Dermatology Flashcards
What are the different forms of eczema
Atopic eczema Contact dermatitis Pompholyx HYperkeratotic palmar eczema Seborrhoeic Esteatotic eczema
What is atopic eczema
Atopy- inherited tendency for asthma, hay fever and eczema
Sensitivity to allergens
Dry and inflamed skin aggravated by cold, heat, hard water, infections, clothes
Often develops at 3 months
Signs of atopic eczema
Pruritus
Itchy papules on cheeks
Flexures affected, elbows and knees, skin dry and lichenified
Infection (through scratching) major problem
Management of atopic eczema
Cleansing:
- regular washing using emulsifying ointment
- Bathe in emolient
- Regular emollient cream
Environment:
- Keep house cool
- Limit allergens in house
Scratching:
- cut nails
- Sedative oral antihistamine at night
When are steroids used for eczema and what is used
When emollients are not sufficient
Topical 1% hydrocortisone v effective
Which areas should you avoid using steroids and why
Avoid face - causes telangiectasia (thinning of face which causes blood vessels to be seen)
Anogenital region as scrotal skin absorbs 80x better than other skin
What are associated side effects seen in more potent steroids
- Secondary infection because steroids are immunosuppressive
- Thinning of skin
- Telangiectasia
- Acne
- Mild depigmentation
- Pituitary- adrenal axis suppression
- Cushing’s
When are topical tacrolimus used and what are their modes of action
Is an alternative drug to oral steroids
Interferes with induction of IL-2
What is an infection of eczema associated with
Impetigo- staphylococcal infection
How should you treat non widespread infected eczema
Topical antiseptic- povidone
Topical fusidic acid or mupirocin
How should you treat widespread eczema
Oral flucoxacillin
However if allergic to penicillin, use erythromycin
What is eczema herpeticum
Infection of atopic eczema caused by the herpes virus
What is eczema herpeticum treated with
Emergency i.v. antivirals in hospital
How is contact dermatitis treated
Remove contact
Emollients, barrier creams, topical steroids, oral antihistamines
When is Napkin Dermatitis
Contact dermatitis + infection (its nappy rash)
What is the difference between irritation and infection of nappy rash
Irritation to ammonia- skin folds not affected
Infection- skin folds affected. Often fungal
How to treat nappy rash that’s not infected
How to treat nappy rash which is infected
Improve hygiene, barrier creams, emollients and leave nappy off
Infected: Clotrimazole
Main treatments for psoriasis
- Emollients
- Topical steroids- anti inflammatory
- Topical dithranol- antiprolifetive
- Topical vitamin D3
- Cytotoxics- methotrexate
- immunosuppressants- ciclosporin
- Oral retinoids
When are oral retinoids used for psoriasis
After methotrexate and/or ciclosporin
Mode of action of oral retinoids and cautions
Bind to nuclear retinoid acid receptor and affect gene transcription- antiproliferative
avoid pregnancy for 3 years after stopping
What is Ringworm and how can you treat it
Fungal infection
-culture of skin scrapings is best practice
What is candidiasis and what does it look like
Fungal infection- seen in skill folds
How are fungal infections treated and how to use them
Imidazole cream - + for 2 weeks after infection has cleared
Topical terbinafin (if fails, use oral terbinafine
How do you treat fungal infections if topical terbinafine fails
Use oral terbinafine
