Dermatology conditions Flashcards
Eczema
Chronic, itchy, inflammatory skin condition that affects people of all ages, although presents more frequently in childhood
Eczema clinical features
Presence of an itch
Generalised dryness
Affects flexures of the limbs (back of knees, inner elbows)
Thickened (lichenified) skin from repeated scratching
Family/personal history of atopy
Eczema severity
Mild - areas of dry skin & infrequent itching
Moderate - areas of dry skin, frequent itchy & redness
Severe - widespread areas of dry skin, incessant itching & redness
Infected - eczema is weeping, crusted or there are pustules with fever or malaise
Eczema mx
Importance of skin care measures & avoidance of triggers
Mild eczema
- Emollients
- Mild potency topical corticosteroids
Moderate eczema
- Emollients
- Moderate potency topical corticosteroids
- Topical calcineurin inhibitors (tacrolimus or pimecrolimus)
- Bandages
Severe eczema
- Emollients
- Potent topical corticosteroids
- Topical calcineurin inhibitors (tacrolimus or pimecrolimus)
- Bandages
- Phototherapy
- Oral corticosteroids
Eczema referral
Uncertain diagnosis
Not controlled with current treatment
Recurrent secondary infection
High risk of complications
Eczema complications
Infection - eczema herpeticum, superficial fungal infections
Psychosocial problems
Acne vulgaris
Chronic inflammatory skin condition affecting mainly the face, back and chest
Characterised by blockage and inflammation of the pilosebaceous unit (hair follicle, hair shaft & sebaceous gland)
Non-inflamed lesions = comedones, inflammatory acne lesions = papules & pustules
Acne fulminans
Sudden severe inflammatory reaction that precipitates deep ulcerations & erosions, sometimes with systemic effects (fever, arthralgia & myalgia)
Acne vulgaris clinical features
Comedones - blackheads or whiteheads
Inflammatory lesions - papules, pustules, nodules or cysts
Scarring
Pigmentation
Seborrhoea (increased sebum production)
Acne vulgaris mx advice
Avoid over-cleaning the skin
Use a non-alkaline synthetic detergent cleansing product BD on acne-prone skin
Avoid oil-based products & remove make-up at the end of the day
Persistent picking or scratching of lesions can increase the risk of scarring
Treatments may irritate the skin, especially at the start of treatment
Mild to moderate acne mx
12 week course of one of the following first-line options:
- fixed combination of topical adapalene with topical benzoyl peroxide
- fixed combination of topical tretinoin with topical clindamycin
- fixed combination of topical benzoyl peroxide with topical clindamycin
Moderate to severe acne mx
12 week course of one of the following first-line options:
- fixed combination of topical adapalene with topical benzoyl peroxide to be applied once daily
- fixed combination of topical tretinoin with topical clindamycin to be applied once daily
- fixed combination of topical benzoyl peroxide with topical adapalene to be applied once daily, with oral lymecycline/doxycycline
- topical azelaic acid applied twice daily, with either oral lymecycline/doxycycline
COCPs in combination with topical agents can be considered as an alternative to systemic antibiotics (eg. Dianette)
Acne vulgaris referral
Urgently refer people with acne fulminans on the same day to the on-call hospital dermatology team
Mild to moderate acne that have no responded to two completed courses of treatment
Moderate to severe acne that has not responded to previous treatment that includes an oral antibiotic
Acne with scarring
Acne with persistent pigmentary changes
Acne vulgaris complications
Skin changes - scarring, hyperpigmentation, depigmentation
Psychosocial effects
Psoriasis
Systemic, immune-mediated, inflammatory skin disease with typically has a chronic relapsing-remitting course & may have nail and joint involvement
