Dermatitis

Question 1

—- is an inflammation of the skin

Answer 1

Dermatitis

Question 2

Facts about Dermatitis

Answer 2

Can be- ACUTE: a single exposure to an irritant CHRONIC: repeated exposure

Characterised by sore, red itching skin.

Question 3

State the most common form of dermatitis in primary care

Answer 3

IRRITANT CONTACT DERMATITIS (ICD) & ALLERGIC CONTACT DERMATITIS (ACD) are most common

Question 4

State the epidemiology of Dermatitis

Answer 4

ICD much more common than ACD
ICD accounts for 80% of occupational skin disorders
Dermatitis accounts for ~30% of skin consultations

Question 5

Aetiology of ICD

Answer 5

ICD: agent must penetrate the outer layer of skin to invoke physiological response

Question 6

state the common irritant of ICD

Answer 6

Nickel, leather, detergents and soaps, solvents, abrasives, oil, acids and alkalis.

Question 7

State facts about Allergic contact dermatitis ACD

Answer 7

first requires sensitisation to occur. Once skin sensitised to allergen, re-exposure triggers memory T-Cells to initiate inflammatory response 24-48hours after exposure

Question 8

Common irritants of ACD

Answer 8

nickel, topical corticosteroids, preservatives, cosmetics & rubber (incl. latex)

Question 9

State the signs and symptoms of Contact Dermatitis

Answer 9

Both cases, rash develops at site of exposure

Acute phase: Lesions appear rapidly, within 6-12 hours of contactSkin appears red, itchy, inflamed & might show papules

Chronic Exposure: Skin becomes dry, scaly, and can crack/fissure

ICD rash tends to be well demarcated. ACD tends to be less well defined

Question 9

State the signs and symptoms of Contact Dermatitis

Answer 9

Both cases, rash develops at site of exposure

Acute phase: Lesions appear rapidly, within 6-12 hours of contactSkin appears red, itchy, inflamed & might show papules

Chronic Exposure: Skin becomes dry, scaly, and can crack/fissure

ICD rash tends to be well demarcated. ACD tends to be less well defined

Question 10

Questions to ask a patient suffering from Dermatitis

Answer 10

Location
Personal history
Exposure
Occupation/work
Known allergies/other ectopic conditions
Family history

Question 11

List the 3 steps in managing Contact Dermatitis

Answer 11

managing itch - avoiding irritants -maintain skin integrity

Question 12

How to pharmacologically manage Contact Dermatitis

Answer 12

P’cological treatment of dermatitis should be managed with a combination of emollients and steroid-based products

Question 13

How to treat Contact Dermatitis in Primary care/pharmacy

Answer 13

Emollients
Apply regularly & liberally.
a) Moisturisers e.g. Aveeno, Diprobase, Oilatum

b) Bath additives e.g. Balneum, Oilatum
c) Soap substitute e.g. Emulsifying Ointment, Aqueous cream, E45

d) Humectants e.g. Urea, lactic acid (Calmurid, Aquadrate, Humiderm

Question 14

Treatment of Dermatitis contd

Answer 14

Topical steroids
OTC: Hydrocortisone 1% crm & Clobetason crm 0.05%
Anti-inflammatory.

Question 15

side effect of using topical steroid to treat dermatitis

Answer 15

skin thining

Question 16

see slide 23 for Steriod ladder and slide 24 for emolient ladder

Question 17

Self advise for dermatitis

Answer 17

AVOID soap/bubble bath  use soap substitute
Avoid contact with stimulus
Use during and after bathing/showering

Question 18

State actions patient should take to reduce the likelihood of Dermatitis occuring

Answer 18

Patient should try to avoid contact with the stimulus causing the dermatitis. If they cannot completely avoid it, they should take the following actions to prevent/reduce the likelihood of it occurring:
Rinsing with water or washing with soap or, preferably, a soap substitute as soon as possible after contact (overuse of skin-cleaning agents can aggravate contact dermatitis).
Substituting products that contain identified allergens or irritants with other products that do not contain them.
Reducing the duration and frequency of contact with an irritant.
Using protective clothing. Most irritant contact dermatitis involves the hands, and protective gloves are the mainstay of protection.
Certain chemicals may demand more heavy-duty protective materials which are not subject to chemical degradation.
Gloves should be removed frequently, as sweating may aggravate existing dermatitis.

Question 19

When to refer a patient with dermatitis

Answer 19

Children under 10 in need of corticosteroid
Lesions on the face unresponsive to emollients
OTC treatment failure
Widespread/severe dermatitis (signs of secondary infection

Question 20

State the treatment options for dermatitis available in secondary care/dermatology

Answer 20

Treatment options in Secondary Care/dermatology:
Immunosuppressants
Adalimumab (black triangle biosimilar)
Self-Management with nurses

Question 21

List the conditions to eliminate in Dermatitis

Answer 21

Psoriasis: Not precipitated to exposure to irritants/allergens

Fungal infections: Defined advancing edge w central clearing

Discoid dermatitis: Lesions oval/circular &clearly demarcated

Urticaria: can be due to food allergy, food additives & medicine. Itchy rash resembling nettle rash. Skin can be oedamatous & blanches when pressed. Respond to antihistamines.