intro to derm

Question 1

6 common problems seen in derm

Answer 1

1. skin cancers - common cause of death in YA;
2. inflammatory disorders (eczema, psoriasis etc.);
3. acne;
4. inherited/childhood skin disease;
5. skin infections;
6. pigment, hair and nails disorders

Question 2

what is eczema

Answer 2

a term used to describe a collection of diseases that have similar presentation (itchy, dry, red) and maye co-exist with eachother - including atopic eczema (majority), allergic contact eczema, discoid, varicose eczema etc.

Question 3

eczema vs dermatitis

Answer 3

all eczema is dermatitis (but not all dermatitis is eczema)

Question 4

what is the atopic triad

Answer 4

asthama, eczema, allergic rhinitis (e.g. hayfever)

Question 5

what are some consequences of eczema itch

Answer 5

loss of sleep, loss of concentration, anger, may not be able to do their job

Question 6

what are Pompholyx

Answer 6

a type of eczema which affects the hands and feet, causing tiny blisters and irritation

Question 7

erythroderma vs suberythroderma

Answer 7

erythroderma - greater than 90% body surface area involved
suberythroderma - 70-90% of body surface area involved

Question 8

what is follicular eczema

Answer 8

eczema around the hair follicules

Question 9

what causes the erythema in eczema

Answer 9

diversion of blood to skin due to inflammatory cytokines or more translucent skin -> may result in increased heat loss and increased itching

Question 10

what causes scale in eczema

Answer 10

excessive production of epidermis which peels off or stays stuck to the top layer so become thick - hyperkeratosis

Question 11

what causes lichenification in eczema

Answer 11

thickened hyperkaeratotic skin due to rubbing with more lines/wrinkles

Question 12

functions of the skin

Answer 12

1. thermoregulation;
2. physical barrier (infection, allergens, waterproofing)
3. key strucutre for body
4. vit D synthesis

Question 13

what is responsible for the waterproofing of the skin

Answer 13

oily (waxy) layer produced by seebum

Question 14

where might babies present with eczema

Answer 14

face

Question 15

what are the typical site for eczema to present

Answer 15

flexures - creases of arms, knees, wrists

Question 16

what is a common reason for treatment failure in derm

Answer 16

“steroid-phobia” - many people wont use steroids as they worry about side effects

Question 17

side effects of hydrocortisone

Answer 17

thin skin (rare)

Question 18

steroid potencies + examples

Answer 18

1. mild e.g. 1% hydrocortisone;
2. medium e.g. emovate;
3. potent e.g. betnovate
4. very potent e.g. dermovate

Question 19

what can occur if wrong potency of steroids is used

Answer 19

too weak - increased suffering, no treatment progression
too strong - skin thinning, possibly cushings (unlikely unless repeat of very potent steroids)

Question 20

what causes asteatotic eczema

Answer 20

lack of oil on the skin - usually if in hosptial/nursing home

Question 21

features of asteatotic eczema

Answer 21

cracking of skin, like a dry river bed

Question 22

treatment for asteatotic eczema (3)

Answer 22

1. bathe less often/for shorter periods of time and use cooler water;
2. use less detergent;
3. apply oil to skin

Question 23

where does irritant contact eczema usually occur

Answer 23

the hands

Question 24

why is history essential in diagnosing the eczema type

Answer 24

many eczemas look the same - may be difficult to differntiate between allergic, irritant and atopic eczema based on examination alone

Question 25

irritant contact vs allergic contact eczema

Answer 25

irritant - arises due to chemicals that irritate skin cells;
allergic - arises due to an immune process

Question 26

common causes of allergic contact eczema (6)

Answer 26

1. nickle
2. fragrances (on perfumes etc.)
3. rubber accelerators
4. chromate
5. formaldehyde
6. plants

Question 27

how can allergic contact eczema be tested

Answer 27

patch testing

Question 28

where might varicose eczema occur

Answer 28

on the lower legs, around varicose veins

Question 29

what might cause varicose eczema

Answer 29

leaking of irritants from stagnant blood stuck in the veins -> likely neutrophils

Question 30

treatments for varicose stasis (and thus varicose eczema) - 6

Answer 30

1. loose weight - associated w obesity
2. exercise
3. elevate legs
4. avoid standing/sitting for long periods
5. compression bandages
6. varicose vein surgery

Question 31

what phsyical barrier can be implemented for eczema and when should it not be used

Answer 31

bandages; should not be used if eczema is infected

Question 32

what bacteria commonly causes infection in eczema (post sractching)

Answer 32

staph aureus

Question 33

presentation of staph infected eczema

Answer 33

yellow/golden crusts or blisters of impetigo

Question 34

treatment for herpes simplex eczema infection

Answer 34

aciclovir

Question 35

how to distinguish discoid eczema from psoriasis

Answer 35

has vesicles and lacks psoriasis scale

Question 36

what casues discoid eczema and how is it treated

Answer 36

caused by bacterial infection of eczema; treated w Abx or antiseptic/steroid combinations

Question 37

what causes seborrhoeic eczema and what area is is commonly seen in

Answer 37

sensitivity to yeast on skin (not in diet); commonly seen around nose, eyebrows, flexures

Question 38

how to treat seborrhoeic dermatitis

Answer 38

topical antifungals

Question 39

what should be considered (to test for) if someone presents with severe sebborhoeic dermatitis

Answer 39

HIV

Question 40

what non-topical treatments can be offered for eczema (treatments not working)

Answer 40

1. local PUVA - UVA phototherapy (psorellan), usually just hands of feet;
2. oral alitretinoin (retinoid);
3. oral azathioprine, ciclosporin (broad spectrum immunosupression)

Question 41

differentials for eczema (5)

Answer 41

1. scabies - check if family/close contacts present with the same symptoms
2. fungal infection of hands - usually unilateral
3. psoriasis - likely to have nail changes, not usually itchy
4. drug eruption
5. rarer diseases e.g. mycosis fungoides

Question 42

Fitzpatrick skin types (6)

Answer 42

I Pale white skin, blue/green eyes, blond/red hair -Always burns, does not tan
II Fair skin, blue eyes - Burns easily, tans poorly
III Darker white skin - Tans after initial burn
IV Light brown skin - Burns minimally, tans easily
V Brown skin - Rarely burns, tans darkly easily
VI Dark brown or black skin - Never burns, always tans darkly