Inflammatory Skin Conditions

Question 1

General description of inflammatory skin conditions

Answer 1

Chronic inflammatory skin disorders that follow a relapsing and remitting course.

e.g. Eczema, acne and psoriasis.

Question 2

Atopic eczema: Description

Answer 2

Eczema (or dermatitis) is characterized by papules and vesicles on an erythematous base.

Atopic eczema is the most common type - usually develops by early childhood and resolves during teenage years (but may recur)

Question 3

Atopic eczema: Causes

Answer 3

Not fully understood, but a positive family history is often present.

A primary genetic defect in skin barrier function appears to underlie atopic eczema.

Question 4

Atopic eczema: Exacerbating factors

Answer 4

Infections,

Allergens (e.g. chemicals, food, dust, pet fur),

Sweating,

Heat,

Severe stress.

Question 5

Atopic eczema: Presentation

Answer 5

Commonly present as itchy, erythematous dry scaly patches.

Common on the:

Face and extensor aspects of limbs in infants

Flexor aspects in children and adults.

Acute lesions are erythematous, vesicular and weepy.

Question 6

Atopic eczema: Management

Answer 6

Avoid known exacerbating agents.

Topical therapies – topical steroids for flare-ups.

Oral therapies:

Antihistamines for symptomatic relief,

Antibiotics (e.g. flucloxacillin) for secondary bacterial infections,

Question 7

Acne vulgaris: Description

Answer 7

An inflammatory disease of the pilosebaceous follicle.

Present in >80% of teenagers aged 13-18 years

Question 8

Acne Vulgaris: Causes

Answer 8

Hormonal (androgen).

Contributing factors:

• Increased sebum production,
• Bacterial colonization

Question 9

Acne vulgaris: Presentation

Answer 9

Non-inflammatory lesions (mild acne):

• open and closed comedones (blackheads and whiteheads).

Inflammatory lesions (moderate and severe acne):

• papules, pustules, nodules, and cysts.

Commonly affects the face, chest and upper back.

Question 10

Acne vulgaris: Management

Answer 10

Topical therapies (for mild acne);

• topical antibiotics, and topical retinoids (comedolytic and anti-inflammatory properties).

Oral therapies (for moderate to severe acne)

• oral antibiotics, and anti-androgens (in females).

Oral retinoids (for severe acne)

Question 11

Acne vulgaris: Complications

Answer 11

Post-inflammatory hyperpigmentation, scarring, deformity, psychological and social effects.

Question 12

Psoriasis: Description

Answer 12

A chronic inflammatory skin disease due to hyperproliferation of keratinocytes and inflammatory cell infiltration.

Affects about 2% of the population in the UK.

Question 13

Psoriasis: Types

Answer 13

Chronic plaque psoriasis is the most common.

Other types:

• guttate (raindrop lesions),
• seborrhoeic (naso-labial and retro-auricular),
• flexural (body folds),
• pustular (palmar-plantar),
• erythrodermic (total body redness).

Question 14

Psoriasis: Causes

Answer 14

Complex interaction between genetic, immunological and environmental factors.

Precipitating factors:

• trauma (which may produce a Köebner phenomenon),
• infection (e.g. tonsillitis),
• drugs, stress, and alcohol

Question 15

Psoriasis: Presentation

Answer 15

Well-demarcated erythematous scaly plaques.

Itchy, burning or painful.

Auspitz sign (scratch and gentle removal of scales cause capillary bleeding).

50% have associated nail changes (e.g. pitting, onycholysis).

Question 16

Psoriasis: Management

Answer 16

Avoid known precipitating factors, emollients to reduce scales.

Topical therapies (for localised and mild psoriasis):

• vitamin D analogues, topical corticosteroids.

Phototherapy (for extensive disease)

• i.e. UVB and photochemotherapy.

Question 17

Psoriasis: Complications

Answer 17

Erythroderma, psychological and social effects