Dermatology Flashcards
1
Q
What is necrotizing fasciitis?
A
A fulminant, rapidly spreading infection with widespread tissue destruction through all tissues and planes
2
Q
What is the mortality like for necrotising fasciitis?
A
Very high
3
Q
What is type 1 necrotizing fasciitis caused by?
A
aerobic and anaerobic bacteria, seen post surgery or in diabetics
4
Q
What is type 2 necrotizing fasciitis caused by?
A
group A streptococci (GAS), arising spontaneously
5
Q
What are the symptoms of necrotizing fasciitis?
A
severe pain at site of initial infection with tissue necrosis
spreading infection across all planes
spreading erythema, pain and crepitus
fever, toxicity and pain
6
Q
What do investigations show in necrotizing fasciitis?
A
increased CRP, ESR, WCC
7
Q
What is the treatment for necrotizing fasciitis?
A
antibiotics (2 = benzylpenicillin and clindamycin, 1 = broad spectrum), surgical exploration, amputation
8
Q
What is cellulitis?
A
infection of the deep subcutaneous layer
9
Q
What are the symptoms of cellulitis?
A
hot and tender area, blisters, low grade fever, lymphedema, poorly demarcated margins
10
Q
Where about does cellulitis affect and then spread to?
A
Starts in the lower leg and spreads upwards
11
Q
How does the skin appear in erysipelas?
A
larger area with erythematous and sharply demarcated from normal skin
12
Q
What causes cellulitis?
A
beta-haemolytic streptococcus, staphylococcus or MRSA
13
Q
Investigations for cellulitis?
A
swab of toes, antistreptolysin O titre (ASOT) and antiDNAse B titre (ADB)
14
Q
What is erysipelas?
A
a more superficial infection of cellulitis, often of the face, has a well demarcated edge
15
Q
What is the treatment of cellulitis?
A
phenoxymethylpenicillin and flucloxacillin (IV or oral depending on how widespread), treat underlying cause, low dose antibiotic prophylaxis if recurrent to prevent further lymphatic damage
16
Q
What is vasculitis?
A
Inflammatory disorder of blood vessels causing endothelial damage
17
Q
What are the symptoms of vasculitis?
A
haemorrhagic papules, pustules, nodules, plaques that can erode and ulcerate, don’t blanch from glass slide, fixed livedo reticularis pattern, pyrexia and arthralgia
18
Q
What is leucocytoclastic vasculitis?
A
the most common cutaneous vasculitis affecting the small vessels
19
Q
how does leucocytoclastic vasculitis usually appear?
A
on lower legs as a symmetrical palpable purpura
20
Q
What is the treatment of vasculitis?
A
can resolve spontaneously, analgesia, support stockings, dapsone, prednisolone
21
Q
What is the cause of leucocytoclastic vasculitis?
A
drugs, infection, inflammatory disease, malignant disease, idopathic
22
Q
What causes pressure sores?
A
elderly, immobile, unconscious, paralysed from skin ischemia, sustained pressure over bony prominence
23
Q
What are the four grades of pressure sores?
A
1 - non blanchable erythema of intact skin
2 - partial thickness skin loss of epidermis/dermis
3 - full thickness skin loss involving subcutaneous tissue, not fascia
4 - full thickness skin loss involving muscle, bone, tendons and joint capsule
24
Q
What is the risk assessment scale called for pressure sores?
A
Norton scale and waterlow pressure sore risk assessment
25
What is the treatment for pressure sores?
bed rest, pillows, air filled cushions, pressure relieving mattress, regular turning, adequate nutrition, non irritant occlusive moist dressings, analgesics, plastic surgery, treat underling cause
26
What is eczema?
superficial skin inflammation with vesicles, redness, oedema, oozing, scaling and pruritis
27
What is the cause of eczema?
Atopy - initial selective activation of Th2 type CD4 lymphocytes in the skin which drive the inflammatory process
28
How common is eczema and who is most likely to have it?
```
In 5% of the population
10-20% of children
Genetic disease
More likely if atopic
20-30% chance of passing onto child
```
29
What are some exacerbating factors of eczema?
dust mites, food allergies, pets, teething, strong detergents, chemicals, woollen clothes, lack of infection in infancy
30
What are the clinical features of eczema?
itchy erythematous scaly patches in flexures, hyper or hypo pigmented skin, blisters if herpes infection, can be punched out lesions (eczema berpeticum)
31
Where does eczema commonly occur on the body?
elbow, ankles, knees, neck
32
How does scratching affect eczema?
produces exconations, causes skin thickening with exaggerated skin markings, can become infected
33
What is the treatment of eczema?
avoid irritants, emollients to hydrate the skin, topical corticosteroids, mild steroids for face (hydrocortisone) and more potent on body (betamethasone or flucinolone), topical immunomodulators (tacrolimus and pimecrolimus), antibiotics if infected, bandaging, oral prednisolone if severe
34
What is exogenous eczema?
Aka contact dermatitis, acute or chronic skin inflammation with sharply demarcated edges, caused by substances in contact with the skin
35
What are the causes of exogenous eczema?
chemical irritants e.g. industrial and cleaning solvents leads to a sensitisation of T lymphocytes over a period of time
36
What are the clinical features of exogenous eczema?
rash with clear cut demarcation or odd shaped areas of erythema and scaling
37
How can you test for exogenous eczema?
Patch testing with suspected allergen
38
What is the management of exogenous eczema?
remove causative agent, steroid creams for a short period of time, antipruritic for itching relief
39
What is acne vulgaris?
facial rash in adolescents
40
What causes acne vulgaris?
seborrhea (high sebum production - an androgenic hormone), comedo formation with ductal hypercornification, colonisation of the pilosebaceous duct with propionibacterium acnes and inflammation of the pilosenaceous unit
follicular epidermal hyper proliferation, blockage of pilosebaceous units with surrounding inflammation , increased sebum production and infection with Propionibacterium acnes via activation of Toll like receptor 2, leading to inflammatory cytokine production
41
What are the symptoms of acne vulgaris?
open (black) or closed (white) comedones, inflammatory papules, pustules, greasy skin (seborrhoea), rupture of inflamed lesions lead to deep seated dermal inflammation and nodulystic lesions, facial scarring
42
Where does acne vulgaris commonly occur on the body?
face, back and sternal areas
43
What is infantile acne?
facial acne in infants and sometimes cystic
44
What causes infantile acne?
maternal androgen influence
45
What is steroid acne?
Occurs secondary to corticosteroid therapy of Cushings, appearing as pustular folliculitis on trunk
46
What is oil acne?
Seen in industrial workers with prolonged oil contact, common on the legs
47
What is acne fulminars?
severe, necrotic and crusted acne lesions
48
Who is acne fulminars seen in?
Rare and in young male adolescents
49
What is the treatment of acne fulminars?
oral prednisolone, analgesics and oral isotretinoin
50
What are the symptoms of acne fulminars?
malaise, pyrexia, arthralgia, bone pain due to sterile bone cysts
51
What is acne conglobate?
cystic acne with abscesses and interconnecting sinuses
52
What is acne excoriee?
deeply exconated and pickled acne with scarring
53
Who is most like to acquire acne excoriee?
Females
54
What is follicular occlusion triad?
severe nodulocystic acne, dissecting cellulitis of the scalp, hidraderitis suppurativa
55
What is the cause of follicular occlusion triad?
Follicular occlusion
56
Who is most likely to have follicular occlusion triad?
Black Africans, rare
57
What is the 1st line treatment of acne?
topical agents e.g. keratolytics
topical retinoids e.g. tretinoin or retinoid like agents
topical antibiotics e.g. crythromycin for inflammatory acne
benzoyl peroxide and azelaic acid (antimicrobial, comedolytic and keratolytic properties)
retinoids, nicotinamide
58
What is the 2nd line treatment of acne?
low dose oral antibiotics for 3-4 months e.g. oxytetracycline, minocycline, erythromycin
hormonal treatment with cyproteroneacetate or ethinylestradiol
59
What is a side effect of 2nd line acne treatment?
DVT
60
What is the 3rd line treatment of acne?
oral retinoid e.g. isotretinoin
synthetic vitamin A analogue that affects cell growth and differentiation
tetratogenic
61
What is 3rd line acne treatment contraindicated for and what measures prevent this?
pregnancy, so must have test and contraceptive advice before
62
What is psoriasis?
A papulo squamous disorder with well demarcated red scaly plaques and inflamed skin - remission and relapses common
63
Who is most likely to get psoriasis?
male = female
common n 16-22 and 55-60years
2% of pop.
64
What is the cause of psoriasis?
group A streptococcus, lithium, UV light, alcohol and stress
65
How does psoriasis occur?
driven by T lymphocytes , resulting in upregulation of Th1-type T cell cytokines and adhesion molecules
66
What will a skin biopsy show of psoriasis?
epidermal ocanthosis and parakeratosis, increased skin turnover, absent granular layer, hyperproliferation, thickened epidermis
67
What are the clinical features of chronic plaque psoriasis?
pinkish red scaly plaques and silver scale on extensor surfaces or sites of trauma, becomes itchy and sore, is lifelong (arthritis and nail changes can accompany it)
68
What are the clinical features of flexural psoriasis
well demarcated, red glazed plaques confined to flexures
69
Where does flexural psoriasis commonly appear?
at groin, nasal cleft and sub mammary areas
70
How does guttate psoriasis appear on the skin?
explosive eruption of very small circular plaques over the trunk caused by streptococcal infections
71
When does guttate psoriasis commonly occur?
2 weeks after streptococci sore throat
72
In who does guttate psoriasis normally appear in?
children and young adults
73
How does erythrodermic and pustular psoriasis normally appear?
pustular psoriasis on hands and feet
74
What symptoms usually accompany erythrodermic and pustular psoriasis?
malaise, pyrexia, circulatory disturbance (systemically unwell)
75
What type of nail changes can occur in psoriasis?
pitting of the nail plate, distal separation of nail plate, yellow brown discolouration, sublingual hyperkeratosis, damaged nail matrix
76
What is the treatment of psoriasis?
topical treatment, phototherapy, systemic therapy and cytokine modulators
77
How does topical therapy treat psoriasis?
hydrates skin, anti proliferative, vitamin D analgues e.g. calcpotriol and calcitrol reduces cell division, coal tar, tazorotene and corticosteroids, topical dithronol inhibits DNA synthesis but can stain the skin, salicyclic acid acts as a keratolytic and helps scalp
78
How does phototherapy treat psoriasis?
UV A/B radiation in conjunction with a photosensitising agent, good for extensive psoriasis
79
What are risks of phototherapy treatment in psoriasis?
can exaggerate skin aging and increase risk of UV induced skin cancer
80
How does systemic therapy treat psoriasis?
oral retinoic acid derivatives e.g. acitretin or etretinate, immunosuppressives e.g. methotrexate or ciclosporin, biological agents e.g. TNF a blockers can all be used in resistant disease or severe, coal tar therapy, dithranol
81
What is the risk of retinoic acid derivatives in psoriasis?
They are teratogenic so CI if pregnant
82
What are the most common causes of skin cancer?
sun exposure, genetics and ethnicity
83
What is the most common type of malignant skin tumour?
basal cell carcinoma (rodent ulcer)
84
What is the cause of basal cell carcinoma?
excessive sun exposure and Gorlins syndrome, immunosuprresion
85
Why does Gorlins syndrome cause basal cell carcinoma?
mutation in the PTCH1 gene
86
What is the appearance of a basal cell carcinoma?
papule or nodule that can ulcerate, telangiectasia or pearly edge over the tumour, flat diffuse superficial form, ill defined morpreic variant
87
What is the nature of a basal cell carcinoma?
slow growth, can erode structures, rarely metastases
88
What is the treatment of basal cell carcinoma?
surgical excision, photodynamic therapy, cryotherapy, imiquimod cream, radiotherapy, Mohs micrographic surgery
89
How common is squamous cell carcinoma?
It is the second most common metastatic skin cancer.
90
What is the cause of squamous cell carcinoma?
Sun exposure or develop from pre existing skin tumours, immunosuppressed, arsenic ingestion
91
What is the nature of squamous cell carcinoma?
very aggressive and can metastasize especially lower lip and ear
92
What is the appearance of squamous cell carcinoma?
keratotic, ill defined nodules that can ulcerate
93
What is the treatment of squamous cell carcinoma?
surgical excision and radiotherapy
94
What are risk factors for malignant melanoma?
pale skin, sun exposure, multiple melanocytic naevii (>50), sun sensitivity, immunosuppression, atypical mole syndrome, giant congenital melanocytic naevi, lentigo maligna, family history
95
What is the most serious skin tumour?
Malignant melanoma due to early metastases and death
96
What could be a potential cause of malignant melanoma?
mutation in B-RAF and oncogene and tumour suppressor proteins linked
97
What is the appearance does lentigo maligna melanoma?
papule, signalling invasive tumour
98
What is the appearance of superficial spreading malignant melanoma?
large, flat, irregular pigmented lesion
99
What is the appearance of a nodular malignant melanoma?
pigmented nodule that can bleed and ulcerate
100
What is the appearance of acral lentiginous malignant melanoma?
pigmented on palm, sole and under nail
101
What is the treatment of malignant melanoma?
surgery, sentinel node biopsy, radiotherapy, immunotherapy, chemotherapy, Ipilunnumas, vemurafenis
102
What is the appearance of a melanocytic naevi (mole)?
flat, brown macule with proliferation of melanocytes at the dermoepidermal junction which then grows into dermis causing elevation above skin surface, even pigmentation and regular border
103
Who is most likely to get a melanocytic naevi?
white skinned people, increased chance with age
104
What can melanocytic naevi mature into?
mature into a dermal naevus with a loss of pigment
105
What causes a blue naevus and what is its symptoms?
caused melanocyte proliferation deep in mid dermis and is asymptomatic
106
What is the appearance of a basal cell papilloma (seborrhoeic wart)?
can be flesh coloured, brown, black or greasy with an irregular surface, look stuck on to skin, have tiny keratin cysts on surface
107
What is the treatment of basal cell papilloma?
cryotherapy or curettage
108
What is the appearance of a dermato fibroma (histocytoma)?
Firm, elevated pigmented nodule with a peripheral ring of pigmentation, mainly in legs
109
Who is most likely to get a dermato fibroma?
females
110
What does a dermato fibroma consist of?
histocytes, blood vessels, fibrosis
111
What is the treatment of a dermato fibroma?
surgical excision
112
What is the appearance of a epidermoid cyst?
cystic swelling of skin with central punctum and cheesy keratin
113
What is a complication of an epidermoid cyst?
They can rupture and cause dermal inflammation
114
What is the appearance of a pilar cyst (trichilemmal cyst)?
smooth cysts without punctum on scalp, can be multiple of familial
115
What is the cause of a keratohcanthoma?
sun exposure
116
What is a kerotohcanthoma?
a rapidly growing epidermal tumour which can lead to central necrosis and ulceration
117
What is a pyogenic granuloma?
a benign overgrowth of blood vessels, readily bleed
118
What is the appearance of a pyogenic granuloma?
rapidly growing, pinkish red nodule, on fingers and lips
119
What is the cause of a pyogenic granuloma?
follows trauma
120
What is a cherry angioma?
a benign angiokeratomas
121
What is the appearance of a cherry angioma?
tiny pinpoint red papules, especially on trunk
122
What is the treatment of a cherry angioma?
No treatment is needed
123
What is the appearance of a solar keratose (actinic karatose)?
erythematous silver scaly papules or patches with a conical surface and a red base
124
What does the surrounding skin of a solar keratose look like?
skin is inelastic, wrinkled and shows flat brown macules due to solar damage
125
What maliganant cancer can solar keratose develop into?
squamous cell carcinoma
126
What is the treatment of a solar keratose?
cryotherapy, topical 5 flurouracil cream, 5%imiquimod cream, diclofenac gel
127
What is Bowens disease?
intraepidermal carcinoma in situ that can become invasive, seen on womens legs
128
What are risk factors for Bowens disease?
female, sun exposure, age, HPV, immunocompromised, HIV
129
What does Bowens disease neighbouring skin look like?
dysplasia
130
What is the appearance of Bowens disease?
can be non specific erythema or warty thickening
131
What is the treatment of Bowens disease?
topical 5 flurouracil, 5% imiquimod cream, cryotherapy, curettage, photodynamic therap, tissue destructive layer
132
What is the appearance of atypical mole syndrome?
individual lesions with irregular pigmentation and border with large number of melanocytic naevi in childhood
133
What does the histology show in atypical mole syndrome?
cytological and architectural atypia
134
What is the treatment of atypical mole syndrome?
Regular review and excise suspicions due to risk of developing malignant melanoma
135
What occurs in giant congenital melanocytic naevi?
large moles present at birth and large lesions, >20cm
136
What is the treatment of giant congenital melanocytic naevi?
Regular review and excise suspicions due to risk of developing malignant melanoma
137
What is the appearance of lentigo maligna?
slow growing macular area of pigmentation on face of elderly, irregular pigmentation and border
138
what is the treatment of lentigo maligna?
excision or 5% imiquimod cream
139
What is a leg ulcer?
a chronic sore on your leg that take more than 4-6 weeks to heal
140
What is the most common type of leg ulcer?
venous
141
Where on the leg does a venous ulcer normally occur?
medial aspect , just over the ankle
142
What are the characteristics of a venous leg ulcer?
shallow, with flat margins, painful, rred and flaky skin on legs, over bony prominences
143
What are the causes of a venous ulcer?
dvt, varicose veins, reduced mobility, traumatic injury, obesity, pregnancy, non healing ulcer, recurrent phlebitis, previous vein surgery - these all cause venous hypertension
144
What preventative factors can be done to prevent leg ulcers?
lose weight, compression stocking, execrcise regularly, elevate leg, stop smoking
145
What other conditions are associated with venous ulcers?
oedema, venous dermatitis, varicositites, lipodermasclerosis, varicose veins
146
What examinations should be done for leg ulcers?
serial measurement of ulcer, assess the type of edge, assess base, note location, smell, surrounding skin, infection, peripheral pulses, sensation, varicose veins, peripheral oedema, BP, BMI, Doppler study, duplex US
147
What is the treatment of an ulcer?
preventative measures, antiplatelet therapy, avascular surgery, clean and dress the wound, compression bandages, antibiotics, diuretics for oedema, analgesics, split thickness skingrafing
148
What are the characteristics of an arterial leg ulcer?
lateral tibial area on the leg, punched out, occasionally deep, irregular in shape, unhealthy appearance of wound bed, necrotic tissue, low exudate
149
What does the surrounding skin of an arterial leg ulcer look like?
thin, shiny, dry sin, no hair, cool o touch, pallor on leg elevation, absent or weak pulses
150
What does the surrounding skin of a venous leg ulcer look like?
haemosiderin staining, thickening and fibrosis, dilated veins at ankle, crusty, dry and hyperkaratoic skin, eczema, itchy, oedema
151
What is the pain like in a venous leg ulcer?
throbbing, aching, heavy
152
What is the pain like in an arterial leg ulcer?
Intermittent claudication, worse at night
153
What are diseases associated with arterial disease?
diabetes, hypertension, smoking, vascular disease, obesity, inability to elevate limb
154
In who is a venous leg ulcer most commonly found?
In women, and older people
155
Where are neuropathic legs ulcers seen?
In pressure points in the foot
156
What is the treatment of a neuropathic leg ulcer?
keep foot clean, remove pressure, paediatrist, treat diabetes
157
What is a common disease associated with neuropathic leg ulcers?
diabetes
158
What is a ankle brachial plexus index used for, give an advantage and disadvantage?
assessment of arterial disease, more sensitive than Doppler study, but can be falsely positive in diabetes and atherosclerosis due to calcification
159
What are the 3 layers of the skin?
epidermis, dermis and subcutis
160
What structures are in the dermis?
hair follicles, sweat glands, blood, lymphatics, vessels and nerves
161
What makes up the epidermis?
keratinocytes, melanocytes, Langerhan cells
162
What makes up the dermis?
fibroblasts
163
What makes up the subcutis?
fat
164
Functions of the skin?
structure, protection, fluid balance, temperature ocntrol, sensation, sun protection, odour
165
Basic topical therapies and their uses?
creams (water based) and ointments (oil based)
emollients - moisturise dry skin
corticosteroids - anti inflammatory
calcineurin inhibitors - locally immunosuppressive
antivirals/antibiotics - infection, infected antifungals, eczema, acne
vit d analogues/dithranol/tar for psoriasis
166
Types of skin lesion?
macule, papule, nodule, pustule, blister, plaque, ulcer
167
Treatment of child atopic eczema?
emollients, then topical steroids then calcineurin inhibitors (adults is the same but then use systemic drugs e.g. azathioprine, ciclosporin, methotrexate)
168
Symptoms of scabies?
similar looking to eczema but has BURROWS
169
Symptoms of urticaria?
red patches (erythema) and weals (mm or cm, red or white, mintues or hours) in the skin, releasing histamine causing small blood vessels to leak into tissue swelling, itching and burning, swelling of the face
170
Treatment of urticaria?
oral antihistamines e.g. loratadine or chlorpheniramine
171
Symptoms of guttate psoriasis?
multiple scaly lesions on trunk (previous throat infection)
172
Treatment of guttate psoriasis?
topical steroids, vit d analoguem UVB
173
Presentation of pityriasis rosea?
in young adults, with single herald patch on trunk, caused by a viral infection
174
DD for a sudden rash?
drug eruption, guttate psoriasis, pityriasis rosea, viral exanthem, plaque psoriasis
175
DD of a changing pigment lesion?
malignant melanoma (cancerous), melanocytic naevus (benign from sun/pregnancy), seboorroeic wart (elderly)
176
DD of adult with red face?
adolescent with acne, adult with rosacea, seborrhoeic dermatitis
177
DD of old person with facial tumour?
basal cell carcinoma, squamous cell carcinoma
178
DD of leg ulceration?
venous/arterial/neuropathic ulcer, vasculitis
179
DD for hair loss?
male pattern (androgenetic type has strong genetic influences), alopecia areata (genetics and autoimmune), scarring apolpecia (causes by SLE, severe infections)
180
Treatment for male pattern hair loss?
topical minoxidil, oral finasteride
181
Treatment of alopecia areata?
topical or intra lesional steroids
182
What is erysipelas?
an infection of streptococcus with sudden onset, erythematous and swollen, unwell and pyrexia, tender skin, treat with antibiotics
183
What is impetigo?
infection with staph aureus
184
Causes of old person with generalised pruritus?
investigate for kidney, liver, endocrine and blood disease
185
What is hirsutism?
growth of terminal hair in a male pattern in a women caused by androgen excess or idiopathic
186
What is hypertrichosis?
excess terminal hair growth in a non androgen distribution
187
Treatment of hirsutism?
depilating creams, waxing, shaving, electrolysis laser
188
What is seborrhoeic dermatitis?
symmetrical cheeks, forehead and scalp, can spread to upper trunk, with scaling and redness, reporting with itching and dandruff with overgrowth of yeasts (pityrosporum) - cradle cap if in infants
189
Treatment of seborrhoeic dematitis?
antifungal agent and steroid (not for scalp) e.g. keratolytic treatment
190
How does adult with rosacea present?
older person with pustules and erythema but no blackheads, rhinophyma (thickening of skin on nose), leading to flushing, burning and sensitive skin, blepharitis (dry eyes with inflamed eyelid margin), telangectasia (prominent blood vessels)
191
Treatment of adult with rosacea?
topical metronidazole and oral tetracycline
azelaic acid, erythromycin, isotretinoin
192
Causes of pigmented skin lesions?
mole, seborrhoeic wart, freckle, basal cell carcinoma, angioma
193
Why are pigmented skin lesions so important?
99% of melanomas present as a pigmented lesion
194
Risk factors for melanoma?
high density freckles, red hair, >100 moles, >5 atypical moles, family history
195
Early signs of melanoma?
pigmented skin lesions getting bigger and getting darker, irregular shape and border, bleeding, itching
196
What is the ABCDE of melanoma?
asymmetry, border irregulaity, colour variabilty, diamete >5mm, elevation irregularity
197
Type of melanoma?
superficial spreading (ssmm), nodular, lentigo maligna (usually face), acral (restricted to palsm and soles)
198
Treatment of melanoma?
surgical excision of 1-3cm, B-RAF inhibitors e.g. vemurafenib, immunotherapy with PD-1 inhibitors e.g. nivolumab
199
Prognosis of melanoma?
breslow thickness: thin lesions
200
Methods to protect yourself from the sun?
spf15, higher if fair, sunblock for lips and nose, sunscreem 20 minutes before going out, reapply, stay covered, in shade, hat, avoid sun at midday
201
What is atopic dermatitis?
eczema
202
What causes xerotic skin?
normally swelled corneocytes fill with NMF to retain moisture and lipid bilayers prevent water loss between the corneocytes
but in xerotic skin, there is a loss of NMF leading to dry skin and crack development and an abnormal lipid bilayer provides inadequate permeability barrier
203
How do occlusive emollients (with and without humectants) treat xerotic skin?
trap moisture in the skin to increase hydration and form an artificial permeability barrier above the stratum corneum
added humectants retain the moisture, further increasing hydration
204
What is the hierarchy of treatments for eczema?
manage triggers, emollients
```
garments, wet wraps, paste bandages
topical calcineurin inhibitors (pimecrolimus cream, tacrolimus ointment)
topical corticosteroids (hydrocortisone, flucinoninde)
```
antibiotics/antiseptics
sedative antihistamines
UV treatment
systemic treatments
antibiotics
205
What is the difference between lesional and non lesional skin?
lesional = clinical inflammation (flare)
| non lesional = skin show signs of subclinical inflammation between flares
206
What is proactive treatment for flares?
reduces frequency of flares by continually controlling sub clinical inflammation
207
side effects of corticosteroids for atopic dermatitis?
skin atrophy, suppression of skin barrier homeostasis, striae, telangiectasia, perioral dermatitis, acne, hypopigmentation, hypertrichosis
208
side effects of calcineurin inhibitors?
burning/stinging after application of TCI, less efficacious than TCS, unsubstantiated cancer risk
209
What is done in phototherapy?
UVB treatment 3x a week , 10-30 treatment overall
narrow band UVB
photochemotherapy uses psoralens and UVA
210
What systemic therapy can be used for atopic dermatitis?
antihistamines e.g. chlorphenamine, hydroxyzine
immune modulators e.g. ciclosporin, azathioprine
211
How does methotrexate treat psoriasis?
a dmard, inhibiting metabolism of folic acid, antiproliferative and antiinflammatory, it is hepatotoxic
212
CI of methotrexate?
pregnancy, breast feeding, hepatic disease, alcoholism, renal impairment, active infection, live vaccines
213
Treatment of guttate psoriasis?
mild-moderate TCS, coal tar, UVB
214
What is acitretin?
an oral retinoid used to treat palmoplantar psoriasis, it a vit A derivative and an anti proliferative reducing hyperkeratosis, adjunct to phototherapy
215
Side effects of acitretin?
dry lips, eyes, mucosa, hyperlipidemia, disturbed liver function, hyperostosis, teratogenic
216
CI of acitretin?
pregnancy
