Eczema/Derm Flashcards
Topical Clobestasone butyrate 0.05% (Eumovate) is what strength corticosteroid? What’s it used for?
Moderate
- Moderate eczema
- Severe eczema on delicate skin (face/flexures)
What can be used for itch in eczema?
Non-sedating antihistamine for 1 month if itch or urticaria in moderate/severe eczema
• Cetirizine 10mg od
• Loratadine 10mg od
• Fexofenadine 180mg od
Short course of sedating antihistamine (max 2 weeks) if itching affecting sleep in severe eczema
• Chlorphenamine po 4mg every 4-6hrs, up to tds
Give 4 indications to refer someone with eczema to dermatology
- > 1-2 flares/month
- Reacting adversely to many emollients
- Facial/genital/axillae eczema not responded to mild topical steroid
- Severe or recurrent secondary infections, or infection not responded within 2 weeks
- Specialist advice needed e.g. bandaging techniques, calcineurin inhibitors
- Persistent facial, eyelid or hand eczema suggestive of contact dermatitis
- The need to diagnose a food allergy
- Causing significant psychosocial disturbance e.g. sleep (If need to give oral corticosteroid for this, but <16yo)
- Diagnosis unsure
Give 2 examples of very potent topical corticosteroids used in eczema, including the available and commonly used dosages and what they’re used in particular for
o Clobetasol propionate 0.05% (Dermovate)
o Diflucortolone valerate 0.3% (Nerisone Forte)
Only prescribed by specialists
Give 2 examples of moderately potent topical corticosteroids used in eczema, including the available and commonly used dosages and what they’re used in particular for
o Betamethasone valerate 0.025% (Betnovate)
o Clobestasone butyrate 0.05% (Eumovate)
Used for moderate flares of eczema, or severe flares on delicate skin like face/flexures
What would you give a 20yo man with widespread dry, red skin, incessant itching, cracking and bleeding and excoriations? It’s worst on their face and armpits. They’re sleeping ok.
Severe eczema so:
Frequent and liberal use of emollients
- Prescribe >500g e.g. dermol, doublebase, hydromol
- Use >qds or >every 2-3hrs, for and after washing
On delicate skin (face/flexures) so moderate (not potent) topical corticosteroid for inflamed areas
e.g. Betamethasone valerate 0.025% (Betnovate) or Clobetasone butyrate 0.05% (Eumovate)
od/bd
- 7-14 days, continue >48hrs after resolves
- Follow FTU (finger-tip units) in info leaflet
- Apply 15-30 mins after emollient at convenient time e.g. before sleep
Non-sedating antihistamine for the itch for 1 month
- Cetirizine 10mg od
- Loratadine 10mg od
- Fexofenadine 180mg od
What would you give someone with widespread dry, red skin, incessant itching, cracking and bleeding and excoriations? It’s worst on their hands, arms and legs. The itching is so bad it’s interfering with their sleep.
Severe eczema so:
Frequent and liberal use of emollients
- Prescribe >500g e.g. dermol, doublebase, hydromol
- Use >qds or >every 2-3hrs, for and after washing
Potent topical corticosteroid on inflamed areas
e. g. Betamethasone valerate 0.1% (Betnovate)
- 7-14 days, continue >48hrs after resolves
- Follow FTU (finger-tip units) in info leaflet
- Apply 15-30 mins after emollient at convenient time e.g. before sleep
Sedating antihistamine for the itch for max 2 weeks
- Chlorphenamine po 4mg every 4-6hrs, up to tds
What would you give a 20yo man with widespread dry, red skin, incessant itching, cracking and bleeding and excoriations? It’s worst on their hands, arms and legs. They’re sleeping ok, but feel pretty depressed about their unsightly skin.
Severe eczema so:
Frequent and liberal use of emollients
- Prescribe >500g e.g. dermol, doublebase, hydromol
- Use >qds or >every 2-3hrs, for and after washing
Short course of oral corticosteroids (bc of psychological distress)
e. g. 30mg prednisolone each morning for 1 week
- Will start potent topical steroid after finishing course
- Probs best to refer to dermatology (NB if they were <16yo you’d refer them instead of starting this oral steroid)
Non-sedating antihistamine for the itch for 1 month
- Cetirizine 10mg od
- Loratadine 10mg od
- Fexofenadine 180mg od
What are the signs that eczema is infected?
Weeping, crusted, pustules, fever, malaise
How would you manage someone who’s widespread eczema has developed lots of pustules, some of which have weeped and then crusted over? (apart from their normal eczema Tx)
Widespread infected eczema so:
swab -> flucloxacillin 250-500mg qds, 30 mins before food for 7 days
- Advise to dispose of old products and provide with new ones
- Possibly topical antiseptic like chlorhexidine, triclosan or potassium permanganate
Prescribe something for scabies. What’s second line?
Permethrin 5% 1 application topically once a week
Malathion is second line
Give an example of a mild topical corticosteroid used in eczema, including the available and commonly used dosages and what it’s used in particular for
Hydrocortisone 0.1%, 0.5%, 1.0%, 2.5%
1.0% commonly used for mild eczema flare, or for moderate flares on delicate skin like face/flexures
Give 2 examples of potent topical corticosteroids used in eczema, including the available and commonly used dosages and what they’re used in particular for
o Betamethasone valerate 0.01% (Betnovate)
o Betamethasone dipropionate 0.05% (Biprosone)
Used in severe eczema flares
How would you manage someone who’s widespread eczema has developed lots of pustules, some of which have weeped and then crusted over? (apart from their normal eczema Tx). They have a penicillin allergy
Widespread infected eczema normally -> swab -> flucloxacillin
But penicillin allergic so:
• 2nd line = erythromycin 250-500mg qds for 7 days
• 3rd line = clarithromycin 250-500mg bd for 7 days
Prescribe something for urticaria
Cetirizine Hydrochloride 10 mg oral once a day
Cetirizine 10 mg oral once a day
Desloratadine 5 mg oral once a day Fexofenadine Fexofenadine (Hydrochloride) 180 mg oral once a day Loratadine 10 mg oral once a day Acrivastine 8 mg oral three times a day
What is chlorphenamine and what is it used for in eczema?
As a sedating antihistamine in severe eczema where itch is affecting sleep
Give 4 risks of using topical steroids
o Transient burning/stinging (~ resolves w/in 2 days of Tx)
o Worsening & spreading of untreated infection
o Skin thinning (Improves on stopping)
o Permanent striae
o Allergic contact dermatitis
o Acne vulgaris / rosacea
o Mild depigmentation (~ reversible)
o Excessive hair growth at application site (hypertrichosis)
o Rarely: adrenal suppression, Cushing’s syndrome, growth suppression in children
How / how often should topical corticosteroids be applied in eczema? How long for?
- Apply sparingly to affected area, 15-30 mins after applying emollient
- Info leaflet ~ specified number of finger-tip units (FTUs) for different body areas
- One FTU ~= 500mg, and treats ~ 2x the flat of the hand with the fingers together
- Apply at time of day most convenient e.g. after washing / before sleep
- Apply max bd
- Continue 48hrs after flare cleared, return for further advice if not cleared w/in 2 weeks
What is loratadine and what is it used for in eczema?
As a non-sedating antihistamine for itch in moderate/severe eczema
What is fexofenadine and what is it used for in eczema?
As a non-sedating antihistamine for itch in moderate/severe eczema
What would you give someone with widespread dry, red skin, incessant itching, cracking and bleeding and excoriations? It’s worst on their hands, arms and legs. They’re sleeping ok.
Severe eczema so:
Frequent and liberal use of emollients
- Prescribe >500g e.g. dermol, doublebase, hydromol
- Use >qds or >every 2-3hrs, for and after washing
Potent topical corticosteroid on inflamed areas
e. g. Betamethasone valerate 0.1% (Betnovate)
- 7-14 days, continue >48hrs after resolves
- Follow FTU (finger-tip units) in info leaflet
- Apply 15-30 mins after emollient at convenient time e.g. before sleep
Non-sedating antihistamine for the itch for 1 month
- Cetirizine 10mg od
- Loratadine 10mg od
- Fexofenadine 180mg od
Give 3 examples of emollients for eczema
How much should you prescribe?
Dermol Doublebase Hydromol Oilatum Cetreban E45
At lesat 500g
When is 30mg po prednisolone used in eczema?
Severe, extensive, causing psychological distress
How would you manage someone who’s eczema has developed a small patch of pustules on their hand, some of which have weeped and then crusted over? (apart from their normal eczema Tx)
Localised infected eczema so:
- Topical Abx cream/ointment (mixed with/out corticosteroid)
• Use no longer than 2 weeks
• e.g. Fusidic acid
- Advise to dispose of old products and provide with new ones
- Possibly topical antiseptic like chlorhexidine, triclosan or potassium permanganate
How often do you need to review someone’s various eczema treatments in primary care?
- Emollients annually
- Maintenance topical corticosteroids every 3-6 months, acutely needs more frequent review
- Non-sedating antihistamines every 3 months
- After tx with oral corticosteroids / oral Abx
What is the difference between mild, moderate and severe eczema?
- Mild: Dry skin, infrequent itching, possibly small areas of redness
- Moderate: Dry skin, frequently itchy, redness, possibly excoriation, possibly localised skin thickening
- Severe: Widespread dry skin, incessant itching, redness; Possibly: excoriation, extensive skin thickening, bleeding, oozing, cracking, altered pigmentation
Topical hydrocortisone 1% is what strength corticosteroid? What’s it used for?
Mild
- Mild eczema
- Moderate eczema on delicate skin (face/flexures)
Generally speaking, what do you use in between flares of eczema and how so?
Continue using emollient frequently
Topical corticosteroid
- On areas prone to flares (not delicate face/genitals/axillae)
- Step down tx: lowest potency which controls Sx (~ class down from what’s used for a flare)
- Intermittent tx: od -> twice weekly
How much emollient should you use in eczema and when?
Use regularly (at least qds or every 2-3 hours)
Use after washing too
And use for washing
Topical betamethasone (Betnovate) 0.025% is what strength corticosteroid? What’s it used for?
Moderate (0.1% is potent)
- Moderate eczema
- Severe eczema on delicate skin (face/flexures)
What would you give someone with dry, red skin on their hands which is pretty itchy, and has a few excoriations?
Moderate eczema so:
Frequent and liberal use of emollients
- Prescribe >500g e.g. dermol, doublebase, hydromol
- Use >qds or >every 2-3hrs, for and after washing
Moderate topical corticosteroid on inflamed areas
e.g. Betamethasone valerate 0.025% (Betnovate) or Clobetasone butyrate 0.05% (Eumovate)
od/bd
- 7-14 days, continue >48hrs after resolves
- Follow FTU (finger-tip units) in info leaflet
- Apply 15-30 mins after emollient at convenient time e.g. before sleep
Non-sedating antihistamine for the itch for 1 month
- Cetirizine 10mg od
- Loratadine 10mg od
- Fexofenadine 180mg od
What do you do if you see someone with eczema herpeticum in GP?
HOSPITAL ASAP
What would you give someone with some dry skin, a few small areas of redness, and some minor itching?
Mild eczema so:
Frequent and liberal use of emollients
- Prescribe >500g e.g. dermol, doublebase, hydromol
- Use >qds or >every 2-3hrs, for and after washing
Mild topical corticosteroid for red areas
e. g. hydrocortisone 1% od/bd for 7-14 days, continue >48hrs after resolves
- Follow FTU (finger-tip units) in info leaflet
- Apply 15-30 mins after emollient at convenient time e.g. before sleep
Topical betamethasone (Betnovate) 0.1% is what strength corticosteroid? What’s it used for?
Potent (0.025% is moderate)
Severe eczema
What would you give someone with dry, red skin on their face which is pretty itchy, and has a few excoriations?
Moderate eczema so:
Frequent and liberal use of emollients
- Prescribe >500g e.g. dermol, doublebase, hydromol
- Use >qds or >every 2-3hrs, for and after washing
On delicate skin (face/flexures) so mild (not moderate) topical corticosteroid for inflamed areas
e. g. hydrocortisone 1% od/bd for max 5 days
- Follow FTU (finger-tip units) in info leaflet
- Apply 15-30 mins after emollient at convenient time e.g. before sleep
Non-sedating antihistamine for the itch for 1 month
- Cetirizine 10mg od
- Loratadine 10mg od
- Fexofenadine 180mg od
What is cetirizine and what is it used for in eczema?
As a non-sedating antihistamine for itch in moderate/severe eczema
What can be used for itching after scabies has been treated?
Crotamiton
Give 4 risks of using oral steroids longterm
o Growth retardation in children
o DM
o HTN
o Osteoporosis
Topical clobetasol (Dermovate) 0.05% is what strength corticosteroid? What’s it used for?
Very potent
Used by specialists in eczema
