Dermatitis and Eczema Flashcards
Key Learnings of Irritant Contact Dermatitis
-Most common
-From freq’ exposure to chemicals or substance which damage the skin (water, soaps, detergents, dribbling)
-Chronic stages present as: very dry thickened, cracking
What is ‘Napkin Dermatitis’?
-A subcategory of irritant contact dermatitis (can be atopic also)
-Very common in infant and toddlers - “Nappy Rash”
-can be complicated by secondary candida infection
Describe key features of contact dermatitis
- True allergy
-Patch test to confirm allergy
-Occurs in unusual patterns related to allergen contact
-Can extend past contact area
What are some common examples of causes of Allergic Contact Dermatitis?
Bandaids, watch band, plant contact, rubber gloves, nickel in earrings, jean stud on abdomen
Describe the key feature of Asteatotic dermatitis
-Common in ELDERLY
-Characterised by very dry flaking skin which splits - “crazy-paving’ appearance
-Particularly effects lowers legs
-Worse in winter (low humidity) and worsened by soap and household heating.
Describe the key features of Atopic Dermatitis (a.k.a Eczema)
Who, why, what, when?
-Common in infancy/childhood
-Genetic Predisposition
-Worse in winter (relapsing, chronic condition)
-RED, SCALY ERUPTION, can be weeping and crusted in acute phase
- Flexures and cheeks
-Intense itch and rubbing which exacerbates condition and becomes resistant to treatments
-Prone to skin infections (strep and staph)
-Antibiotics often required initially
Describe discoid dermatitis key characteristics
-Common in young to middle-aged
-Round, disc-like scaling lesions -intensely itchy
-clearly demarcated edges
-Can be confused with ringworm
- acute and weeping, commonly secondary infection
-Occurs on trunk and limbs
Describe key feature of dyshydrotic/pompholyx presentations of dermatitis:
-Common in young people
-characterised by lines of small vesicles (blisters with clear fluid)
-Blisters=intensely itchy, maybe burning feeling, sore
-Exudate when burst
-Pompholyx is a severe form of dyshydrotic
* Peeling flaking skin and vesicles
*similar appearance to fungal infections
-Connected to STRESS
Describe the key features of Seborrheic Dermatitis
(to be updated)
How can we differentially diagnose between tinea and psoriasis (and dermatitis)?
Tinea (ringworm) = has an active outer, red scaling edge and CLEARING centre (kind of like a blursed fairy circle of ew). Psoriasis presents as thicker pinky red plaques with a silvery scale that can be throughout the whole plaque, not just edges. Doesn’t have blisters. Is commonly located on extensor (external side) of knees and elbows. Dermatitis is less thick and more so found on flexures and trunk.
Which one of the following options best describes atopic eczema?
a) mostly caused by allergy due to contact with some substance or chemical in the environment
b) It is intensely itchy and has a genetic predisposition
c) Is an exogenous form of dermatitis
b) It is intensely itchy and has a genetic predisposition
Which one of the following best applies to asteototic eczema?
a)Intensely itchy, raised, erythematous scaling lesions
b) Often confused with tinea corporis (ringworm)
c) Most common in elderly, particularly on lower legs
d) Characterised by round, disc-like lesions
e) Often occurs with young people and connected to stress
Asteototic eczema is most common in elderly, particularly on lower legs.
It’s giving lizard people. I don’t want to get older.
Which one of the following best applies to pompholyx / dyshidrotic eczema?
a) Most common in elderly, particularly on lower legs
b) Characterised by round, disc-like lesions
c) Often occurs with young people and connected to stress
c) Often occurs with young people and connected to stress - and I swear if I get these this painful, itchy exudate filled blisters from uni stress I will throw handdssss ( which will probably now hurt )
Which one of the following is the most characteristic, and potentially MOST distinguishing, symptom of eczema?
a) Cracks in the skin
b) Redness
c) Itch
d) Scaly texture
e) Weeping
c) itch
List some Non-Pharmacological treatment options and advice for dermatitis and eczema:
- Avoid precipitating factors
-Avoid scratching
-Bath every 2nd day
-Pat skin dry, don’t rub
-keep skin cool
-Occlusion or wet dressing
Hydrocortisone (DermAid®, Sigmacort®, 0.5-1%, varied scheduling). What, who, and how often?
-Mildly potent topical corticosteroid to treat ‘flare ups’ of dermatitis.
-Also available combined with antifungals or local antihistamines
-Applied to the affected area/s up to tds
Clobetasone (Eumovate® 0.05%, S3)
What and how often?
-More potent topical corticosteroid than hydrocortisone.
-Used in mod-severe ‘flare-ups in dermatitis and eczema
-Apply bd to affected area
Mometasone furoate (Zatamil®, 0.1% hydrogel or ointment, S3)
-Apply od to affected area/s
-Stronger than eumovate and hydrocortisone
-Was in recent years prescription only, now 1x 15g tube available S3
What is the number of adult FTUs required to apply each dose to an adult for the
-neck and face
-chest and abdomen (combined)
-back and buttocks (combined)
-per hand
-Per leg
-per foot
PBS Prescription treatment for Atopic Dermatitis: Calcineurin inhibitor - Pimecrolimus cream (Elidel® 1% 15g).
-Who?
-How does it work?
How often to apply?
-Second line treatment in for facial atopic eczema if topical corticosteroids are C/I or ineffective
-PBS - have to be OVER 3 Y/O
- Non-steroid inhibitor of inflammatory cytokines, believed to block T cell activation, and thus prevent inflammatory mediator release from mast cells
- Applied BD (3-6 weeks dependant on age)
-SUN PROTECTION
NON PBS Prescription treatment for Atopic Dermatitis:
Crisaborole (Staquis®)
-How does it work?
-Who is it for?
-How long can it be used for?
PDE-4 inhibitor (anti-inflammatory - reduces secretion of certain cytokines)
-Indication: mild - mod atopic dermatitis in patients >2 y/o
-No comparative trials with topical corticosteroids
-Ca be used up to 28 days per treatment course
List treatment options specific to: Allergic Contact Dermatitis
Avoid irritant/allergen
Topical corticosteroid
Severe/acute – may require oral corticosteroids
List treatment options specific to Irritant Contact Dermatitis
Avoid irritant/allergen
Topical corticosteroid
Severe/acute – may require oral corticosteroids
List treatment options specific to: Atopic Dermatitis/Eczema
Soap substitutes
Emollients/moisturisers
Topical corticosteroid
Severe – see immunosuppresants (off-label), biological agents
Topical pimecrolimus or crisaborole
Tar preparations
List treatment options specific to: Discoid Dermatitis
If infected – oral antibiotics
Topical corticosteroids
With/without modified dressing
List treatment options specific to:
Dyshidrotic/Pompholyx Dermatitis
Bathe in salt water (help dry up vesicles)
Topical corticosteroids
Severe/acute – may require oral corticosteroids
List treatment options specific to: Asteatotic Dermatitis
Soap substitutes
Emollients/moisturisers
Topical corticosteroids
List some key referral points in Dermatitis:
-If a secondary bacterial infection exists
-Serious underlying diseases (e.g. diabetes)
-Large/extensive area/s, moist and/or bleeding
- Patch testing if allergen not obvious for allergic contact dermatitis
-Confirming non-fungal before supplying OTC S3 topical steroid (the fungus will remain unresolved and may significantly worsen)
