Inflammatory skin conditions Flashcards
What is eczema?
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.
What is atopic eczema?
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.
What are the exacerbating factors of eczema?
chemicals food dust pet fur sweating heat severe stress
What is the presentation of eczema?
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
how might eczema present in richly pigmented skin?
brown, grey or purple bumps (papular or follicular eczema)
What may chronic scratching/rubbing of eczema lead to?
Can lead to lichenification
What might nails show in eczema?
Nail pitting/ridging
What is the management of eczema?
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
What are the complications of eczema?
secondary bacterial infections (crusted weepy lesions)
secondary viral infection- molloscum contagiosum, viral warts, eczema herpeticum
Would you request any investigations for eczema?
Not usually
However in very few children with difficult to control eczema, a prick test or serum specific IgE may be helpful
How would you explain to a parent how best and how often to use a moisturiser?
Apply gently and generously and regularly
Apply 2-4 times a day on the entire skin surface
Are topical steroids used for eczema on the face? If so which one would you prescribe?
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
What is an example of an antihistamine used for eczema?
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
How would you explain to an eczema patient why their eczema has reappeared after years due to winter?
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
What is acne?
An inflammatory disease of the pilosebaceous follicle
What are the causes of acne?
Hormonal (androgen) Increased sebum production Abnormal follicular keratinization Bacterial colonization Inflammation
What is the presentation of acne?
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
What is the management of acne?
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)
What are the complications of acne?
Post inflammatory hyperpigmentation
Scarring
Deformity
Psychological and social effects
What is psoriasis?
A chronic inflammatory skin disease which is due to hyperproliferation of keratinocytes and inflammatory cell infiltration
What are the types of psoriasis?
Chronic plaque psoriasis Guttate (raindrop) Seborrhoeic (naso labial and retro-auricular) flexural (body folds) pustular (palmoplantar or generalised) erythrodermic (total body redness)
What are the causes of psoriasis?
Psoriasis is a complex interaction between genetic, immunological and environmental factors
Precipitating factors…
- Trauma (which may produce kobner phenomenon)
- Infection
- Drugs
- Stress
- Alcohol
What is the presentation of psoriasis?
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
What is Auspitz sign?
This is when a psoriasis patient scratches at the scales which cause gental removal and can cause capillary bleeding
What is the management of psoriasis?
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
What are the complications of psoriasis?
erythroderma
psychological
social
