Eczematous eruptions: Nummular, Eczema herpticum, Infected eczema, Actinic keratosis

Question 1

What is nummular? Diagnosis?

Answer 1

Aka discoid eczema.

Long term skin condition that causes skin to be itchy, swollen, and cracked in circular or oval patches.

Clinical diagnosis

Question 2

Presentation of nummular?

Answer 2

Coin shaped lesions (1-10cm symmetric)
Itchy
vesicles and papules coalesce into plaques

Question 3

Management of nummular?

Answer 3

Start with moderate-potent steroid (incredabily itchy)

Moisturise

Sedating antihistamine for sleep disturbance (due to itchiness)

Question 4

What is venous stasis? Diagnosis/IVx? RFs?

Answer 4

Occurs due to venous insufficiency with poor circulation in the lower legs -common in the legs.

Clinical diagnosis

RFs:
- varicose veins
- trauma/surgery
- cardiac failure
- thrombophlebitis
- age >50

Question 5

Presentation of venous stasis?

Answer 5

Hyperpigmented plaques on lower legs -anterior or media

erythema
ulcers
may be scaly
may have oedema

Question 6

Management of venous stasis?

Answer 6

Compression stockings
Elevation (higher than heart level)
Walk more often

Topical steroids
Abx if infected

Treat ulcers

Question 7

What is eczema herpticum? Diagnosis/IVx?

Answer 7

Viral skin infection caused by herpes simplex virus (HSV1).

Clinical diagnosis
May do a viral swab.

Question 8

Presentation of eczema herpticum?

Answer 8

Fever
Lymphadenopathy
Painful blisters
Covers a specific dermatome.
Vesicular rash
Erythematous
Sometimes itchy
Vesicles containing pus

Question 9

Management of eczema herpticum?

Answer 9

Oral Aciclovir 400-800mg 5x a day for 7 days/

Consider referral if pt is unwell.

Admit to hospital if under <2yrs old.

Refer on the day if any eyelid/eye involvement.

Question 10

Cause and diagnosis/IVx of infected eczema?

Answer 10

Staphylococcal or streptococcal bacteria

Occurs due to breaks in the skins.

Reduced immunity in skin for people with atopic eczema.

Question 11

Presentation of infected eczema?

Answer 11

severe itchiness
new burning sensations
blistered skin
fluid drainage
white or yellow pus
skin warm to touch
eczema hurts to touch

Question 12

Management of infected eczema?

Answer 12

Flucloxacillin (macrolide if penicillin allergy)

Question 13

Define, cause and diagnosis of actinic keratosis?

Answer 13

Aka solar keratosis.

A premalignant skin condition that can lead to squamous cell carcinoma (SCC).

Caused by sun exposure leading to DNA damage within the keratinocytes.

Clinical diagnosis.

Question 14

Presentation of actinic keratosis?

Answer 14

RED-BROWN MACULE/PAPULE with a rough yellow-brown scale over it.
Thickened papules or plaques.
Erythematous skin
Keratoic, rough, warty surface

Lesions are found on sun-exposed areas of skin:
e.g. hands, face, back, lower arms.

Question 15

Management of actinic keratosis?

Answer 15

Cryotherapy or surgical removal.

Diclofenac gel (Solerase -NSAID)
- prescribe for 8wks
- review at 4wks to see for improvement. -if no improvement 2ww referral.

Tretinon (Retin-A) pts with mild actinic damage (e.g. erythema, scaling)

Sunscreen
Acid peels (alpha hydroxy acids)​
Topical chemotherapy with 5-Fluorouracil cream​.

Pt education on sun protection​