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Eczema & Psoriasis Flashcards

1
Q

In what proportion of children does eczema occur?

A

15-20%

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2
Q

At what age does eczema typically present in children?

A

typically before 6 months

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3
Q

When does the majority of childhood eczema clear?

A

clears in 50% of children by age 5

clears in 75% of children by age 10

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4
Q

In younger children and infants what are 3 areas typically affected by eczema?

A
  1. Face
  2. Trunk
  3. Extensor surfaces
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5
Q

What areas of the body are affected by eczema in older children?

A

more typical distribution: flexor surfaces and creases of face and neck

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6
Q

What are 4 steps of the management of eczema in children?

A
  1. Avoid irritants
  2. Simple emollients: large quantities should be prescribed
  3. Topical steroids
  4. In severe cases: wet wraps and oral ciclosporin
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7
Q

What is an example of the amount of emollient which may be prescribed for children?

A

250g/ week with ratio to steroid 10:1

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8
Q

What is the guidance on which steroid cream to use for eczema?

A

use the weakest steroid cream which controls patients’ symptoms

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9
Q

What are the 4 strenghts of topical steroids and examples of each?

A
  1. Mild: hydrocortisone (0.5-2.5%)
  2. Moderate: eumovate + betnovate RD
  3. Potent: betnovate + cutivate
  4. Very potent: dermovate
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10
Q

What is the mild topical steroid that is used for eczema?

A

hydrocortisone 0.5-2.5%

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11
Q

What are 2 types of moderate topical steroid used for eczema?

A
  1. Betamethasone valerate 0.025% (Betnovate RD)
  2. Clobetasone butyrate 0.05% (Eumovate)
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12
Q

What are 2 types of potent steroid cream used for eczema?

A
  1. Fluticasone propionate 0.05% (Cutivate)
  2. Betamethasone valerate 0.1% (Betnovate)
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13
Q

What is a very potent topical steroid used for eczema?

A

Clobetasol propionate 0.05% (Dermovate)

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14
Q

What is a finger tip unit?

A

= 0.5g = sufficient to treat a skin area about twice that of the flat of an adult hand

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15
Q

What finger tip units can be used for the hand and fingers (front and back)?

A

1

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16
Q

What finger tip units can be used for the adult foot (all over)?

A

2.0

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17
Q

What finger tip units of steroid cream can be used for the adult front of check and abdomen?

A

7.0

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18
Q

What finger tip units of steroid cream can be used for the adult back and buttock?

A

7.0

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19
Q

What finger tip units of steroid cream can be used for the adult face and neck?

A

2.5

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20
Q

What finger tip units of steroid cream can be used for the adult entire arm and hand?

A

4.0

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21
Q

What finger tip units of steroid cream can be used for the adult leg (entire) and foot?

A

8.0

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22
Q

What does the BNF is the recommended quantity of topical steroids that should be prescribed for an adult for single daily application to the face and neck for 2 weeks?

A

15-30g

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23
Q

What does the BNF is the recommended quantity of topical steroids that should be prescribed for an adult for single daily application to both hands for 2 weeks?

A

15-30g

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24
Q

What does the BNF is the recommended quantity of topical steroids that should be prescribed for an adult for single daily application to the scalp for 2 weeks?

A

15-30g

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25
Q

What does the BNF is the recommended quantity of topical steroids that should be prescribed for an adult for single daily application to both arms for 2 weeks?

A

30-60g

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26
Q

What does the BNF is the recommended quantity of topical steroids that should be prescribed for an adult for single daily application to both legs for 2 weeks?

A

100g

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27
Q

What does the BNF is the recommended quantity of topical steroids that should be prescribed for an adult for single daily application to the trunk for 2 weeks?

A

100g

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28
Q

What does the BNF is the recommended quantity of topical steroids that should be prescribed for an adult for single daily application to the groin and genitalia for 2 weeks?

A

15-30g

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29
Q

What are 5 prognostic markers for severe eczema?

A
  1. Onset at age 3-6 months
  2. Severe disease in childhood
  3. Associated asthma or hay fever
  4. Small family size
  5. High IgE serum levels
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30
Q

What are 4 aspects of the management of eczema in adults?

A
  1. Emollients
  2. Topical steroids
  3. UV radiation
  4. Immunosuppressants e.g. ciclosporin, antihistamines and azathioprine
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31
Q

What are 3 types of immunosuppressants that can be used for the management of adult eczema?

A
  1. Ciclosporin
  2. Antihistamines
  3. Azathioprine
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32
Q

What is eczema herpeticum?

A

severe primary infection of the skin by herpes simplex virus 1 or 2

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33
Q

In what patient group is eczema herpeticum more commonly seen?

A

children with atopic eczema

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34
Q

How does eczema herpeticum often present?

A

rapidly progressing painful rash

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35
Q

What is usually seen on examination of eczema herpeticum?

A

monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1-3 mm in diameter

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36
Q

What is the management of eczema hepeticum?

A

admit for IV aciclovir (life-threatening)

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37
Q

What is the prevalence of psoriasis?

A

2%

38
Q

What 2 things are patients with psoriasis at increased risk of?

A

arthritis and cardiovascular disease

39
Q

What are 3 things involved in the multifactorial pathophysiology of psoriasis?

A
  1. Genetic
  2. Immunological
  3. Environmental
40
Q

What are 3 genes associated with psoriasis?

A
  1. HLA-B13
  2. HLA-B17
  3. HLA-Cw6
41
Q

What is the role of immunology in the pathophysiology of psoriasis?

A
  • abnormal T cell activity stimulated keratinocyte proliferation
  • increasing evidence this is mediated by group of T helper cells, Th17, producing IL-17
  • third effector cell subset in addition to Th1 and Th2
42
Q

What are 4 environmental factors that can influence psoriasis?

A
  1. Skin trauma
  2. Stress
  3. Streptococcal infection (can trigger)
  4. Sunlight (can improve)
43
Q

What are the 4 recognised subtypes of psoriasis?

A
  1. Plaque psoriasis
  2. Flexural psoriasis
  3. Guttate psoriasis
  4. Pustular psoriasis
44
Q

What is the most common subtype of psoriasis?

A

plaque psoriasis

45
Q

What is the presentation of plaque psoriasis?

A

well-demarcated red, scaly patches affecting the extensor surfaes, sacrum and scalp

46
Q

What is the appearance of flexural psoriasis?

A

in contrast to plaque psoriasis, the skin is smooth

47
Q

What is the appearance of guttate psoriasis?

A

multiple red, teardrop lesions appear on body - trunk and limbs

48
Q

What is the cause of guttate psoriasis?

A

it is a transient rash frequently triggered by a streptococcal infection 2-4 weeks prior to lesions

49
Q

Where does pustular psoriasis affect?

A

commonly occurs on the palms and soles

50
Q

What are 2 features commonly also seen with psoriasis?

A
  1. Nail signs: pitting, onycholysis
  2. Arthritis
51
Q

What are 5 complications of psoriasis?

A
  1. Psoriatic arthropathy (around 10%)
  2. Increased incidence of metabolic syndrome
  3. Increased incidence of cardiovascular disease
  4. Increased incidence of venous thromboembolism
  5. Psychological distress
52
Q

What are 4 things that can exacerbate psoriasis?

A
  1. Trauma
  2. Alcohol
  3. Drugs: beta blockers, lithium, antimalarians, NSAIDs, ACEis, infliximab
  4. Withdrawal of systemic steroids
53
Q

What are 6 drugs which can exacerbate psoriasis?

A
  1. Beta blockers
  2. Lithium
  3. Antimalarials (chloroquine and hydroxychloroquine)
  4. NSAIDs
  5. ACE inhibitors
  6. Infliximab
54
Q

What are 4 steps to the management of chronic plaque psoriasis?

A
  1. First line: potent corticosteroid once daily plus vitamin D analogue applied once daily
  2. Second line: if no improvement after 8 weeks, offer vitamin D analogue twice daily
  3. Third line: if no improvement after 8-12 weeks offer either: potent corticosteroid applied twice daily for up to 4 weeks or coal tar preparation applied once or twice daily
  4. Short-acting dithranol
55
Q

What is the first line management of psoriasis?

A
  • potent corticosteroid once daily plus vitamin D analogue applied once daily
  • apply separately, once in morning and other in the evening
  • for up to 4 weeks
56
Q

How long should the first line treatment for psoriasis be applied?

A

up to 4 weeks

57
Q

What is the second-line management for psoriasis?

A

if no improvement after 8 weeks then offer a vitamin D analogue twice daily

58
Q

What are 2 options for third line management of psoriasis?

A

if no improvement after 12 weeks offer either:

  1. potent corticosteroid applied twice daily up to 4 weeks
  2. coal tar preparation applied once or twice daily
59
Q

What are 3 examples of topical vitamin D analogues?

A
  1. Calcipotriol (Dovonex)
  2. Tacalcitol
  3. Calcitriol
60
Q

What are 4 possible negative effects of using steroids in psoriasis?

A
  1. skin atrophy
  2. striae
  3. rebound symptoms
  4. systemic side effects when potent on large areas (>10% of body surface area)
61
Q

What are 2 recommendations from NICE about using topical steroids in psoriasis?

A
  1. aim for 4 week break before starting another course of topical corticosteroids
  2. recommend using potent coricosteriods for no longer than 8 weeks at a time and very potent corticosteroids for no longer than 4 weeks at a time
62
Q

How do vitamin D analogues work to treat psoriasis?

A

reduce cell division and differentiation

63
Q

How common are adverse effects with vitamin D analogues?

A

uncommon

64
Q

What are is an advantage of vitamin D analogues over corticosteroids?

A

can be used long term

65
Q

What is an advantage of vitamin D analogues over coal tar and dithranol?

A

do not smell or stain

66
Q

viWhat is the action of vitamin D analogues in psoriasis?

A

reduce scale and thickness of plaques but not erythema

67
Q

When should vitamin D analogues be avoided?

A

pregnancy

68
Q

What is the maximum weekly amount of vitamin D analogues for adults?

A

100g

69
Q

What are 2 areas of psoriasis tha tsteroids are useful to treat?

A

flexural psoriasis and facial psoriasis (mild steroids)

70
Q

If steroids are ineffective for psoriasis what are 2 things that should be used second line?

A
  1. vitamin D analogues or
  2. tacrolimus ointment
71
Q

What are 3 places that the skin is particularly prone to steroid atrophy?

A
  1. Scalp
  2. Face
  3. Flexures
72
Q

How long should topical steroids be used on the face, scalp and flexures?

A

no more than 1-2 weeks/ month

73
Q

What are 2 things recommended by NICE for scalp psoriasis?

A
  1. potent topical corticosteroids once daily for 4 weeks
  2. if no improvement: either different formulation of potent corticosteroid (e.g. shampoo or mousse) and/or topical agent to remove adherent scale (e.g. containing salicylic acid, emollients and oils) before application of potent corticosteroid
74
Q

What do NICE recommd fo the management of face, flexural and genital psoriasis?

A

mild or moderate potency corticosteroid, once or twice daily for maximum 2 weeks

75
Q

What are 7 aspects of secondary care management of psoriasis?

A
  1. Phototherapy - UV B light
  2. Photochemotherapy - psoralen + UVA (PUVA)
  3. Oral methotrexate
  4. Ciclosporin
  5. Systemic retinoids
  6. Biological angets: infliximab, etanercept, adalimumab
  7. Ustekinumab (IL-2 and IL-23 blocker) - ni trials
76
Q

What is the first line type of phototherapy which can be used for psoriasis in secondary care?

A

ultraviolet B light 3x a week

77
Q

What are 2 adverse effects of phototherapy for psoriasis?

A
  1. Skin ageing
  2. Squamous cell cancer (not melanoma)
78
Q

What is the first line systemic therapy provided in secondary care for psoriasis?

A

oral methotrexate

79
Q

What is a situation when oral methotrexate is particularly useful to treat psoriasis?

A

if associated joint disease

80
Q

What is the mechanism of action of coal tar to treat psoriasis?

A

inhibits DNA synthesis

81
Q

What is the mechanism of action of calcipotriol to treat psoriasis?

A

reduces epidermal proliferation and restores a normal horny layer

82
Q

What is the mechanism of action of dithranol?

A

inhibits DNA synthesis, wash off after 30 mins

83
Q

What are 2 side effects of dithranol?

A

burning

staining

84
Q

What age group is guttate psoriasis common in?

A

children and adolescents

85
Q

What are 5 aspects of the management of guttate psoriasis?

A
  1. Most cases resolve spontaneously in 2-3 months
  2. no firm evidence to support use of antibiotics to eradicate strep infection
  3. topical agents as per psoriasis
  4. UVB phototherapy
  5. tonsillectomy if recurrent episodes
86
Q

pitWhat is the typical appearance of pityriasis rosea?

A

herald patch followed 1-2 weeks later by multiple ertyehmatous slightly raised oval lesions with fine scale confined to outer aspects of the lesions

may follow distribution with longitudinal diameters of oval lesions running parallel to line of Laner - fir tree appearance

87
Q

What sometimes precedes pityriasis rosea?

A

recent respiratory tract infections

88
Q

What is the typical course of pityriasis rosea?

A

usually disappears after 6-12 weeks, self-limiting

89
Q

Where is the herald patch for pityriasis rosea usually located?

A

on trunk

90
Q

What infective agent is thought to maybe play a role in pityriasis rosea?

A

herpes hominis virus 7 (HHV-7)

91
Q

Which age group is typically affected by pityriasis rosea?

A

young adults

GP (43 decks)

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