Inflammatory Skin Conditions Flashcards
What is atopic eczema commonly associated with?
Hayfever
Asthma
Describe the epidemiology of atopic eczema
Childhood condition - can resolve during teenage years
20% prevalence in <12yo
Runs in families
What are the exacerbating factors of eczema?
Infections Allergens - chemicals, food, dust, pet fur Sweating Heat Severe stress
What genetic defect is associated with atopic eczema?
Skin barrier function defect - loss of function of filaggrin proteins
What are the main symptoms of eczema?
Itch!!! - must have this
Cyclic symptoms - get worse and better
Flexural surfaces
What signs are seen in eczema?
Acute lesions are erythematous, vesicular and weepy
They may have a discoid appearance or a follicular pattern
What can happen if lesions are chronically scratched?
Excoriations
Lichenification
What nail changes can be seen in eczema?
Nail pitting and ridging
How is mild eczema treated?
Reduce exposure to the trigger
Regular use of emollients - generous use!
Intermittent corticosteroids - 1% hydrocortisone
How long should 1% hydrocortisone be used for in mild eczema?
48 hours after the flare up has calmed down
How is moderate eczema treated?
as above
Moderately potent topical steroid - 0.025% betamethasone
Non-sedating anti-histamine to help with itch
Topical calcineurin inhibitors for prevention- tacrolimus
How is severe eczema treated?
Potent corticosteroid - 0.1% betamethasone or 0.05% clobetasone
Flexural areas and face - 0.025% betamethasone
Antihistamine
What are betnovate and dermovate?
Betnovate - betamethasone
Dermovate - clobetasone
What other therapies can be used?
Phototherapy
How are infected wounds in eczema treated?
Swab all infected area
Empirical Antibiotics - flucloxacillin or clarithromycin if pen allergic
Pick antibiotic based on sensitivity from swab
What are the complications of eczema?
Secondary infection - bacterial or viral
What can secondary viral infections due to eczema be caused by and lead to?
Molluscum contagiosum
Lead to viral warts and eczema herpeticum
What is acne vulgaris? How common is it?
Inflammatory disease of pilosebaceous follicle
Over 80% of teenagers 13-18
Why is acne vulgaris particularly common in teenagers?
Androgens increase with puberty
What factors can contribute to acne vulgaris?
Increased sebum production
Abnormal follicular keratinisation
Bacterial colonization - propionibacterium acnes
Inflammation
How does mild acne vulgaris present?
Non-inflammatory lesions with mixed open and closed comedones (blackheads and whiteheads)
On face, chest and upper back
How does moderate-severe acne vulgaris present?
Inflammatory lesions - papules, pustules, nodules and cysts
On face, chest and upper back
How is acne managed?
General measures
Topical therapies for mild acne
Oral therapies for moderate to severe acne
Oral retinoids
What general measures are suggested for acne?
Don’t over clean
Choose make up cleaners appropriately
Avoid squeezing spots - scar
Maintain healthy diet
What topical therapies can be given for acne?
Benzoyl peroxide
Topical clindamycin (antibiotic based on guideline)
Topical retinoids
What oral therapies can be given for acne?
Oral abx - doxycycline
Anti-androgen - female
What do you have to be aware of with prescribing oral retinoids?
Oral retinoids such as Isotretinoid are teratogenic - girls must be on contraception and have regular LFT and lipid checks
What complications are associated with acne vulgaris?
Post inflammatory hyperpigmentation
Scarring
Deformity
Psychological and social effects
What is psoriasis?
Chronic inflammatory skin disease due to hyper-proliferation of keratinocytes and inflammatory cell infiltration
Affect 2% of population
What are the types of psoriasis?
Chronic plaque psoriasis (most common) Guttate - raindrop lesions Sebhorrhoeic - nasolabial and retroauricular Flexural - body folds Pustular - palms and soles of feet Erythrodermic - total body redness
What can precipitate psoriasis?
Trauma - Koebner phenomenon Infections - tonsilitis Drugs Stress Alcohol
What is koebner phenomenon?
Skin lesions appearing on lines of trauma
How does psoriasis present?
Well demarcated erythematous scaly plaques
Common on extensor surfaces and over scalp
Auspitz sign
50% have nail changes
5-8% have psoriatic arthropathy
What is auspitz sign?
Scratching and gentle removal of scales leads to bleeding
What nail changes are seen in psoriasis?
Onycholysis - nail detach from nail bed
Pitting
What general measures are suggested for psoriasis?
Avoid precipitating factors
Emollients - reduce scales
What topical therapies can be given for psoriasis?
Vit D analogues Topical corticosteroids Coal tar preparations Dithranol Topical retinoids Keratolytics Scalp preparations
What can be used in psoriasis management?
General measures
Topical therapies
Phototherapy
Oral therapies
What oral therapies can be used for psoriasis?
Methotrexate Retinoids Ciclosporin Mycophenolate Fumaric acid esters Biological agents
What complications are associated with psoriasis?
Erythroderma
Psychological and social effects
