GP conditions - dermatology Flashcards
What is eczema, its cause, common affected areas and presentation
- Chronic atopic condition
- Caused by defects in the normal continuity of the skin barrier leading to inflammation in the skin
- Dry, red, itchy and sore patches of skin
- Usually over flexor surfaces
- Periods of well control with problematic flares
What is used in to prevent flares of eczema (maintenance)
- Emollients
How is a mild flare of eczema managed
- Liberal and frequent use of emollients
- Mild topical corticosteroids (1% hydrocortisone)
How is a moderate flare of eczema managed
- Liberal and frequent use of emollients
- Moderately potent topical corticosteroids (eumovate/clobetasone butyrate 0.05%)
How is a severe flare of eczema managed
Step up :
- Liberal and frequent use of emollients
- Potent topical corticosteroid (betnovate (betamethasone valerate 0.1%)
- Topical calcineurin inhibitors (tacrolimus)
- Bandages
- Phototherapy
- Oral steroids
What is the most common caused of infected eczema
Staphylococcus aureus
How is a secondary bacterial infection of eczema in ppl who are not systemically unwell managed
- Emollients and topical corticosteroids
- Do not routinely offer abx
What is the first choice topical abx for infected eczema if appropriate
- Fusidic acid 2%
- 3 times a day for 5 to 7 day
what oral abx is used for infected eczema if appropriate ?
- Flucloxacillin (500mg 4 times a day for 5 to 7 days).
- Clarithromycin if penicllin allergy (250mg twice as day for 5 to 7 days)
- Erythromycin if penicliin allergy and pregnant (250mg to 500mg four times a day for 5 to 7 days)
how does infected eczema present
Weeping pustules, crusts, rapidly worsening eczema, fever and malaise
Eczema herpeticum : what is it, cause, presentation
- Viral skin infected
- Caused by HSV or VZV
- Presentation : pt with eczema develops widespread, painfulm vesicular rash with systemic symptoms (fever, lethargy, irritability and reduced oral intake).
- Lymphadenopathy
How does the rash in eczema herpeticum present
- Widespread
- Erythematous, painful and sometimes itchy
- Vesicles containing pus
How is eczema herpeticum managed
- Mild / moderate = oral aciclovir
- Severe = IV aciclovir
what can be used for severe itching in eczema flares and that affecting sleep
- Non sedating antihistamines (e.g. cetirizine, loratidine)
- Sedating antihistamines (chlorphenamine, short course !)
Define a bulla and a vescile
- Bulla : circumscribed collection of free fluid (>1cm)
- Vesicle : circular collection of free fluid (1cm or smaller)
Define a pustule
Vesicle containing pus
Define a macule and a patch
- Macule : circular, flat discolouration (<1cm) = browm, blue, red or hypo pigmented
- Patch : circumscribed flat discoloration (>1cm)
Define a papule and a nodule
- Papule : superficial, solid, elevated, <0.5cm, colour varies.
- Nodule : circular, elevated, solid lesion, >1cm.
Define a plaque
- Superficial, elevated solid flat, topped lesion (>1cm)
What is the cause of venous/stasis eczema ?
- Underlying venous disease causing poor tissue perfusion
Who does venous eczema affect and where on the body ?
- Middle aged / elderly patients
- Legs : valves in the veins stop working blood leaks backwards. Increased pressure causes fluid to leak into the surrounding tissue.
How does venous eczema present ?
- Early : capillary veins and haemosiderin deposition around ankles = brown hyperpigmentation
- Later : eczema (itching, dry scaly area, erythematous and purpuric) +/- lipodermasclerosis +/- ulceration
how is venous eczema managed ?
- Emollients +/- mild to moderate steroids
- Manage underlying venous insufficient - postural drainage/compression stockings
who does a seborrheic wart usually affect and how does it present ?
- > 60 yrs
- Warty nodule, usually pigmented, ‘stuck on/bunch of grapes appearance’
- Reassurance only needed
