Eczema & Acne Flashcards
What are the important history taking and physical examinations to consider when looking at acne?
Sex Age Motivation Occupation Previous treatment Cosmetic usage Menstrual history Medications Skin type, colour Scarring Pigmentation
What would we see in mild acne?
Non-Inflammatory
Open (blackheads) and Closed comedones (whiteheads)
What would we see in moderate acne?
Inflammatory lesions, papules, pustules, nodules and cysts.
What would we see in severe acne?
> 5 pseudocysts
50 total inflammatory count
Permanent scar and post inflammatory pigmentation.
What is Acne fulminans?
Most severe form of cystic acne
characterised by abrupt onset of nodular and supportive acne with systemic manifestations
(fever, myalgia)
What is Drug induced acne?
Can be seen as a side effect of numerous medications (anabolic steroids, corticosteroids)
What is Acne excoriee?
Papules and comedones are neurotically excoriated leaving crusted lesions that may scar.
Treatment for Acne
Topical retinoids Benzoyl peroxide Topical antibiotics Azelaic acid antibiotic tablets Combined pill Isotretinoin tablets
What is Rosacea?
Common skin disease in adults with a variety of clinical manifestations.
- not associated with seborrhoea
Most common in fair-skinned.
Clinical features of Rosacea
Polymorphic disease with several variants
Affects central convex areas of the face (nose, forehead, cheeks, chin)
Development of facial pustules
Onset marked by vascular change - notably episodic flushes no sweating.
Erythema with burning sensation.
Tissue thickening.
Treatment of Rosacea
Avoidance of obvious irritants
Oral antibiotics
Metronidazole cream or gel is a major topical therapy
Azelaic acid cream or gel
What is eczema?
Atopic dermatitis - a common inflammatory skin condition that commonly affects flexural areas.
(barrier dysfunction and inflammation)
What is the definition of atopic eczema?
An itchy skin condition in the last 12 months plus 3 of the following: Onset before age 2 History of flexural involvement History of generally dry skin History of other atopic disease
Pathogenesis of Eczema
Genetics - many genes implicated Key role for Filaggrin gene Atopic family history - eczema, asthma, hay fever. Epidermal barrier dysfunction Environmental factors
What are the clinical features of Eczema?
Itch
Disturbance - flexures, neck, eyelids, face, hands and feet
Acute changes - pruritus, erythema, scale, papule, vesicle, exudate, crusting, excoriation
Chronic changes - Plaques, fissures
What is Exogenous (external) Eczema
Contact dermatitis - irritant - allergic Lichen simplex Photo allergic or photoaggravated
What is Endogenous (internal) eczema?
Atopic Discoid Venous Seborrhoeic dermatitis Pompholyx Juvenile plantar dermatitis Asteatotic
What type of hypersensitivity is allergic contact dermatitis?
Type 4 hypersensitivity
- contact of materials (necklace, belt, jeans) with the skin reacting in a red rash - an allergic reaction.
What is irritant contact dermatitis?
Skin injured by
- Friction - micro-trauma, cumulative
- Environmental factors - cold, over-exposure to water, chemicals such as acids, alkalis, detergents and solvents
* certain occupations are more susceptible such as hairdressers, NHS staff, Cleaners…
What is patch testing?
When is it used?
Potential allergens applied (no needles involved)
Baseline/standard sereis - applies to all patients
- applied Monday, remove wednesday
Re-asses Friday
– used in allergic contact dermatitis
What is Seborrhoeic dermatitis?
Infants:
- Distinctive pattern
- Predilection for scalp, proximal flexures
- <6 months age usually
- often clears within weeks of treatment.
(less itchy and child normally well)
- What is Seborrhoeic eczema in adults?
- How does it present?
- How is it treated?
- Chronic dermatitis
Malassezia yeast increased in the scaly epidermis of dandruff and seborrehoic dermatitis. - Red, sharply marginated lesions covered with greasy looking scales. Distinctive distribution - areas rich in supply of sebaceous glands (scalp, face, upper trunk)
- Topical anti-yeast (ketoconazole)
What is Discoid eczema?
Circular plaques of eczema
Cause often unknown
May develop at sites of trauma/irritation
What is Pompholyx/vesicular eczema?
Palms and soles
Intensely itchy
More common under 40 years
Sudden onset of crops of vesicles
What is Asteatotic eczema?
Very dry skin Cracked scaly appearance Most commonly shins affected Climate - heat Excessive washing/soap
What is Venous eczema?
Stasis eczema or varicose eczema Increased venous pressure Oedema Ankle and lower leg involved - compression stockings.
- What is eczema herpeticum?
2. What treatment can be used?
1. Disseminated viral infection Fever and often unwell Itchy clusters of blisters and erosions Herpes simplex 1 and 2 Swollen lymph glands 2. Admission, antivirals, consider secondary bacterial infection
What treatment is used for eczema?
Patient education Avoid causative/exacerbating factors Emollients (moisturisers) - ointments - greasy but effective - creams - lighter - lotions - more watery Soap substitutes. Intermittent topical steroids - different potency Antihistamines or antimicrobials Calcineurin inhibitors
Treatment for severe eczema?
UV light
Immunosuppression
