Inflammatory skin conditions

Question 1

Eczema is associated with which other conditions?

Answer 1

Eczema, asthma and allergic rhinitis make up the atopic triad

Question 2

Give some examples of triggers for eczema

Answer 2

• Allergens (e.g. chemicals, dust, food, pet hair)
• Heat/sweating
• Stress

Question 3

Describe the typical location/distribution of eczema in:

a) adults and children
b) babies

Answer 3

a) Flexural distribution, e.g. antecubital/popliteal fossa

b) Face and extensor distribution

Question 4

Describe the typical appearance of eczema (using the SCCAM model)

Answer 4

• Size: large
• Configuration: irregular shape, poorly defined border
• Colour: erythematous
• Associated secondary features: excoriation, lichenification
• Morphology: patches

Question 5

Describe the typical conservative and medical management of eczema

If eczema is severe, which treatments may be used?

Answer 5

Conservative:
- Avoid triggers

Medical:

• Emollients
• Topical steroids
• Antihistamines to reduce itching

Severe eczema:

• Oral steroids
• Phototherapy

Question 6

What is the key complication to consider in eczema?

Answer 6

Secondary infection:

• Bacterial
• Viral (e.g. eczema herpeticum)

Question 7

What is acne vulgaris?

Answer 7

An inflammatory condition of the pilosebaceous glands

Question 8

Describe the typical morphology of acne

Which associated secondary features may be present?

Answer 8

Any/of the following may be present:

• Papules
• Nodules
• Pustules
• Open/closed comedones

May also be associated secondary features e.g. scarring, hyperpigmentation

Question 9

Which areas does acne most commonly affect?

Answer 9

Face, chest and upper back (seborrheic distribution)

Question 10

Describe the management of mild, moderate and severe acne

Answer 10

Mild:

• Topical benzoyl peroxide
• Topical antibiotic
• Topical retinoid

Moderate:

• Oral antibiotic, e.g. lymecycline or tetracycline
• COCP (in females)

Severe:
- Oral retinoid (isotretinoin)

Question 11

The key complications of acne vulgaris are…

Answer 11

• Scarring

- Psychological distress

Question 12

Describe the pathophysiology of psoriasis

Answer 12

Hyperproliferation of keratinocytes

Question 13

The most common type of psoriasis is…

Give an example of another type

Answer 13

Chronic plaque psoriasis

Another type: guttate (raindrop) psoriasis

Question 14

Give some examples of triggers for psoriasis

Answer 14

• Stress
• Drugs/alcohol, e.g. beta blockers
• Trauma (Koebner phenomenon)

Question 15

Describe the typical appearance of psoriasis (using the SCCAM model)

Answer 15

• Size: variable
• Configuration: multiple discrete lesions; irregular shape; well-demarcated border
• Colour: erythematous
• Associated secondary features: silver scale
• Morphology: plaques

Question 16

Which other features may be present in systemic examination in a patient with psoriasis?

Answer 16

Nail changes (50% of patients):

• Pitting
• Onycholysis

Question 17

Describe the typical location/distribution of psoriasis

Answer 17

Typically affects the extensor surfaces, e.g. knees, elbows

Question 18

Describe the stepwise management of psoriasis

Answer 18

1. Topical: vitamin D analogues (calcipotriol); steroids; retinoids; coal tar preparations
2. Phototherapy
3. Oral immunosuppressants, e.g. methotrexate, ciclosporin, biologics