Eczema, psoriasis & acne Flashcards
Atopic Eczema (also called infantile eczema)
Chronic (usually) inflammatory itchy (pruritic) skin condition which develops in early childhood (<2yrs)
20% of school children - diffuse with limb and face involvement
FH of atopy or food allergies
Atopic facial signs
Morgan-Dennie folds (extra skin fold in upper eyelid)
Eczema on cheeks but sparing the tip of the nose
Mouth breathing. ‘Allergic shiners’ - dark shiny circles under both eyes
Skin signs of atopic Eczema
Dryness (xerosis) and erythema
Poorly defined macules with signs of excoriation (scratching) – can lead to lichenification
Pompholyx
A type of eczema affecting the hands and feet with itchy blisters followed by inflammation and dry skin
Childhood eczema
Atopic eczema but in older children
More commonly flexural and if chronic may become lichenified
Impact of infantile and childhood eczema
15-20% of school children
Impacts sleep, school performance, relationships, confidence and mood, etc
Treatment for Eczema
Mild - Emollient therapy + mild steroids
Moderate - Emollient therapy + moderate steroids + topical calcineurin inhibitors + Bandages
Severe - Emollient therapy + potent steroids + topical calcineurin inhibitors + Bandages + Phototherapy + systemic treatment
Emollients
Can be bath additives, soap substitutes or topical therapy
Work by providing a barrier & prevent water loss
May require multiple applications
Infected Eczema
Normal skin pathogens are more virulent in eczema (staph aureus, HSV or VZV, impetigo)
Topical Steroids (how much and side effects)
Use fingertip measures (1 per two hand surfaces) - prolonged use thins skin
Contact allergic Dermatitis
Type IV delayed hypersensitivity due to hapten/compound allergy
Nickel particularly. Check with patch testing.
Venous Eczema
Skin changes due to venous stasis in the lower legs
Can lead to lipodermatosclerosis
Seborrhoeic dermatitis (or eczema)
Usually on scalp (dandruff) or milder on face and presternal area (symmetrical) –> Type IV reaction to pityrosporum yeast Often recurrent. Worse in males and immunosuppressed (HIV or parkinsons). Associated with Blepharitis and otitis externa.
Psoriasis (AKA psoriasis vulgaris)
Scaly salmon pink plaques, particularly on extensor surfaces with are sharply demarcated - 2% prevalence
40% heritability - abnormal, reactive epidermal differentiation and hyperproliferation with a T-cell infiltrate
Triggers for psoriasis
Infections or antibiotics for infection
Smoking
Stress
Koebner phenomenon
Skin trauma elicits lesions
Types of psoriasis
Guttate – look like rain drops
Palmo-plantar - pustular, discrete lesions
Severe unstable (pustular or erythrodermic)
Treatment of psoriasis
Local treatment is generally effective and avoids SEs but is messy and long.
Can use topical therapy, systemic or phototherapy
Tacrolimus
Calcineurin inhibitor
Phototherapy
UVB (narrow or broad band) is gentler or UVA (stronger) with/without psoralen (sensitising agent)
Risks include photoaging and skin cancer risk (max 200 sessions)
Local treatments of psoriasis
Emollients, corticosteroids, Tacrolimus, topical Vit D (analogues), Coal tar (to stop itching), Dithranol
Dithranol
accumulates in mitochondria leading to free radical release and so inhibits cell proliferation
Systemic therapy for psoriasis
Retinoids – Vit A analogues
Immunosuppressants – methotrexate or cyclosporin
Biologics – anti-TNF or anti-IL-2
Eczema Herpeticum (HSV)
Disruption of normal skin barrier can lead to widespread and aggressive HSV spread. Can be life threatening so should children should be admitted for IV aciclovir
Pathophysiology of Acne
Increased sebum secretion –> narrowing of pilosebaceous duct –> bacterium P. Acnes activity in blocked duct –> secondary inflammation
White head>Blackhead>Pustules>cysts
Treatment of Acne
Topical –> benzoyl peroxide, Vit A (isotretinoin) and Abx
Systemic –> hormones (dianette, yasmin), Abx (tetracycline, erythromycin), Roaccutane (isotretinoin) (risk of sucicidality)
Side effects of Roccutane (Isotretinoin)
Teratogenic - women should use two forms of contraception ideally
Most common SE is dry eyes, skin and lips. Can also cause low mood/depression, hair thinning, photosensitivity, raised triglycerides
Distribution of Eczema
In older children the classic pattern of flexor surfaces and face/neck creases. In young children it may be more on the extensor surfaces and in infants the face and trunk are often more affected
Acne Rosacea
a chronic skin condition of unknown cause typically affecting the nose, cheeks and forehead. starts with flushing, then telangiectasia and later persistent erythema, papules and pustules.
Management of Acne rosacea
Topical metronidazole if mild. More severe –> oral oxytetracycline. Also sun protection and laser therapy can be used.
First line treatment for chronic plaque psoriasis
Emollients with potent steroids OD and Vit D (calcipotriol) OD as first line. If no improvement Vit D BD, then steroid BD or coal tar OD/BD. can also add Dithranol
Acne Fulminans
a very severe form of acne associated with systemic upset (fever) and hospital admission is often required and the condition usually responds to oral steroids
Classification of acne
Mild - open and closed comedones with or without sparse inflammatory lesions
Moderate - widespread non-inflammatory lesions with numerous papules and pustules
Severe - extensive inflammatory lesions with nodules, pitting and scarring
Role of Dietary modification in acne treatment
None, from this i am taking that there is no significant role of dietary fat in acne.
Management of Seborrhoeic dermatitis
Face/Body – topical Ketoconazole or steroids.
Scalp - zinc pyrithione (head and shoulders) or tar (Neutrogena T). 2nd line is ketoconazole. Selenium sulphide or topical corticosteroids can also help.
Melasma
Hyperpigmented macules in sun-exposed areas (face). chloasma is used for melasma during pregnancy. More common in women and people with darker skin. Linked to pregnancy or COC/HRT
Things which will make psoriasis worse
Trauma
Alcohol
Drugs - B-blockers, Lithium, antimalarials (chloroquine & hydroxychloroquine), NSAIDs and ACEis
Withdrawal of systemic steroids.
