Dermatology

Question 1

What are the red flags for atopic eczema chronic relapsing nature?

Answer 1

Generalised Erythroderma
Severe Generalised infection
Eczema herpeticum

Question 2

What are the general patient principles for eczema?

Answer 2

• Provide patient leaflet
• Explain to patient that genetic and environmental factors play a role in the condition
• Multiple triggers such as skin infection, stress, poor skin barrier maintenance
• Avoid irritants - perfumes, detergents, soaps, toiletroooes,

Question 3

What is the psychological assessment required for Atopic Eczema?

Answer 3

Effect of eczema on daily activities, sleep and mood

Question 4

What are the generalised principles of atopic eczema?

Answer 4

Provide a patient information leaflet
Explain to patient that genetic and environmental factors play a role in the condition
Multiple known trigger factors include skin infection, stress, poor skin barrier maintenance
Avoid irritants such as perfumes, detergents, soaps, toiletries, cosmetics, certain fabrics e.g synthetic fibres, extreme temperature
No benefit to dietary modifications without confirmed food allergy. Exclusion diet therefore not routinely recommended.

Question 5

What signs in eczema warrant same day referral?

Answer 5

Generalised erythroderma
Severe generalised infection
Eczema herpeticum

Question 6

What can be used for maintenance in eczema?

Answer 6

Emollients

Question 7

What is the advice for applying emollients?

Answer 7

Apply liberally and frequently even when skin is clear 3-8 times a day.
Remove emollient in tub/pot with clean spoons
Wash using a soap substitute as can dry the skin
Dry excess water after bathing and apply emollient
Ointments more effective than creams but less acceptable as stickier. Patients may require an ointment in winter and cream in summer.

Question 8

What is the management for eczema flares?

Answer 8

1st line: Topical Steroids
2nd line: Topical Immunomodulators

Question 9

What is the guidance for topical steroids in eczema?

Answer 9

Use early in flares (signs of redness, inflammation or itching)
Potency depends on severity and site

Question 10

What is the guidance for topical immunomodulators in eczema?

Answer 10

Generally best used for maintenance treatment in patients with frequent flares. In acute flares can cause stinging and skin reaction.

Question 11

What is the guidance for topical steroids when deciding potency?

Answer 11

Consider lower steroid potency needed to control eczema.
Step up potency if required after 7 days.
Treatment should be continued for 48hr after flare has been controlled

Question 12

What should you do to the potency of steroids in flexures?

Answer 12

Increase potency - potent or very potent topical corticosteroids should not be used on flexures.

Question 13

How long is the gap between applications of an emollient and a steroid?

Answer 13

30 mins

Question 14

For acute treatment of eczema on the body (not face, genitals or axillae) - what should you use for infrequent flares? (every 4-8 weeks)

Answer 14

Prescribe a strength to match the severity of eczema - used once a day for 7-14 days
- Mild = hydrocortisone 1%
- Moderate = clobetasone butyrate 0.05%
- Severe - betamethasone valerate 0.1%

• Review in 1-2 weeks to plan long-term management

Question 15

For acute treatment of eczema on the body (not face, genitals or axillae) - what should you use for frequent flares? (every 4-8 weeks)

Answer 15

Use topical steroid once daily for 2 weeks (4 weeks if severe flare)
Then alternate days for 2 week (4 weeks if flare severe).
Once eczema under control continue using ongoing maintenance weekend therapy - apply steroid to the areas that tend to flare on 2 days consecutively - (sat/sun) until further review

Question 16

For acute treatment of eczema on the face, genitals or axillae - what should you use?

Answer 16

Consider prescribing mild potency topical steroid and increase to a moderate only if necessary.
For moderate or severe flares use moderately potent steroid for a max of 5 days.
If not responding seek specialist advice
Avoid applying topical steroid around the eyes due to risk of glaucoma