Eczma/Dermatitis Flashcards

1
Q

Definitions

A

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

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2
Q

Skin philosophy

A

Skin is a barrier between the body and environment
Prevents water loss
Protects from irritants
It has sensory involvement in both touch and temperature

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3
Q

Causes

A

Most cases develop under the age of 5

Prevalence increased if parents are affected by atopic conditions

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4
Q

How does it occur?

A

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

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5
Q

Trigger factors

A
Materials i.e. Wool, synthetic fabrics
Hormones, teething, sleep deprivation
Cow’s milk 
Food colourings
Eggs
House dust
Moulds
Pollen
Animal dander
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6
Q

Symptoms of eczema

A

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

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7
Q

Common locations

A

Areas of joints such as elbows, knees, neck and wrists

In children the most common areas are cheeks, face and scalp

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8
Q

Red flag symptoms

A
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
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9
Q

Lifestyle advice

A
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
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10
Q

Emollients

A
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

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11
Q

Topical corticosteroid

A
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

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12
Q

Contact dermatitis

A

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

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13
Q

Symptoms of contact dermatitis

A

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

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14
Q

Irritant contact dermatitis

A

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

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15
Q

Allergic contact dermatitis

A

Not genetic

Metal jewellery, perfume and cosmetics, preservatives, latex and plants

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16
Q

Treatment for contact dermatitis

A

Avoid irritant or allergen
1st line: Emollient
2nd line: Topical corticosteroid
3rd line: Oral corticosteroid in severe cases

17
Q

What is psoriasis?

A

Most common form is chronic plaque psoriasis

Inflammatory skin disease affecting skin, joints and nails

18
Q

How does psoriasis occur?

A

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

19
Q

Symptoms of psoriasis

A
Inflamed areas on the skin
Raised, red and scaly plaques
Scales are white/silvery
Itchy
Painful
Symmetrical patches
Pitted fingernails
20
Q

Factors inducing psoriasis flare ups

A
Infections i.e. strep throat
Hormonal changes
Skin injury
Stress and anxiety
Alcohol
Smoking
Medication i.e. β blockers, lithium, antimalarials
21
Q

Pharmacological treatments of psoriasis

A
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
22
Q

Coal tar preparations

A
Removes loose scales
Slows skin overgrowth
Messy to apply, unpleasant smell
May stain clothing
Can cause light sensitivity
23
Q

Dithranol

A

Slows production of skin cells
Apply sparingly to affected area
May irritate skin
Stains clothing and messy to use

24
Q

Vitamin A analogues i.e. Tazarotene

A

Not to be used on face or skin folds

25
Q

Salicylic acid preparations

A

Reduces excessive scaling

26
Q

Phototherapy

A

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

27
Q

Treatment for severe psoriasis

A
  1. Acitretin
    - Retinoid, but avoid use in women of child bearing age
  2. Ciclosporin
    - Usually used in transplant patients
    - 3-4 weeks until benefit seen
  3. Methotrexate
    - Slows down rapid division of skin cells
    - Reduces inflammation
  4. Biologicals
    - Monoclonal antibodies
  5. Topical calcineurin inhibitors
    - Tacrolimus, Pimecrolimus
    - Off label use