Inflammatory Skin conditions

Question 1

how might atopic eczema present?

Answer 1

• itchy erythmatous dry scaly patches
• on face and extensor regions in infants
• flexor aspect child / adult
• chronic scratching leads to excoriations and lichenification

Question 2

What do acute lesions of eczema look like?

Answer 2

erythematous, vesicular and weepy (exudative)

Question 3

what are the exacerbating factors of eczema

Answer 3

• infection
• allergens e.g. chmicals, food, dust, pet fur
• sweating
• heat
• severe stress

Question 4

What are the nail signs of eczema

Answer 4

nail pitting and ridgin

Question 5

How is eczema managed?

Answer 5

1) emollients / bandages / bath oil / soap subsitute
2) topical steroids for flare ups OR topical immunomodulators e.g (tracrolimus , pimecrolimus)
3) Oral therapy (antihistamins for symptom relief)
4) oral antibiotics e.g fluclox for secondary bact inf
5) antivirals e.g. aciclovir for secondary herpes inf
6) Phototherapy / immuosuppressants e.g. oral prednisolone, azothioprine, ciclosporin

Question 6

What are the complications of atopic eczema?

Answer 6

1) bacterial inf

3) viral infection e.g, molluscum contagiosum, viral warts, eczema herpeticum

Question 7

who is affected by acne vulgaris?

Answer 7

80% of teenagers

Question 8

what causes acne vulgaris?

Answer 8

hormones (androgens)

Question 9

What factors contribute to acne vulgaris?

Answer 9

1) increased sebum production
2) abnormal follicular keratinization
3) bacterial colonisation
4) inflammation

Question 10

How does acne vulgaris present?

Answer 10

1) non inflammatory = open (blackheads) and closed (whiteheads) comodomes
2) inflammatory = papules, pustules, nodules and cysts

Question 11

what areas are usually affected by acne vulgaris?

Answer 11

face, chest, upper back

Question 12

How long does treatment need to be continued to have an effect on acne vulgaris?

Answer 12

6 weeks

Question 13

What are the treatments for acne vulgaris?

Answer 13

• Topical (for mild acne) = benzoyl peroxide and topical antibiotics and topical retinoids
• Oral ( moderate) = oral abx e.g. tetracycline and anti-androgens
• severe - oral retinoids e.g. roacutane

Question 14

what is psoriasis?

Answer 14

A chronic inflammatory skin disease due to hyperproliferation of kertinocytes and inflammatory cell infiltrate.

Question 15

What are the types of psoriasis?

Answer 15

• chronic plaque psoriasis (most common)
• guttate (raindrop lesions)
• seborrhoeic (naso -labial and retro-auricular)
• flexural (body folds)
• pustular ( palmar / plantar)
• erythrodermic (total body redness)

Question 16

What is the Koebner phenomenon?

Answer 16

lesions occur in scars

• psoriasis
• lichen planus

Question 17

How does psoriasis present?

Answer 17

• well demarcated erythematous sclay plaques
• itchy, burning or painful
• extensor surfaces or scalp
• pitting, onycholysis of nails
• psoriatic arthritis

Question 18

What is the treatment for psoriasis?

Answer 18

• emollients
• topical (vitamin D anologues, corticosteroids, coal-tar , dithranol, retinoids, keratolytics and scalp preparations.)
• Phototherapy (for extensive psoriasis) - UVB
• Oral therapies ( methotrexate, retinoids, ciclosporin, mycophenolate, mofetil, fumaric acid esters)
• biological agents e.g. infliximab

Question 19

What are the complications of psoriasis/

Answer 19

erythroderma

Question 20

What are the 6 Ps of Lichen Planus?

Answer 20

• Pruritic
• Planar
• Purple
• Polygonal
• Papules
• plaques

Question 21

How does lichen planus present?

Answer 21

• flat topped, smooth, shiny polygonal purplish red itchy papules
• symmetrical distribution
• flexural aspect of wrist
• wickham’s striae (lacy white streaks) overly papules. if on tongue cannot be scraped off.
• koebner phenomenon
• nail dystrophy
• effects skin and mucosal surfaces

Question 22

What are the differentials for lichen planus?

Answer 22

• drug reaction
• eczema
• psoriasis
• candidiasis

Question 23

What inv are done for lichen planus?

Answer 23

skin biopsy

Question 24

How is lichen planus treated?

Answer 24

• topical corticosteroids e.g. elocon to reduce inflammation