androgenetic alopecia, consider polycystic ovarian syndrome (PCOS)
Rx of acne
Topicals:
- keratolytics
- comedolytic
- anti-bacterial treatments
- combination treatments
Systemic:
- Systemic antibiotics
- antiandrogenic OCP (females only)
- antiandrogens (females only)
- Systemic retinoids
Who gets rosacea?
- Affects women more than men (3:1)
- Affects middle aged > young individuals
- Sun-damaged, Celtic skin more affected
- Men can get tissue hyperplasia as a complication- rhinophyma
