inflammatory skin conditions

Question 1

what is atpopic eczema?

Answer 1

eczema/dermatitis is characterised by papules + vesicles on an erythematous base

atopic eczema is most common type- usually develops early childhood, resolvse teenage years but can recur

Question 2

what is the prevalence of atopic eczema in UK?

Answer 2

20% in <12yo

Question 3

what are the causes of atopic eczema?

Answer 3

not understood, but positive FH

primary genetic defect in skin barrier underlies- loss of function variants of protein filaggrin

Question 4

what are the exacerbating factors of atopic eczema?

Answer 4

infection
allergens eg chemicals, food
sweating
heat
severe stress

Question 5

how does atopic eczema present?

Answer 5

itchy, erythematous dry scaly patches

can have nail pitting + ridging of nails

more common on face + extensor limbs for infants; flexor limbs in children/adults

Question 6

how do acute lesions in atopic eczema present?

Answer 6

erythematous
vesiuclar
weepy/exudative

Question 7

what does crhonic scratching/rubbing lead to in atopic eczema?

Answer 7

excoriations

lichenification

Question 8

what is the management of atopic eczema?

Answer 8

1) general- avoid exacerbating agents, frequent emolients +/- bandages + bath oil/soap substitute
2) topical- steroids for flare ups, immunomodulators eg tacrolimus, pimecrolimus
3) oral- antihistamines for symptoms, abx flucloxacillin for secondary bacterial info, antivirals aciclovir for secondary herpes infection
4) phototherapy + immunosuppressants eg oral prednisolone, azathioprine, cyclosporin for severe non-responsive cases

Question 9

what are the complications of atopic eczema?

Answer 9

1) secondary bacterial infection- crusted weepy lesions
2) secondary viral infection- molluscum contagiosum (pearly papules with central umbillication), viral warts + eczema herpeticum

Question 10

what is acne vulgaris?

Answer 10

an inflammatory disease of the pilosebaceous follicle

Question 11

what is the epidemiology of acne vulgaris?

Answer 11

> 80% 13-18yo

Question 12

what are the causes of acne vulgaris?

Answer 12

1) hormonal- androgen
2) contributing factors- increased sebum production, abnormal follicular keratinisation, bacterial colonisation (propioniacterium acnes) + inflammation

Question 13

how does mild acne vulgaris present?

Answer 13

non-inflammatory lesions- open + closed comedones (blackheads + whiteheads)

common sites- face, chest, upper back

Question 14

how does mod-severe acne vulgaris present?

Answer 14

inflammatory lesions- papules, pustules, nodules, cysts

common sites- face, chest, upper back

Question 15

what is the management of mild acne vulgaris?

Answer 15

1) general- treatment needs to be continued for at least 6 weeks for effect, no specific food found to cause
2) topical- benzoyl peroxide + topical antibiotics
3) topical retinoids- comedolytic + anti-inflammatory

Question 16

what is the management of moderate-severe acne vulgaris?

Answer 16

oral therapies- oral abx and in fmeales anti-androgens

Question 17

what is the management of severe acne vulgaris?

Answer 17

oral retinoids

Question 18

what are the complications of acne vulgaris?

Answer 18

post-inflammatory hyperpigmentation
scarring
deformity
psychological + social effects

Question 19

what is psoriasis?

Answer 19

a chronic inflamatory skin disease due to hyperproliferation of keratinocytes + inflammatory cell infiltration

Question 20

what are the different types of psoriasis?

Answer 20

1) most common- chronic plaque psoariasis
2) guttate- raindrop
3) seborrhoeic- naso-labial + retro-auricular
4) flexural- body folds
5) pustular- palmar-plantar
6) erythrodermic- total body redness

Question 21

what is the epidemiology of psoriasis?

Answer 21

2% of UK population

Question 22

what are the causes of psoriasis?

Answer 22

complex interaction between genetic, immunological, environmental actors

Question 23

what are the precipitating factors of psoriasis?

Answer 23

trauma- can produce koebner phenomenon
infection eg tonsillitis
drugs
stress
alcohol

Question 24

what is the presentation of psoriasis?

Answer 24

1) well-demarcated erythematous scaly plaques
2) lesions can be itchy, burning or painful
3) common on extensor surfaces and scalp
4) auspitaz sign- scratch + gentle removal of scales cause capillary bleeding
5) 50% have associated nail changes eg pitting, onycholysis
6) 5-8% associated psoriatic arthropathy (a range)

Question 25

how do you manage localised + mild psoriasis?

Answer 25

1) general- avoid precipitating factors, emollients to reduce scales
2) topical therapies:
vitamin D analogues
topical corticosteroids
coal tar preparations
dithranol
topical retinoids
keratolytics
scalp preparations

Question 26

how do you manage extensive psoriasis?

Answer 26

phototherapy ie UVB + photochemotherapy ie psoralen + UVA

Question 27

how do you manage extensive + severe psoriasis or psoriasis with systemic involvement?

Answer 27

oral therapies:
methotrexate
retinoids
ciclosporin
mycophenolate mofetil 
fumaric acid esters 
biological agents eg infliximab, etanercept, efalizumab

Question 28

what are the complications of psoriasis?

Answer 28

erythroderma

psychological + social effects