Dermatitis / Eczema Flashcards
Dermatitis background
Affects 1 in 5 people
Eczema and dermatitis are interchangeable
Cumulative irritant contact dermatitis occurs after a few months or several years
Dermatitis classification
Red, scaly, itchy skin
Factors: environment, stress, ageing.
Clinical: acute, chronic, sub-acute
Class: exogenous or endogenous
Develops from damage to skin and natural oils/moisture escapes.
Exogenous vs endogenous
Ex: precipitated by external agents
irritant or allergic
End: no external cause
atopic, seborrheic, or discoid
Irritant contact dermatitis
Most common
Frequent exposure to chemicals or substances
Water, soaps, detergents, dribbling
Chronic: very dry, thick, cracking
Allergic contact dermatitis
True allergy
Unusual patterns related to contact w/ allergen
Sticking plaster, watch band, plants, rubber gloves, nickel.
Asteatotic
Old people
Very dry flaking skin which splits
Cracked dermatitis with crazy-paving appearance
Lower legs
Worse in winter, low humidity, worsened by soap, household heating.
Atopic dermatits
Common in infancy/childhood
Genetic predisposition
Often worse in winter
Red, scaly eruption which can be weeping and encrusted in the acute phase
Flexures and cheeks
Chronic itching and rubbing= marked thickening, prone to skin infection (staph and strep)
itchy = scratch = dry, split skin
Vicious cycle as infection makes eczema worse and resistant to treatment
Antibiotics required to eliminate infection
Discoic dermatitis
Young to middle aged
Round, disc-like lesions
Demaracted edges
Often confused w/ tinea
intense itch, scaly lesion
Acute, weep, and develop secondary infection
Trunk and limbs
Not common on head and neck
Dyshidrotic/pompholyx
Young people
Small vesicles (blisters w/ clear fluid), itchy, burning, sore
Leak when burst
Hands and sometimes feet
Pomppholyx is severe form
Peeling, flaky skin
Similar to fungal infection
Connected to stress
Differentially diagnose dermatitis from other skin conditions
Tinea - ringworm has active outer red scaling edge and clear centre. not typically itchy.
Psoriasis- thick plaque w/ silver scale, no blisters, very itchy, palms and soles, extensors.
Treatment of dermatitis/eczema (non-pharm, S3, prescription)
Non-pharm: avoid trigger, avoid scratching, bath every 2nd day, pat skin - don’t rub, keep skin cool, wet dressings.
S3: soap substitutes, emollients/moisturisers, antihistamine, tar/ichthammol, topical corticosteroids, colloidal oatmeal.
Script: compounded coal tar, potent corticosteroids, antibiotics, biological agents, calcineurin inhibitors, oral immunosuppressant agents.
Counsel on the use of fingertip units
FTU is amount of cream or ointment squeezed from a tube to cover the tip of the index finger to its first crease.
1 FTU should cover area twice the size of a flat adult hand (fingers together). Apply after bathing.
Explain the use of antihistamines and tar preparations
Antihistamines used to reduce itch. sedating ones preferred.
Tar (pine tar, liquid coal tar) used to reduce epideermal thickness, antiseptic, compliance issues and photosensitivity.
Explain the use of topical corticosteroids
Used to reduce redness, itch, and inflammation.
Avoid if uncertain diagnosis.
Choose potency based on site and severity.
Use an appropriately potent product for shortest time necessary to control skin disorder.
Compare different topical corticosteroids
Hydrocortisone (dermaid, hydrozole, 0.5-1%)
Mildly potent to treat ‘flare ups’, available in combination w/ local anaesthetic or antifungals, applied to area up to tds.
Clobetasone (eumovate 0.05%)
More potent than hydrocortisone, apply bd.
Mometasone furoate (zatamil 0.1% hydrogel or ointment)
Apply od to area
