Eczema and psoriasis

Question 1

What is eczema?

Answer 1

A reduction in the lipid layer of the skin leading to a loss in moisture

No single known cause and is likely a mix of genetic and environmental factors

Can be exacerbated by stress/hormones

Question 2

Complications associated with eczema

Answer 2

Infection (usually S. Aureus)
Psychosocial- distress caused due to self image
Erythroderma- generalised redness of skin can result in dehydration, heart failure, infection and death
Eye abnormalities- conjunctiva may be irritated

Question 3

Diagnosing eczema

Answer 3

Assess severity:clear, mild, moderate, severe, infected

Assess effect on quality of life (impact on sleep, activites and well being)

Question 4

IDing triggers

Answer 4

Ask about symptoms after eating certain foods. Perhaps keep a food diary for 4-6weeks

Ask about change sin skin care products especially if eczema was well controlled before

Ask about symptoms around pets/pollen esp. if eczema is seasonal

OTC allergy testing not really recommended

Question 5

Treatment for mild eczema

Answer 5

Generous amounts of emollient

Mild corticosteroid for flare ups

Advise to stay away from irritants and to not scratch eczema affected skin

Question 6

Treatment for moderate eczema

Answer 6

Advise to stay away from irritants and to not scratch eczema affected skin
Generous amounts of emollient

Moderate potency steroid for flares
Mild potency steroids for face/flexures

Antihistamine for itching

Topical antibiotics or oral flucoxacillin if infected

Question 7

Treatment for severe eczema

Answer 7

Advise to stay away from irritants and to not scratch eczema affected skin
Generous amounts of emollient

Moderate potency steroid for face/flexures ~5 days
Short course of oral steroids if eczema is very severe

Sedating antihistamines if itching affects sleep
Occlusive dressings may help

Question 8

Two approaches to steroid use

Answer 8

Step down: Use lowest possible amount to control symptoms

Intermittant: Weekend therapy-use on two consecutive days
or
twice weekly

Question 9

2nd line treatments for moderate/severe eczema

Answer 9

Calcineurin inhibitors such as tacrolimus and pimecrolimus

• act as immuonmodulating drugs
• Calcineurin is responsible for inflammation in the skin via activation of t lymphocytes

Should only be prescribed by specialists

Question 10

Tacrolimus

Answer 10

Calcineurin inhibitor

for >2yrs

Used where appropriate max strength steroids have been used but are ineffective and there risk of further side effects from further use of steroids

Question 11

Pimecrolimus

Answer 11

Same indications tacrolimus but for face and neck

Question 12

Alitretinoin

Answer 12

For severe hand eczema that has not responded to steroid treatment
stop if:
-adequate response achieved
-no response at 12 weeks
-adequate response not achieved in 24 weeks

Part of the retinoid family- related to vit A

Question 13

What is psoriasis?

Answer 13

Chronic inflammatory multisystem disease
Presents as scaly, itchy skin lesions in the form of patches, papules or plaques
Inflammatory cells accumulate in stratum corneum
If enough neutrophils build up it is known as pustular psoriasis

Question 14

What can trigger psoriasis?

Answer 14

Strep throat infection (esp. guttate psoriasis)
Drugs-lithium, NSAIDS, beta blockers
Sunlight 
trauma 
stress
smoking 
climate changes

Question 15

Treatment for plaque psoriasis

Answer 15

Potent steroid OD + Vit D analogue

Phototherapy/systemic therapy (specialist only)

Question 16

Treatment for scalp psoriasis

Answer 16

Potent steroid OD

Coal tar shampoo (but not on its own for severe psoriasis)

Where topical steroids cannot be used in mild/moderate cases, Vit D preparations can be used

Phototherapy/systemic therapy (specialist only)

Question 17

Treatment for face/flexure/genital psoriasis

Answer 17

Emollient + mild/moderate topical steroid~ 2 weeks

Phototherapy/systemic therapy (specialist only)

Question 18

Treatment for gutatte psoriasis

Answer 18

If greater than 10% of body surface then refer

Usually self limiting in~3months so no treatment is an option

However if necessary, treat as with limb/trunk psoriasis

Question 19

Pustular psoriasis

Answer 19

Generalised pustular psoriasis is a medical emergency that requires immediate specialist treatment

Localised psoriasis requires dermatologist intervention and usually systemic treatment

Question 20

Erythrodermic psoriasis

Answer 20

Requires immediate specialist treatment as it can be life threatening

Question 21

Nail psoriasis

Answer 21

Keeps nails short to avoid detachment of nails
Avoid prosthetic nails and manicures
If mild give no treatment, if severe refer to dermatology