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Y3 Patient Sem 1 > Eczema, Acne and Psoriasis > Flashcards

Eczema, Acne and Psoriasis Flashcards

1
Q

what are the impacts of skin conditions?

A
  • psychological impact i.e depression
  • increased risk of CVD
  • development issues in children
  • bullying
  • 3.5 million appoitments a year for psoriasis
  • behavioural problems
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2
Q

what are the types eczema?

A
  • atopic - 80% of cases
  • gravitational - linked to venous pressure with liquid to leak
  • seborrhoeic
  • asteatotic
  • herpeticum
  • pompholyx
  • lichen - hard skin
  • discoid
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3
Q

what is the epidemiology of eczema?

A

• Affects all ages, most commonly in children
o Most cases before age 5
o More in urban areas, higher socioeconomic groups
o Many cases clear in late childhood/adolescence, but not all
o Age of 7 65% of cases will clear and by 16 this has increased further to 75%
o 1 in 20 people who have eczema will have chronic severe eczema.

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4
Q

what is the pathophysiology of eczema?

A

• Caused by Dysfunctional skin barrier (altered conversion of keratinocytes to protein/lipid scales)
o Water loss from skin
o Hyper-reactivity
o Infection
• T helper cell dysregulation also thought to be involved
• Gene that codes for theagral which causes dystfunctional conversion of protein lipids scales this means you lose water more easily and cause dry hard skin. This also increases risk of allergies and infection.

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5
Q

what are the risk factors of eczema?

A
  • stress
  • genetics - family links
  • pollen and pets
  • rough clothes
  • contact allergens
  • soap and detergent
  • extreme temps - winter are usually worse
  • house dust mite faeces
  • certain foods
  • skin infections
  • hormones, pre menstural and pregnancy
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6
Q

what are the symptoms?

A
  • itching and inflammed skin
  • papules and plaques
  • can become weeping and . blistered
  • scaling skin
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7
Q

what is the treatment of mild eczema?

A

usually some dry skin with itching and maybe some redness

  • emollients, key treatment to maintain skin and reduce flares. apply liberally
  • mild topical steroid, if inflamed skin, use sparingly FTU
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8
Q

what is the treatment for mild eczema?

A

dry itchy skin, may have some areas of thickening

  • emollients increase the risk
  • moderate potency topical steroid (hydrocortisone) 7-14 days use
  • may trial non sedating antihistamine if itch is present
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9
Q

what to use inbetween flares?

A

 Use low potency steroid (consider intermittent use 2/7 or just weekends)
 Topical calcineurin inhibitors (tacrolimus) second line options by specialist
 Review use every 3-6 months

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10
Q

what is the treatment for the severe eczema?

A

covers wide area, skin thickening and may bleed

  • increase emollient use
  • potent topical steroid
  • non sedating antihistamine
  • if sleeping is impaired, then use sedating antihistamine
  • oral corticosteriod
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11
Q

what is the treatment for infected eczema?

A

weeping, crusted, pustules and may have systemic symptoms

  • oral antibiotics may be required
  • topical antibitoics if it is a local infection
  • fluxacillion as first line and clarithromycin as 2nd
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12
Q

what is patient and parent advice for eczema?

A
  • Use emollients frequently and liberally, even when skin is clear
  • Continue steroids for 48 hours after inflammation reduced
  • Avoid scratching – maybe recommend rubbing?, scratch mittens and cut nails to avoid damage to skin
  • Adverse effects of topical corticosteroids, max 1-2 times daily
  • Time course of eczema
  • Link to other allergic conditions
  • Advice to avoid exposure to triggers, e.g. washing powder
  • How to recognise flares / infection and treat promptly
  • Diet alteration under specialist advice only
  • Direct to patient friendly resources
  • Discard old topical products if treating infective episode
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13
Q

what are emollients?

A

• Creams, bath additives, ointments, gels, lotions, etc etc
• Some contain urea, lanolin, antiseptics. Try to avoid where possible
• More than one emollient often needed, tailor to patient preferenc
• Apply corticosteroids 30 minutes later
• Do not prescribe aqueous cream
• Caution with soap/wash substitutes
• Adverse effects
o If one doesn’t work, try another and check for additives. Consider a small test quantity
o Watch out for fire warnings! - paraphen based
• Application technique very important – during/after washing, don’t rub in

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14
Q

what are the different types of psoriasis?

A
  • vulgaris - most common
  • nail
  • palmonplantar
  • erythrodermic
  • guttate
  • scalp
  • flexural
  • pustular
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15
Q

what is psoriasis?

A

chronic, inflammatory disorder of skin and joints. can be relasping and remitting. mainly effects elbows and knees aswell as scalp and ears.

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16
Q

what is the epidemiology of psoriasis?

A
  • Prevalence between 1-2% in UK
  • First presentation between ¾ of cases15-25 years, then 55-60
  • Mainly affects Caucasian population
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17
Q

what is the pathophysiology of psoriasis?

A

• Inflammatory cells present in all layers of psoriatic skin leading to epidermal hyper proliferation and vascular changes.
o Particularly important role for T cells, TNF alpha and interleukins.
o Turnover is massively increased 40x higher so there is inflammation
o Capillaries are closer to the surface of the skin, so more likely to bleed

18
Q

what are the risk factors of psoriasis/

A
  • obesity
  • smoking
  • alcohol
  • genetics
  • hormones
  • medications
  • skin injury
  • stress
  • infection
19
Q

what are the complications of psoriasis?

A

o Psoriatic arthritis – screening for symptoms and use of PEST tool
- Up to 30% chronic degenerative disease
o Depression/anxiety – screening at appointments for symptoms
- Between 2/3rd of people will have this
o Metabolic syndrome and CVD – lifestyle modification, screening
-Increase glucose intolerance and hyperlipidemia linked to CVD increase risk

20
Q

what are the treatments for psoriasis?

A

topical treatments

  • emollients, steriods. not on nice guidelines but accepted as 1st line
  • ointments for thick scaly skin
  • cream or gel for larger areas
  • caution for corticosterioids
  • 4 week blocks of treatment
21
Q

what is the treatment for trunk and limb psoriasis?

A

potent corticosteroid and vitamine D analogue.

coal tar if non of the above are effective

22
Q

what are the treatments for scalp psoriasis?

A

potent corticosteroid.
if not effective try a different formulation and or salicylic acid/emoillient

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

23
Q

what are the treatments for face, flexures and genitals?

A

mild-moderate steroid with a short term treatment.

if not effective/long term needed use calcineurin inhibitor

24
Q

what is the patient advice for psoriasis?

A

• How often to apply, how much, warnings with sharing pumps, warnings fire risk
• Apply emollients before other topical preparations to improve absorption
- Smooth motion, in direction of hair growth
• Skin irritation and photosensitivity with vitamin D analogues
• Several weeks for effect to be seen, persevere
• Avoid scratching and picking
• Report joint symptoms immediately
• Importance of review after 4 weeks – toxicity, adherence, effectiveness. Is it working?
• Combination steroid and calcipotriol product better than each alone
• Emollients for daily use, other treatments for flares
• Treatment break in between steroid courses, in between could use Vit D
• Steroids and vitamin D analogues may take weeks to take affects 2-3 weeks
• Coal tar takes 4-5 weeks to be effective

25
Q

what are the types of acne?

A
  • vulgaris (Most common)
  • rosacea
  • conglobata
  • fulminans
26
Q

what is the epidemiology of acne?

A
  • affects 90% during teenage years but it can persit
  • more men than woman in early years but more woman than men later on
  • 1/5th suffer from severe acne
27
Q

what is the pathophysiology of acne?

A

involves pilosebaceous follicles
linked to
- inflammed action
- increased production and altered composition of sebum
- growth of bacteria within sebum in hair follicles
- increased outer skin cells and this causes blockage

28
Q

what are the risk factors of acne?

A
  • genetics 80% family
  • high glycaemic index foods
  • medications
  • polycytsic ovary syndrome
  • smoking
  • stress
  • cosmetics
29
Q

what are the symptoms of acne?

A 
<5mm in diameter
- papules
- pustules
>5mm in diameter
- nodules
-cysts
large areas affected
- scarring and lesions
30
Q

what is the treatment of mild-moderate acne?

A

o Topical retinoid (adapaline 0.1% gel/cream, isotretinoin)
o Benzoyl peroxide (BPO - 4% cream or 5% gel/wash)
o Azelaic acid (20% cream, 15% gel)
=Milder action not as potent but causes less skin irritation
o Topical antibiotic (clindamycin 1%) always with BPO
o Combination products seen
o Emollients to combat dry skin (oil free/non-comedogenic)
o Continue treatment for 6-8 weeks, if no improvement refer to GP

31
Q

what is the treatment for moderate severity acne?

A

o Oral antibiotic and topical retinoid combination
= Doxycline, azithromycin but has more resistance
o Can add BPO - helps to reduce incidence of resistance
o Treat for 6-8 weeks and can repeat causes but not for long term use

32
Q

what is for severe acne treatment?

A

isotretinion oral

usually see a combination of drugs to try and combat all aspects

33
Q

what is the patient advice for acne medications?

A

o Do not over clean the skin
o Do not pick/squeeze lesions – scarring risk
o Use non-comedogenic / no oil products (uncertain benefit for facial cleansers)
o Bleaching of hair and clothing – BPO
o Skin irritation, if severe reduce application frequency/switch – all
o Avoid contact with eyes and mucous membranes - all treatments
o Sunscreen and avoid sunbeds – retinoids/BPO/oral antibiotics
o Avoid in pregnancy – retinoids/oral antibiotics
o Apply to whole affected area, not just individual lesions
o For gels: apply after washing and then remove a few hours later to avoid irritation
o For washes: apply and leave on for a few minutes, then rinse off
o Apply pea sized amount to entire affected area, wash off after 30-60 mins (retinoids)
o Lifestyle advice important – avoid use of triggers and things that will make it worse

34
Q

what is the medicine optimisation in dermatology/

A
  • need to identify as there are overlapping symptoms
  • ask impact of the phsyiological issues
  • monitor cCVD
  • mental health screening??
35
Q

what are hydrocolloid dressings?

A

occlusive and waterproof
they prevent water loss and promote accumualtion of moisture.
used in necrotic wounds
do not use in infective wounds as it would promote grotwth of bacteria

36
Q

what is a hydrogel dressing/

A 
60-90% water content
draw moisture into the wound and rehydrate the skin making it easier to remove the dressing
can be availiable as gels, dressings
use in necrotic
do not use in infected
37
Q

what is an aliginate?

A

absorbs exudate
made from seaweed but still need to have a moist environment
add a film to these to promote skin healing
use for a weeping wound
to not use in a dry wound

38
Q

what is a foam dressing

A

not to be used in a dry wound as they stick and may pull it off
good for deep wounds as you can pack the dressing and cover with a secondary dressing

39
Q

what is a necrotic wound?

A

dead skin that needs rehydration

40
Q

what is a sloughly wound?

A

complex mixture of fibrin and proteins and can build up quickly on a skins surface
acts a bacterial growth medium so need to make sure to not overhydrate them

41
Q

what is a granulating wound?

A

fragile mixture of proteins and polysaccarides

need to be kept moist

Y3 Patient Sem 1 (20 decks)

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