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Y3 Patient sem 1 > Dermatology: eczema, acne and psoriasis > Flashcards

Dermatology: eczema, acne and psoriasis Flashcards

1
Q

What is the major form of eczema?

A

Atopic

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2
Q

What makes the skin barrier dysfunctional in eczema?

A

Conversion of keratinocytes to protein/lipid scales in INTERRUPTED, causing water loss, hyper-reactivity and infection
- T helper cell dysregulation also thought to be involved

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3
Q

What are the risk factors of eczema?

A
  • stress
  • genetics
  • pollen and pets
  • rough clothes
  • contact allergens
  • soap and detergent
  • extreme temperatures
  • house dust mites
  • certain foods
  • skin infection
  • hormones
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4
Q

What sort of disease is eczema?

A

A chronic disease with flares

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5
Q

What symptoms are experienced with eczema?

A
  • Itchy, inflamed, dry skin (accompanied by scratching)
  • Papules and plaques main features
  • Can become weeping, crusted, blistered, scaling, thick
  • Sleep disturbance common (itching)– big impact
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6
Q

Describe mild eczema and treatments

A

Some dry skins, some itching, a little redness

  • emollients are first line treatment (improve skin barrier, reduce number of flares and have a steroid sparing effect – apply liberally)
  • mild topical steroid if inflamed skin, spread thinly using FTU
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7
Q

Describe moderate eczema and treatments

A

Dry skin, itching, redness, some thickening
- increase emollient use
- moderate potency topical steroid. Start with hydrocortisone on sensitive areas. Aim for max 7-14 day use, 5 if on sensitive areas
- consider trial of non-sedating antihistamine if itch present, review 3 months after
- If needed between flares:
- Use low potency steroid (consider intermittent use)
Topical calcineurin inhibitors (tacrolimus) second line options by specialist
Review use every 3-6 months

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8
Q

Describe severe eczema and treatments

A

Widespread as above, skin thickening, bleeding, oozing, etc
- treatment: same as moderate +If itch affecting sleep, consider sedating antihistamine
Consider oral corticosteroid (prednisolone)* if severe symptoms and distress.
Consider between flares:
Use lower potency steroid (consider intermittent use)
Topical calcineurin inhibitors (tacrolimus) second line options by specialist
Review use every 3-6 months

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9
Q

Describe infected eczema and treatments

A 
Weeping, crusted, pustules, +/- systemic symptoms
Oral antibiotics (flucloxacillin for about 2 weeks) may be required, if localised infection use topical
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10
Q

Name 2 light emollients

A

E-45

Diprobase

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11
Q

Name 2 moderate emollients

A

Oilatum

Hydrous crm

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12
Q

Name Greasy emollients

A

50% white soft/liquid
Epaderm
Emulsifying

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13
Q

Name low potency topical steroids

A

Hydrocortisone 0.1, 0.5, 1, 2.5%

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14
Q

Name moderate potency topical steroids

A

Clobetasone butyrate 0.05%

Betamethasone valerate 0.025%

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15
Q

Name potent topical steroids

A

Betamethasone valerate 0.1%

Betamethasone dipropionate 0.05%

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16
Q

How should emollients be used?

A
  • Use emollients frequently and liberally, even when skin is clear
  • apply 30 mins before corticosteroids
  • Some contain urea, lanolin, antiseptics. Try to avoid where possible
  • Do not prescribe aqueous cream (contains SLS - irritation)
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17
Q

How long should you continue steroids for after inflammation has reduced?

A

48 hours after inflammation has reduced

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18
Q

What is psoriasis?

A
  • Chronic, inflammatory disorder of skin and joints (relapsing remitting in nature)
  • Vulgaris (chronic plaque) 80% of plaque psoriasis sufferers have mild-moderate severity disease managed in primary care using topical therapy.
  • more of a systemic illness
19
Q

What causes psoriasis

A

Inflammatory cells present in all layers of psoriatic skin leading to epidermal hyper proliferation and vascular changes.
Particularly important role for T cells, TNF alpha and interleukins.
- hyper proliferation of cells - 40x higher turnover

20
Q

When does psoriasis present?

A

First presentation between 15-25 years, then 55-60

- mainly effects Caucasian people

21
Q

What are the risk factors for psoriasis?

A
  • obesity
  • smoking
  • alcohol
  • genetics
  • hormones
  • medications
  • skin injury
  • stress
  • infection
22
Q

What symptoms present with psoriasis?

A
  • Commonly affecting the buttocks, lower back, scalp, elbows, knees, nails.
  • Thick, scaly skin (acanthosis and hyperkeratosis)
  • May bleed if scales scraped off
23
Q

What are some complications of psoriasis?

A
  • Psoriatic arthritis – screening for symptoms and use of PEST tool
  • Depression/anxiety – screening at appointments for symptoms
  • Metabolic syndrome and CVD – lifestyle modification, screening
24
Q

What is included in the treatment of psoriasis?

A
  • Emollients, steroids. See patient advice/practical use sections in eczema
  • Ointment for thick scale, cream/lotion/gel for larger areas, lotion/solution for scalp
  • Caution with potent/very potent corticosteroids, 4 week break between courses
  • Treat for 4 week blocks, importance of regular review must be stressed
25
Q

What is used on the trunk and limb in psoriasis?

A

Adults: Potent corticosteroid AND vitamin D analogue (calcipotriol).

Coal tar if above not effective

26
Q

What is used on the scalp in psoriasis?

A

Potent corticosteroid.
If not effective try a different formulation and/or salicylic acid/emollients.

Combine steroid with calcipotriol or use vitamin D analogue alone if not effective/tolerated

27
Q

What is used on the face, flexures and genitals in psoriasis?

A

Mild-moderate steroid
Short term treatment

If not effective/long term treatment needed, use calcineurin inhibitor

*treat for 2 weeks not 4 weeks

28
Q

What are the vitamin D analogues?

A
  • calcipotriol
  • calcitrol
  • tacalitol
29
Q

What treatments are used for mild psoriasis?

A
  • emollients
  • Topical corticosteroid alone or with topical vitamin D analogue
  • Calcineurin inhibitor (tacrolimus)
  • Coal tar or dithranol
30
Q

What treatments are used for moderate psoriasis?

A
  • Phototherapy plus topical treatments
  • Oral methotrexate or ciclosporin plus topical
  • Oral acitretin plus topical
31
Q

What treatments are used for severe psoriasis?

A
  • add biological agent

- Apremilast, dimethyl fumarate (not examinable)

32
Q

How long does coal tar take to work?

A

3-4 weeks

33
Q

What is the most common type of acne?

A

Vulgaris - Affects mainly the face, back and chest

34
Q

What does the epidemiology of acne include?

A
  • Involves pilosebaceous follicles (PSF). Likely to involve:
    • Inflammatory action
    • Increased production /altered composition of sebum (due to androgens)
    • Growth/activity of Cutibacterium acnes within sebum in hair follicles
    • Keratinocyte proliferation / differentiation, stimulated by Cutibacterium acnes
35
Q

What are Comedogenesis and hypercornification key features?

A
  • Leads to blockage of PSF, and acne lesions

- Closed comedones more likely to progress to acne lesions

36
Q

What are open comedones?

A

blackheads, melanin interacts with the atmosphere and turns black

37
Q

what are closed comedones?

A

whiteheads - lower down, progress to acne regions

38
Q

What are the risk factors of acne?

A
  • Family members with acne
  • High glycaemic index foods – increase androgens
  • Medications (not technically acne!) – lithium, anti-epileptics
  • Polycystic ovary syndrome (PCOS)
  • Smoking?
  • Stress
  • Cosmetics – look for those that are labelled non-comedogenic
39
Q

What are symptoms < 5mm in diameter? (mild)

A
  • papules (small red, raised bumps)

- pustules (white pus filled)

40
Q

What are symptoms > 5mm in diameter? (severe)

A
  • nodules and cysts (deep, big pus filled)
41
Q

What is the treatment for mild-moderate acne?

A
  • Topical retinoid (adapaline 0.1% gel/cream, isotretinoin)
  • Benzoyl peroxide (BPO - 4% cream or 5% gel/wash)
  • Azelaic acid (20% cream, 15% gel)
  • Topical antibiotic (clindamycin 1%) always with BPO
  • Combination products seen
  • Emollients to combat dry skin (oil free/non-comedogenic)
  • Continue treatment for 6-8 weeks, if no improvement refer to G
42
Q

What is the treatment for moderate severity acne?

A
  • Oral antibiotic (can use erythromycin) and topical retinoid (avoid in pregnancy)
  • Can add BPO (antibacterial and acts using free radical oxidation)
  • Treat for 6-8 weeks
43
Q

What is the treatment for severe acne?

A
  • isotretinoin (oral) 18+

all other treatments 12+

44
Q

What is some advice regarding retinoids?

A
  • avoid in pregnancy

- apply pea sized amount to entire affected area, wash off after 30-60 mins

Y3 Patient sem 1 (22 decks)

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