Eczema and psoriasis Flashcards
What is eczema?
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
Complications associated with eczema
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
Diagnosing eczema
Assess severity:clear, mild, moderate, severe, infected
Assess effect on quality of life (impact on sleep, activites and well being)
IDing triggers
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
Treatment for mild eczema
Generous amounts of emollient
Mild corticosteroid for flare ups
Advise to stay away from irritants and to not scratch eczema affected skin
Treatment for moderate eczema
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
Treatment for severe eczema
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
Two approaches to steroid use
Step down: Use lowest possible amount to control symptoms
Intermittant: Weekend therapy-use on two consecutive days
or
twice weekly
2nd line treatments for moderate/severe eczema
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
Tacrolimus
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
Pimecrolimus
Same indications tacrolimus but for face and neck
Alitretinoin
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
What is psoriasis?
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
What can trigger psoriasis?
Strep throat infection (esp. guttate psoriasis) Drugs-lithium, NSAIDS, beta blockers Sunlight trauma stress smoking climate changes
Treatment for plaque psoriasis
Potent steroid OD + Vit D analogue
Phototherapy/systemic therapy (specialist only)
Treatment for scalp psoriasis
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)
Treatment for face/flexure/genital psoriasis
Emollient + mild/moderate topical steroid~ 2 weeks
Phototherapy/systemic therapy (specialist only)
Treatment for gutatte psoriasis
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
Pustular psoriasis
Generalised pustular psoriasis is a medical emergency that requires immediate specialist treatment
Localised psoriasis requires dermatologist intervention and usually systemic treatment
Erythrodermic psoriasis
Requires immediate specialist treatment as it can be life threatening
Nail psoriasis
Keeps nails short to avoid detachment of nails
Avoid prosthetic nails and manicures
If mild give no treatment, if severe refer to dermatology
