Dermatology Flashcards
What are the signs and symptoms of eczema? Where might you typically see the rash in infants compared to older children?
Erythematous and dry rash
Itching –> exocoriation marks and lichenification
In infants: classically on the face
In older children: flexor aspects of arms and legs
Exudative if superimposed bacterial infection
What is the first line treatment for eczema?
manage exacerbating factors- stress, diet
Emollients- frequent and soap substitutes
What is used for flare ups in eczema?
Topical steroids
A patient with long standing eczema on Balneum emollient and topical hydrocortisone for flare ups is coming in for review. She says the Balneum helps keep her moisturised but the hydrocortisone is not really doing anything for the flare ups. What would be the next option?
Steroid ladder:
Mild- hydrocortisone
Moderate- eumovate (clobetasol butyrate)
What is the steroid ladder?
Mild- hydrocortisone
Moderate- eumovate (clobetasol butyrate)
Potent- betnovate (betamethasone valerate)
Very potent- dermovate (clobetasol propionate)
What are the side effects of long term topical steroids?
Skin thinning, striae, easy bruising, telangectasia
What other topical ointments can be used to avoid using steroids?
Calcineurin inhibitors eg. tacrolimus, pimecrolimus
What are the options for severe eczema not responding to topical therapies?
Immunosuppresants eg. ciclosporin, methotrexate, azothioprine
Phototherapy- UVB
Biologics
What are some complications of eczema?
Eczema herpecticum
Secondary bacterial infection- Treat with topical fusidic acid or oral Abx if needed
Secondary viral infection- molluscum
What is the underlying pathophysiology of psoriasis?
Hyperproliferation of keratinocytes in epidermis and inflammatory cell infiltration–> thickened epidermis
What are the types of psoriasis? What is the most common type?
Plaque psoriasis- most common. Itcy scaly rash.
Guttate psoriasis- associated with recent illness. Raindrop lesions on trunk and limbs.
Seborrheic
Pustular- tender on palms and soles
Generalised (erythodermic)- total body redness, triggered by rapid withdrawal of steroids.
What is the phenomen called when you get psoriasis on a trauma scar?
Koebner’s phenomenon
What signs and symptoms may a person with psoriasis have?
Well dermarcated, shiny, scaly plaques on flexor surfaces and scalp
Very itchy
Auspitz sign- localised bleedign where itching has caused scales to break off
Nail signs- pitting, onycholysis
Associated arthritis
What is the first line treatment in psoriaisis?
Avoid exacerbating factors eg. stress, drugs- lithium, beta blockers, treat infections
Emollients
What are the options to treat localised and mild psoriasis?
Topical vitamin D analogues eg. calcipotriol
Topical steroids eg. betamethasone
Coal tar preparations
Topical retinoids eg. tazarotene
