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GP > Eczema, Psoriasis, Papulopustular Conditions > Flashcards

Eczema, Psoriasis, Papulopustular Conditions Flashcards

1
Q

Eczema risk factors?

A
  1. Asthma, Hayfever

2. FH of Atopic eczema

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2
Q

Eczema pathogenesis?

A

Mutations of Filaggrin gene -> decreased epidermal fatty acid -> dry skin

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3
Q

How common is eczema, what ethnicity, what environment?

A
  1. 20% Children, 10% adults
  2. Atopic for Asians and Africans
  3. Dry places (Melbourne), cold (heaters are drying)
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4
Q

3 main features of Eczema?

A
  1. “Water-color” Red, Dry, Itchy, Scaly
  2. Ill-defined edges
  3. Lichenification
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5
Q

How common is allergen causing Eczema, where on the body (Infant/Child n adult)?

A
  1. Only 10%
  2. Infants: around the mouth (food)
  3. Child/Adults: face & hands (dust mite, pet fur)
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6
Q

What are the distributions of eczema in Infants vs Child n Adult?

A

Infant: Face

Child/Adult: Flexors

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7
Q

Endogenous Variants of Eczema (5)?

PI DVD

A

Pompholyx (Blistering)
Infected (Crust)

Discoid
Varicose
Asteatotic (Dry)

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8
Q

Infected Eczema most commonly infected by?

A
  1. Staph Aureus (Impetiginsation)

2. HSV (Eczema Herpeticum)

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9
Q

What is the prognosis of Eczema? Any occupational precautions?

A
  1. Most child improve with age
  2. Severe cases persist
  3. Dry skin occupational: nursing, hair-dressing, mechanic
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10
Q

Most common cause of butterfly rash?

A

Seborrhoeic dermatitis

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11
Q

Pompholyx eczema

A

Blisters and vesicles

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12
Q

Discoid Eczema cause?

A

Unknown

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13
Q

Asteatotic Eczema features (3)?

A
  1. “Crazy Paving appearance”
  2. Elderly
  3. Lower legs
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14
Q

Exogenous variants of Eczema (3)

A
  1. Irritant Contact
  2. Allergic Contact
  3. Photoallergic
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15
Q

Irritant Contact Dermatitis is? Commonly affects where?

A
  1. Agents directly damaging skin

2. Hands

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16
Q

Common agents causing Irritant Contact Dermatitis? (4)

A
  1. Water, Oils
  2. Detergents, soaps
  3. Acids and Alkalis (cement)
  4. Solvents and abrasives
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17
Q

Allergic Contact Dermatitis is?

A
  1. Allergic (T4HSR)

2. Contact (allergen contacting skin)

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18
Q

Common contact allergens?

A

Nickel, Chrome, Plants, Rubber, Hair dyes, Latex

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19
Q

Eczema lifestyle management? (3)

A
  1. Avoid Dry: no long hot showers, no soap (use moisturiser/bath oil as substitute)
  2. Avoid Overheat: bed, heater
  3. Avoid Irritation: clothing label, wool
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20
Q

Ointment vs Cream

A

Ointment
OILment, messier, more effective
Cream more pleasant, not moisturising if skin is dry, when infective

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21
Q

Eczema treatment? (3)

A
  1. Moisturisers (ointment)
  2. Topical Steroids (ointment, infected use cream)
  3. Wet dressing (on steroid ointment, remove when dry)
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22
Q

Infected Eczema treatment? (3)

A
  1. Soak off crusts (gauze)
  2. Topical Steroids (CREAM)
  3. PO abx or antivirals
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23
Q

Topical Steroid Side effects?

A
  1. Skin atrophy
  2. Steroid acne, rosacea, perioral dermatitis
  3. Glaucoma/cataracts
  4. Tachyphylaxis (tolerance)
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24
Q

How common is Psoriasis? What ethnicity?

A
  1. 2% of population

2. All racial types

25
Q

Psoriasis is a risk factor of? (2)

A
  1. 10% Psoriatic Arthritis

2. 2 times increased risk of CV disease (chronic inflammatory condition)

26
Q

Psoriasis core features? (3)

A
  1. “oil-color” mahogany Red, no itch, silver scale, salmon plaque
  2. Well-defined border
  3. Improves with sunlight (thus UV therapy)
27
Q

Psoriasis onset and peak incidence age? Poor prognosis if?

A
  1. Onset any age
  2. Peak early adulthood
  3. Early onset, severe disease
28
Q

Psoriasis pathogenesis?

A
  1. Rapid turnover of keratinocytes

2. New layer of epidermis in 4 days rather than 1 month -> Thick scale

29
Q

Psoriasis distribution? Spares where? (4)

A
  1. Extensors
  2. Lower back/buttocks
  3. Nails/scalp
  4. Spares faces (sunlight exposure)
30
Q

Koebner Phoenomenon

A

Skin lesions developing on the lines of injury (e.g. scratch)

31
Q

Flexural Psoriasis is psoriasis but?

A

Loses scaling characteristic

32
Q

Nail sign of Psoriasis? (3)

A
  1. Nail Thickening
  2. Onycholysis
  3. Nail pitting
33
Q

Variants of psoriasis?

A
  1. Flexural
  2. Pustular
  3. Guttate
34
Q

Pustular Psoriasis features? (3)

A
  1. Hands/feet
  2. NO plaque (pustule and brown dots)
  3. Maybe painful
35
Q

Guttate Psoriasis features? (3)

A
  1. “Rain-drop”and retains typical signs
  2. Young patient
  3. Triggered by Strep Throat
36
Q

Guttate Psoriasis prognosis?

A
  1. Good prognosis with phototherapy

2. Early abx if recurrent tonsilitis

37
Q

Psoriasis topical treatment? (4)

A
  1. Moisturisers (ointment)
  2. Topical steroids (short term high dose)
  3. Topical Calcipotriol (VitD long term)
  4. Topical Tar/Salicylic acid/Anthralin
38
Q

Phototherapy concept? Difference from solarium?

A
  1. UVB light, resembles natural sunlight

2. Solarium is UVA, damages skin

39
Q

Psoriasis systemic therapy? (3)

A
  1. Immunomodulator: PO MTX, Cyclosporin
  2. PO Acitretin (vitA)
  3. TNF Biologics: etanercept, infliximab, adalimumab
40
Q

4 factors for Acne pathogenesis ?

A
  1. Androgen mediated sebum increase
  2. Hyperproliferation of keratin -> comedones
  3. Inflammation
  4. Infection of Propionibacterium Acne
41
Q

RF of acne?

A
  1. Avoid high Glycaemic diet
  2. Oils on skin (make-up)
  3. Drugs (Steorids, OCP)
  4. Endocrine (PCOS)
42
Q

Acne patients must check? (3)

A
  1. Type and grade of acne (guides tx)
  2. Psychological impact
  3. Check for any scarring
43
Q

What are Comedones, whats the difference between whiteheads and blackheads?

A
  1. Keratin buildup in pores

2. White = closed, Black = open

44
Q

3 Severity of Acne

A
  1. Comedonal
  2. Papulopustular
  3. Nodulocystic
45
Q

What are the lifestyle mx of Acne? (3)

A
  1. Cleansing: Only wash face 1-2 daily, wash hair regularly
  2. Don’t squeeze spots (aggravates inflammation)
  3. Avoid excessive/oil-based makeup, remove before bed
46
Q

Treatment for comedonal Acne

A
  1. Extraction

2. Topical Retinoid (like SABA prn)

47
Q

Treatment for Papulopustular acne? Avoid what combination?

A

Mild: Topical Retinoid/abx + Benzyl Peroxide
Moderate: Topical Retinoid + PO abx (Doxy, Minocycline, Trimethoprim)

Avoid Topical + PO abx

48
Q

Treatment for papulopustular Acne in Female patients? (2)

A
  1. Topical Retinoid/abx + Benzyl Peroxide

2. Hormonal: Cyproterone acetate (anti-androgen)

49
Q

Acne involving back or chest warrants what treatment?

A

Oral abx

50
Q

Severe nodulocystic acne treatment? Side effects?

A
  1. PO Isotretinoin 6mo (refer Dermatologist)

2. Teratogenic, LFT/lipids, dryness, mood changes

51
Q

Rosacea onset age? Cause and RF?

A
  1. 30-50y/o
  2. Unknown
  3. Fair-skin
52
Q

Rosacea triggers? (3)

A
  1. Heat/sunlight
  2. Alcohol
  3. Spicy foods
53
Q

What are the core features of Rosacea? (4)

A
  1. Erythema/Flushing, Telangiectasia, papulopustular
  2. Ace of clubs distribution
  3. NO comedones
  4. Rhinophyma
54
Q

How do you treat Rosacea? (4)

A
  1. Avoid triggers, sun protection
  2. Topical MNZ gel (papules)
  3. PO abx (Doxy/Mino/Trimethroprim) 6mo, prevent Rhinophyma
  4. Laser (Vascular for flush, Ablative for rhinophyma)
55
Q

Variants of Rosacea (2)?

A
  1. Peri-oral dermatitis

2. Peri-orofacial dermatitis

56
Q

POD distribution? (3)

A
  1. Peri-mouth
  2. Base of nose
  3. Eyelids
57
Q

What causes of POD? (2)

A
  1. Idiopathic (Young women, mainly mouth)

2. Topical steroids

58
Q

Treatment of POD and prognosis?

A
  1. Stop Topical Steroids
  2. PO abx as per acne, but 2 mo (Doxy/mino/trimeth)
  3. Usually clears does not recur

GP (2 decks)

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