Dermatology Conditions (FCM)

Question 1

How does eczema differ in those with long standing disease in comparison to those with short term disease?

Answer 1

Long standing disease:

eczema is often localized to the flexure of the limbs

Question 2

How does eczema present in infants?

Answer 2

• It primarily involves the face, the scalp and extensor surfaces of the limbs
• The nappy area is usually spared

Question 3

What might you expect to see in an eczema flare? (3 things)

Answer 3

It varies in appearance:

• Poorly demarcated redness
• Fluid in the skin (vesicles)
• Scaling or crusting of the skin

Question 4

What is the first line treatment in infected eczema?

Answer 4

Flucloxacillin
Clarithromycin (If allergic)
- If pregnant and allergic to penicillin: erythromycin

Question 5

How would you manage a person with infected eczema that has not responded to treatment?

Answer 5

2ww referral

Question 6

When would you refer someone with eczema to dermatology ?

Answer 6

If their Eczema is associated with severe and recurrent infections, especially deep abscesses or pneumonia

Question 7

How would you manage mild eczema?

Answer 7

1. Emollients (Used QDS)
2. Mild topical corticosteroid (hydrocortisone 1%) - ONLY on areas of red skin
   - continue treatment for 48 hours after the flare

Question 8

What are creams and lotions better for when treating eczema?

Answer 8

Red inflamed skin

Because it is believed that the evaporation of water-based products cools the skin.

Question 9

What are ointments better for when treating eczema? how can they be used?

Answer 9

Dry non inflamed skin

- They can be used as a substitute to soap

Question 10

How would you manage moderate eczema?

Answer 10

1. Emollients (Used QDS)
2. Moderate topical corticosteroid (Betamethasone valerate 0.025% or Clobetasone butyrate 0.05%) - ONLY on areas of red skin
   - continue treatment for 48 hours after the flare
3. For delicate areas of skin (such as the face and flexures):
   - Consider starting with a mild potency topical corticosteroid (such as hydrocortisone 1%)
   - Increase to a moderate potency corticosteroid only if necessary. (Aim for a maximum of 5 days’ use)

Question 11

What medication can you trial for severe itch or urticaria in eczema?

Answer 11

Cetirizine, loratadine, or fexofenadine - TRIAL for 1/12

Question 12

How would you manage severe asthma?

Answer 12

1. Emollients (Used QDS)
2. Potent topical corticosteroid (Betamethasone valerate 0.1%) - ONLY on areas of red skin
   - MAXIMUM 5/7
3. For delicate areas of skin (such as the face and flexures):
   - Moderate potency corticosteroid (such as betamethasone valerate 0.025% or clobetasone butyrate 0.05%).
   - Use for a maximum of 5/7
4. If there is severe itch or urticaria:
   - 1/12 trial of a non-sedating antihistamine (such as cetirizine, loratadine, or fexofenadine).
5. If itching is severe and affecting sleep:
   - Short course (maximum two weeks) of a sedating antihistamine (such as chlorphenamine)

Question 13

What are open and closed comedones?

Answer 13

Open comedones:
Blackheads

Closed comedones:
White heads

Question 14

Why would you consider a referral to endocrinology in a patient with acne ?

Answer 14

If you are considering PCOS