Inflammatory skin conditions

Question 1

What is eczema?

Answer 1

Also known as dermatitis
Is a chronic skin condition which is common in children but also prevalent in adults
a medical condition in which patches of skin become rough and inflamed with blisters which cause itching and bleeding.

Question 2

What is atopic eczema?

Answer 2

The most common type of eczema
It usually develops by early childhood and resolves during teenage years
May recur

itchy and inflamed patches of skin.

Question 3

What are the exacerbating factors of eczema?

Answer 3

chemicals 
food 
dust 
pet fur 
sweating 
heat 
severe stress

Question 4

What is the presentation of eczema?

Answer 4

acutely= Itchy papules and vesicles which are often weepy (Exudative)

chronically= dry scaly itchy patches which can be erythematous in paler skin or a grey/brown in richly pigmented skin

Question 5

how might eczema present in richly pigmented skin?

Answer 5

brown, grey or purple bumps (papular or follicular eczema)

Question 6

What may chronic scratching/rubbing of eczema lead to?

Answer 6

Can lead to lichenification

Question 7

What might nails show in eczema?

Answer 7

Nail pitting/ridging

Question 8

What is the management of eczema?

Answer 8

General measures…..

• avoid known exacerbating agents
• frequent emollients (softens skin)
• +/- bandages
• soap substitute

Topical therapies……

• topical steroids for active areas
• topical immunomodulators eg: tacrolimus, pimecrolimus for maintenance therapy as steroid sparing agents

Oral therapies…

• antihistamines for symptomatic relief
• abx ie: flucloxacillin for secondary bacterial infections
• antivirals (aciclovir for secondary herpes infection)

Photopherapy and immunosuppressants (azathioprine. ciclosporin, methotrexate) for severe non responsive cases, biologic therapy

Question 9

What are the complications of eczema?

Answer 9

secondary bacterial infections (crusted weepy lesions)

secondary viral infection- molloscum contagiosum, viral warts, eczema herpeticum

Question 10

Would you request any investigations for eczema?

Answer 10

Not usually

However in very few children with difficult to control eczema, a prick test or serum specific IgE may be helpful

Question 11

How would you explain to a parent how best and how often to use a moisturiser?

Answer 11

Apply gently and generously and regularly

Apply 2-4 times a day on the entire skin surface

Question 12

Are topical steroids used for eczema on the face? If so which one would you prescribe?

Answer 12

Yes- topical steroids are very safe when used appropriately, they will not thin the skin if used intemittently
The midly potent topical steroid, hydrocortisone 1% ointment once daily generously should be used

Question 13

What is an example of an antihistamine used for eczema?

Answer 13

A sedating anti-histamine i.e.: chlorphenamine could be considered as a short term measure
Non sedating anti-histamines don’t tend to help eczema patients with the itching

Question 14

How would you explain to an eczema patient why their eczema has reappeared after years due to winter?

Answer 14

Eczema is a chronic skin disease, and control rather than a cure is the aim
Eczema most typically occurs in infants however the humidity in winter can exacerbate skin dryness and the eczema is then more likely to flare
If it does glare it is appropriate to sue the topical steroids previously prescribed
continued use of emollients and soap avoidance can help to reduce the frequency of flares

Question 15

What is acne?

Answer 15

An inflammatory disease of the pilosebaceous follicle

Question 16

What are the causes of acne?

Answer 16

Hormonal (androgen)
Increased sebum production 
Abnormal follicular keratinization 
Bacterial colonization 
Inflammation

Question 17

What is the presentation of acne?

Answer 17

You can have both non inflammatory and inflammatory lesions
Non inflammatory lesions= mild acne= this is open and closed comedones

Inflammatory lesions= moderate and severe acne= papules, pustules, nodules and cysts

In hyperpigmented skin Inflammatory lesions may not be as clear, it may be seen as hyperpigmented lesions (acne hyperpigmented lesions), non erythematous nodules may be present and detected by palpation

Acne commonly affects the face, chest, upper back

Question 18

What is the management of acne?

Answer 18

General measures- like advising on skincare, treatment needs to be continued at least 6 weeks to have an effect

Topical therapies can be used for mild acne- Benzoyl peroxide and topical antibiotics (antimicrobial properties) and topical retinoids (comedolytic and anti- inflammatory properties)

Oral therapies (for moderate to severe acne)- oral antibiotics and anti androgens (in females)

Question 19

What are the complications of acne?

Answer 19

Post inflammatory hyperpigmentation
Scarring
Deformity
Psychological and social effects

Question 20

What is psoriasis?

Answer 20

A chronic inflammatory skin disease which is due to hyperproliferation of keratinocytes and inflammatory cell infiltration

Question 21

What are the types of psoriasis?

Answer 21

Chronic plaque psoriasis 
Guttate (raindrop)
Seborrhoeic (naso labial and retro-auricular) 
flexural (body folds) 
pustular (palmoplantar or generalised)
erythrodermic (total body redness)

Question 22

What are the causes of psoriasis?

Answer 22

Psoriasis is a complex interaction between genetic, immunological and environmental factors

Precipitating factors…

• Trauma (which may produce kobner phenomenon)
• Infection
• Drugs
• Stress
• Alcohol

Question 23

What is the presentation of psoriasis?

Answer 23

Well demarcated erythematous scaly plaques
In richly pigmented skin- psoriasis can present as dark brown, grey or purple patches or plaques

Lesions can be itchy, burning or painful

Common on the extensor surfaces of the body and over the scalp

Auspitz sign

50% have nail changes- pitting, oncholysis

5-8% suffer from associated psoriatic athropathy- symmetrical polyarthritis, asymmetrical oligomonoarthritis, lone distal interphalangeal disease, psoriatic spondylosis, arthritis mutilans

Question 24

What is Auspitz sign?

Answer 24

This is when a psoriasis patient scratches at the scales which cause gental removal and can cause capillary bleeding

Question 25

What is the management of psoriasis?

Answer 25

General measures- avoid known precipitating factors, give emollients to reduce scales

Topical therapies- for localised and mild psoriasis- vit D analogues, topical corticosteroids, coal tar preparations, dithranol, topical retinoids, keratolytics, scalp preparations

Photopherapy- used for extensive disease
ie: UVB and photochemotherapy ie: psoralen + UVA

Oral therapies- for extensive and severe psoriasis, or psoriasis with systemic involvement
Methotrexate, retinoids, ciclosporin, mycophenolate, mofetil, fumaric acid esters, biological agents

Question 26

What are the complications of psoriasis?

Answer 26

erythroderma
psychological
social