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
