Eczma/Dermatitis Flashcards
Definitions
Atopic: A group of conditions which include asthma, eczema and hay fever
Eczema: Red, dry, itchy skin which can sometimes become weeping, blistered, crusty and scaly
Skin philosophy
Skin is a barrier between the body and environment
Prevents water loss
Protects from irritants
It has sensory involvement in both touch and temperature
Causes
Most cases develop under the age of 5
Prevalence increased if parents are affected by atopic conditions
How does it occur?
Normal skin has tightly packed keratinocytes forming a natural barrier
In dermatitis, skin cells are less tightly held together allowing the penetration of allergens increasing inflammation as well as the loss of water and fat
It may be due to abnormal inflammatory or allergen response
Trigger factors
Materials i.e. Wool, synthetic fabrics Hormones, teething, sleep deprivation Cow’s milk Food colourings Eggs House dust Moulds Pollen Animal dander
Symptoms of eczema
Skin appears red and cracked, dry and flaky, undergoing lichenification and change in skin pigmentation
During a flare up: skin is moist, weepy, crusting around edges, small water blisters may develop on hands and feet, may result in sleep disturbances, tiredness and irritability
Common locations
Areas of joints such as elbows, knees, neck and wrists
In children the most common areas are cheeks, face and scalp
Red flag symptoms
Need to refer for the following: If current management system not controlling flare ups Adverse reaction to emollients Signs of infection Psychological implications Severe fissures in skin Differential diagnosis suspected
Lifestyle advice
Moisturise 2-3 times a day Replace soap with emollient Protective clothing/Avoid aggravating clothing Avoid triggers Keep cool Do not scratch (pat wet skin dry not rub) Keep nails short Eczema support sign posting
Emollients
First line available OTC Hydrates and soothes skin Apply liberally several times a day Apply to damp skin Replace soap with emollient First choice: greasy emollients Ointments, creams, bath additives Do not use aqueous cream
Urea: keratin softener, hydrating agent
Lauromocrogols: local anaesthetic properties
Lanolin or derivatives
Antiseptic
Creams and lotions as evaporation of water-based products cools skin
Ointments for dry skin are more effective but poorly tolerated
Topical corticosteroid
Second line Reduce itching, inflammation and redness Lower strengths available as OTC Ointments preferred to creams Apply thinly once or twice daily 1. Hydrocortisone 1% cream 15g Can be sold to the public for allergic contact dermatitis, irritant dermatitis, insect bite reactions, mild to moderate eczema in 10 years or older 2. Clobetasone 0.05% cream 15g over 12 years for eczema and dermatitis only Max treatment 7 days for corticosteroids
Refer when: under 10 years old, pregnancy, application to face or anogenital region, broken skin, infected skin including acne, cold sores and athlete’s foot
Contact dermatitis
Inflammation of the skin that occurs when you come into contact with a particular substance
Irritant: a substance that directly damages the epidermis
Allergen: a substance that triggers the immune system to respond in a way which affects the skin
Symptoms of contact dermatitis
After exposure to irritant or allergen, the reaction occurs within a few hours
Most commonly affects hands and feet
Skin appears red, itchy, blistered, dry, cracked and scaly
Irritant contact dermatitis
May cause burning or stinging sensation
Can result from single exposure of strong irritant or multiple exposure to weak irritant
Soaps and detergents, perfume and cosmetics, solvents, powders and plants
Allergic contact dermatitis
Not genetic
Metal jewellery, perfume and cosmetics, preservatives, latex and plants
Treatment for contact dermatitis
Avoid irritant or allergen
1st line: Emollient
2nd line: Topical corticosteroid
3rd line: Oral corticosteroid in severe cases
What is psoriasis?
Most common form is chronic plaque psoriasis
Inflammatory skin disease affecting skin, joints and nails
How does psoriasis occur?
Skin replacement process speeds up, taking just a few days to replace skin cells that would usually take 21-28 days.
This abundance of skin cells builds up to form raised plaques on the skin
Symptoms of psoriasis
Inflamed areas on the skin Raised, red and scaly plaques Scales are white/silvery Itchy Painful Symmetrical patches Pitted fingernails
Factors inducing psoriasis flare ups
Infections i.e. strep throat Hormonal changes Skin injury Stress and anxiety Alcohol Smoking Medication i.e. β blockers, lithium, antimalarials
Pharmacological treatments of psoriasis
1st line: Emollient - Reduce scale and reduce itch 2nd line: Topical corticosteroids - Once stopped, may cause rebound psoriasis 3rd line: Topical vitamin D preparations Calcipotriol, Calcitriol - Slows rate at which skin cells divide
Coal tar preparations
Removes loose scales Slows skin overgrowth Messy to apply, unpleasant smell May stain clothing Can cause light sensitivity
Dithranol
Slows production of skin cells
Apply sparingly to affected area
May irritate skin
Stains clothing and messy to use
Vitamin A analogues i.e. Tazarotene
Not to be used on face or skin folds
Salicylic acid preparations
Reduces excessive scaling
Phototherapy
Uses UV light to clear psoriasis and keep it away for a while
Duration: 8-10 weeks
Sessions: 2-3 a week
Uses narrowband UVB or ultraviolet A light
Before administering UVA, patient needs to have their skin sensitised using psoralen
Treatment for severe psoriasis
- Acitretin
- Retinoid, but avoid use in women of child bearing age - Ciclosporin
- Usually used in transplant patients
- 3-4 weeks until benefit seen - Methotrexate
- Slows down rapid division of skin cells
- Reduces inflammation - Biologicals
- Monoclonal antibodies - Topical calcineurin inhibitors
- Tacrolimus, Pimecrolimus
- Off label use
