Lecture 10 - Eczema Flashcards
Define atopic eczema
Chronic, relapsing and itchy skin condition
What causes atopic eczema?
No single cause but is triggered by stress, hormonal changes (women), exposure to pets, home dust mites, pollen and food allergens
Reduction in lipid barrier of the skin, leads to increased water loss and a tendency towards dry skin
What are the complications associated with atopic eczema?
Infection - bacterial infection with S,aureus - risk of herpes simplex and fungal infections
Psychosocial - distress, missed school days, self-image, sleep disturbances
Erythroderma - severe skin condition that can result in complications such as dehydration, HF, infection and death
Eye abnormalities - irritation of the conjunctiva
What is the treatment advice for mild eczema?
Avoid scratching, house dust mites, irritants and soaps, stress and diet
Prescribe generous amounts of emollients
Step up and consider a mild corticosteroid cream or ointment
What is the treatment for moderate eczema ?
Prescribe generous amounts of emollients
Intensive treatments are needed:
- moderate potent topical corticosteroids e.g. betamethasone validate 0.025% or clobetasone butyrate 0.05% and continued for 48 hours
for delicate areas of skin consider starting with a mild potency topical corticosteroid e.g hydrocortisone 1%
Topical antibiotics if infected (Max 2 weeks) - fusidic acid or mupirocin ointment if small areas or oral flucloxacillin
What is the treatment of severe eczema?
Prescribe intensive treatment until the flare is controlled
Prescribe generous amounts of emollients and advice frequent and liberal use
Prescribe a potent topical corticosteroid for inflamed areas (betamethasone valerate 0.1%)
For delicate areas of skin such as the face or flexures use a moderate potency corticosteroid
if itching is severe consider prescribing a sedating antihistamine
If there is severe extensive eczema causing psychological distress - consider prescribing a short course of oral corticosteroids
Give examples of eczema triggers
Diet
Irritants
Inhalants
Hormonal
Climate
Infections
Define psoriasis
Chronic, inflammatory disorder, multi-system disease with predominately skin ad joint manifestations
Characterised by scaly, itchy skin lesions which can be in the form of patches, papules or plagues
What are the causes of psoriasis?
Strep infection
Some drugs - lithium and NSAIDs, beta blockers
Sunlight
Trauma
Stress
Alcohol
Smoking
Climate change
Hormone changes
HIV/AIDs
Whats the treatment for plaque psoriasis?
Emollient
Potent topical corticosteroid applied once daily reviewed after 4 weeks no longer than 8 weeks treatment without a break
Vit D analogue applied once daily
2nd and 3rd line options are via a specialist
Define scalp psoriasis treatment
Potent topical corticosteroid
Consider treatment with a Vit D analogue alone if can’t you use a corticosteroid or in combination with a potent corticosteroid scalp application
coal tar preparations
2nd and 3rd line options via a specialist
Define face/flexural/genital psoriasis treatment
Emollient and short-term mild or moderate topical corticosteroid preparation (OD or BD for up to 2 weeks), only being used for 1-2 weeks each month
4 week break need between corticosteroid courses
2nd and 3rd line options via a specialist
Define guttate psoriasis treatment
if lesions widespread - refer urgently to a dermatologist
not widespread:
self limiting usually resolves in 3-4 months
no treatment can be option
or consider topical treatments
Define pustular psoriasis treatment
Generalised pustular psoriasis - refer for same day specialist assessment and treatment
Medical emergency and requires urgent hospital treatment
Localised to the hands and feet
Define erythrodermic psoriasis treatment
arrange for same-day specialist assessment and treatment
associated with several potentially life-threatening complications
