Eczema & Psoriasis Flashcards
What is eczema?
An atopic condition with IgE Ab to common allergens
How does eczema commonly present?
Pruritus: Leads to scratching & exacerbations
Erythematous, weeping, crusted rash
Lichenification (rare)
What is the distribution of eczema depending on age?
> 2m = Face + trunk
Young child = Extensors
Older child/adult = Flexures + friction surfaces
What are the causative factors of an eczema flare?
Irritants Infection: S.A Contact allergens Abrasive fabrics Extremes of temperature Hormonal change: Premenstrual flare Stress
How is eczema diagnosed?
MUST have itchy skin plus >3 of:
- Hx of itchy skin creases
- Hx of asthma/hay fever
- General dry skin in preceding year
- Visible flexural eczema (cheeks/forehead/limbs if <4yo)
- Onset in first 2 years of life
OTHER: RAST testing for triggers
How is eczema managed?
Skin hydrated
1) Emollients: Diprobase TDS
2) TOP Steroids: SHORT course <7d for flare-up
3) TOP Tacrolimus + Pimercrolimus: Atopic eczema not controlled by max TOP steroids (usually kids)
4) PO Fluclox: If concomitant bacterial infection
5) Alitertinoin/ systemic steroids/MTX/Ciclosporin/Azathioprine if severe refractory
6) Biologics
Other: Bandages, avoid allergens, UV light
What steroids should be used in eczema?
EMOLLIENT first then steroid 30mins after STEROID LADDER: FACE: Hydrocortisone 1% -Mild Eumovate (can be used on face) Betnovate 0.1% (body)- Moderate potency Mometasone (ONLY body)- Potent Dermovate 0.05% (ONLY body)- Very Potent
What prophylactic therapy can be used to help with eczema?
Cotton clothing AVOID nylon/wool
Cut nail’s short
Avoid soap/biological detergents
Exclusive breast-feeding
What is the prognosis of eczema?
Resolves in:
50% by 12yo
75% by 16yo
What is an important complications to look out for in someone with eczema?
- Eczema herpeticum: Infection with HSV Area of rapidly worsening, painful eczema, Clustered blisters, Punched out erosions, uniform in appearance, can coalesce to form large areas, Possible fever, distress, lethargy
- Bacterial- Staph Aureus infection
What is psoriasis?
T-Cell mediated autoimmune disorder
T-Cells produce cytokines leading to ↑keratinocyte proliferation
↑dermal antigenic adhesion molecules in vasculature
Leads to chronic, relapsing, inflammatory skin disorder characterised by scaly erythematous plaques
What are the aggravating factors for psoriasis?
Lack of sunlight
Infection: Group B Strep = Guttate
Trauma = Kobner Phenomenon
Lifestyle factors: Stress, OH-, Smoking, obesity
Meds: NSAIDs, Li, BB, ACEi, Anti-malarials, steroid withdrawal
How does psoriasis typically present?
Plaques: Scaly & erythematous
Auspitz sign: Pinprick bleed on scale removal
Nail changes: Onycholysis, pitting, subungal keratosis
What are signs of plaque psoriasis?
Symmetrical & well defined
Erythematous plaques w/silver scale
Extensors: Elbows, knees, scalp, sacrum
Describe flexural psoriasis
Plaques in moist flexural areas: Axillae, groin, submammary, umbilicus
Less scaly
Describe guttate psoriasis
High numbers of small plaques <1cm Look like punched out lesions Usually on trunk & limbs Typically young people POST-STREP infection Last 3-4m
Describe pustular/erythrodermic psoriasis
REFER TO DERM
Yellow/brown pustules within plaques
Palms & soles
Females
Describe generalised psoriasis
REFER TO DERM- MEDICAL EMERGENCY!
Severe systemic upset: Fever, dehydration, ↑WCC
How is psoriasis investigated?
Clinical diagnosis (same as eczema)
PASI/DLQI: Scores to assess severity & QoL
?Bloods: If also joint pain (Serology (RF, ANCA) for psoriatic arthritis)
?Biopsy: Histology
How is psoriasis managed?
Control NOT cure
Avoid triggers
Education
Consider CV risk if >10% affected
How is an exacerbation of psoriasis treated?
1) TOP Steroids: Betnovate/ Betamethasone 0.5% for 7d
AND
Vit D analogue: CALCITROL OD
Review at 4w
If no improvement at 8w = Vit D analogue BD
If no improvement at 8-12w = TOP steroid BD for 4w
How is psoriasis treated in the long term?
1) Emollients: Diprobase
Coal tar, Dithranol
2) PUVA therapy: UVB light therapy >10% skin affected + refractory to TOP therapy
3) Retinoid: Tazoretene
4) Non-biologics: Methotrexate, Ciclosporin, Acitretin
5)Biologics- Severe or arthropathy: Adalimumab
What is Acne Vulgaris?
Disorder of pilosebaceous follicles of face & upper trunk
How does acne occur?
At puberty androgens ↑sebum production from sebaceous glands
This blocks glands = comedones
Open = blackheads
Closed = white heads → papules, pustules, nodules
