Dermatology Flashcards
atopic eczema when and who
1 in 5 children in UK
80% before 5
atopic eczema pathophysiology
impairment of epidermis - due to mutation of FLG gene encoding filaggrin gene…the protein contributes to stratum corneum
so allergens penetrate…IgE sensitisation, pathogen entry + water loss
more T helper 2 cells (compared to 1)
more production of IgE…more mast cell hypersensitivity
triggers atopic eczema
allergens
clothing
skin infection - staph
contact allergens
inhalant allergens
hormonal
climate
teethin
stress
diet
atopic triad
atopic eczema
asthma
allergic rhinitis
…describes genetic predisposition
exam atopic eczema
erythema
dry skin
bleeding
water blisters on hand and feet
hair loss
where affected atopic eczema
infants - scalp, face and extensors more likely
toddlers - flexural, mouth
licenification define
scratching leads to…. evidence of chronic, poorly controlled eczema
asian, black caribbean and black african patterns atopic eczema
discoid and follicular
atopic eczema ddx
psoriasis
allergic contact dermatitis
seborrhoeic dermatitis
contributing factors in hx diagnose atopic eczema
visible
personal hx of dry skin, atopic
onset before 2 yrs old
moderate and severe eczema
mod - frequent itching, excorations and lichenification
severe - widespread, severe, bleeding , oozing, cracking, pigment changes, systemic sx
eczema daily care
emollient
fragrance free and alcohol free - aveeno
avoid trauma
topical steroids
topical tacrolimus
education
non sedating antihistamines
management flares eczema
mild - hydrocortisone 1%
mod - betamethason 0.025%, cetirizine
severe - betamethasone valerate 0.1%, certirizine, chlorphenamine
eczema complications
infection with staph
herpes simplex virus (grouped vesicles and punched out erosions) ..when disseminated eczema herpeticum (can lead to herpes and DIC)
PSYCHOSOCIAL
atopic marsh
one third of children with eczema will develop asthma or hayfever in future
when psoriasis develop
1 third before 20
psoriasis patho
T cell infiltration of epidermis, secreting substances that activate uncontrolled proliferation of keratinocytes
risk fx psoriasis
infection - strep throat
stress
koebner phenomenon
obesity
fhx
drug induced
koebner phenomenon
appearance of new lesions on previously unaffected areas of skin, secondary to trauma
types of psoriasis
chronic plaque- most common
guttate
flexural
scalp and facial
pustular
erythrodermic
nail changes
psoriasis children
guttate, flexural and scalp
chronic plaque
raised
thick silvery white scale
well defined
auspitz - pin point bleeding after scale is scratched
guttate
small red plaques across torso
raindrop appearance
following infection
older children and adolescents psoriasis
older - face, ears and nails
adolescents - elbows, knees and scalp
psoriasis ddxq
eczema
lichen planus
pityriasis rosea
investigations can be used psoriasis
skin biopsy
PASI (psoriasis area and severity index) - severity and psychological impact
psoriasis management
emollients
topical vit d analogues - calcipotriol
topical steroids
dithranol
coal tar preparation - shampoos
phototherapy
methotrexate
biologic therapy - adalimumab, etanercept
psoriasis complications
juvenile psoriatic arthritis
secondary skin infections
mental health
worse prognosis psoriasis
psoriatic arthropathy
