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dermatology > management of common inflammatory skin conditions > Flashcards

management of common inflammatory skin conditions Flashcards

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Dermatology Board Prep flashcards
1
Q

describe the management of eczema

A
  1. emollients and avoid triggers if known
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2
Q

what are the known triggers of eczema

A

soaps, detergents, overheating/ rough clothing, skin infections, pets, pollens, food, house-dust mites, stress

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3
Q

what are emollients, function and forms

A
  1. contains fats and water + can have additional ingredients (antimicrobials)
    the greasier, the better
  2. rehydrates skin and re-establishes surface lipid layer
  3. relieves itching
  4. reduces acute flares
  5. available in lotions, sprays, creams, ointments, gels, soap substitutes
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4
Q

order of grease of different forms of emollients

A

more water, less fat = lotions
creams
less water, more fat, greasiest = ointments

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5
Q

advice for patients with eczema

A
  1. encourage pt to use liberally and frequently 2-4x a day
  2. apply asap after washing to trap moisture in the skin
  3. if using another topical, 30 minutes after application
  4. use pump dispensers - minimize the risk of bacterial contamination, if using a pot use a clean spoon or spatula each time to reduce risk
  5. paraffin emollients are flammable
  6. continue using emollient after an acute flare has settled
  7. can get irritant or allergic reaction to emollients e.g preservations/ perfumes in creams
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6
Q

describe management of acute flare up of eczema

A
  1. moderate/potent topical steroid for 1-2 weeks then review
  2. if sleep disturbance - consider sedative anti-histamine - chlorphenamine (piriton)
  3. consider taking skin swabs
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7
Q

describe the potency of corticosteroids in eczema

A
  1. hydrocortisone
  2. eumovate
  3. betnovate
  4. dermovate
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8
Q

what is the purpose of using topical steroids

A
  1. reduce inflammation

2. immunosuppressive and anti-proliferative effects on keratinocytes

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9
Q

what are the side effects of topical steroids

A

local se:

skin atrophy -thinning 
telangiectasia
striae 
acne
perioral dermatitis 
allergic contact dermatitis 
may mask/ cause/ exacerbate skin infections
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10
Q

what are the systemic SE from oral corticosteroids

A 
cushing's syndrome
immunosupression 
hypertension 
diabetes
osteoporosis
cataracts
steroid induced psychosis 
fluid retention
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11
Q

what guide can you give to patient when explaining how much topical steroid to use

A

adult fingertip unit - FTU

different for children and adults

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12
Q

describe maintenance in management of eczema and psoriasis

A

emollients and low potency steroids

consider dry or medicated bandages or dressings - not for wet eczema

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13
Q

how to manage eczema patient with frequent flare ups

A

For frequent flare-ups:

Check compliance
Consider a steroid weekend regime (potent steroids for 2 consecutive days on areas that tend to flare, every week)
Consider alternatives to topical steroids e.g. Protopic
Swab skin and take nasal swabs (if Staph positive, give nasal Bactroban for 1 week)
Consider the possibility of contact allergic dermatitis secondary to topical therapies if no response to treatment

Immunomodulators e.g Protopic
E.g. eczema on the eyelids / face requiring topical steroids regularly, any skin atrophy

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14
Q

what are topical calcineurin inhibitors

A

act to reduce skin inflammation by inhibiting calcineurin - key agent in inflammatory conditions of the skin

“Steroid-sparing”

Two types

  1. Protopic (tacrolimus ointment)
  2. Elidel (pimecrolimus cream)

Used in atopic dermatitis to treat active disease & prevent flare-ups

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15
Q

what are the side effects of calcineurin inhibitors

A

Local: Skin irritation – “burning, stinging”

Increased risk of developing HSV on the treated area

Do not give in acute infections

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16
Q

how should scalp eczema be managed

A

Tar-based shampoo; if <18 months, use emollient bath oil

Water-based topical steroid scalp applications e.g. Betacap for eczematous areas; may need to remove scale with Sebco ointment first

17
Q

when should you consider referral to specialist light therapy or oral immunosupression

A

Diagnostic uncertainty

Severe eczema

Moderate-severe eczema only partially responding to steps 1-5

Steroid atrophy or concerns regarding the amount of topical steroids / immunomodulators being used

Possible cases of contact allergic dermatitis

18
Q

describe the action of methotrexate, which conditions is it used in, how is it taken

A

Reduces inflammation, immunosuppressant
Used in: Psoriasis, Eczema
Taken once a week: PO/IM/SC; Folic acid co-prescribe

19
Q

what are the side effects of methotrexate

A

Side effects:

GI upset, mouth ulcers, fatigue, anaemia, liver & (rarely) lung fibrosis
Bone marrow suppression: Increased risk of infections safety-net pt
Teratogenic / reduced fertility in men: Effective contraception for both men and women during treatment and for at least 6 months after stopping treatment

20
Q

describe methotrexate drug interactions

A

Drug interaction between Trimethoprim and Methotrexate (increases risk of marrow aplasia)

Should not have live vaccines whilst on Methotrexate

21
Q

describe pre treatment screening needed for methotrexate

A

Pre-treatment screening: Pregnancy test, FBC/U&Es/LFTs

22
Q

describe monitoring required for patients on methotrexate

A

Monitoring: FBC, U&Es, LFTs every 2-3 months once established on treatment

23
Q

what is azathiprione action, when is it used

A 
Immunosuppressant 
Used in (mostly unlicensed): Atopic eczema
24
Q

what are the side effects of azathioprine - steroid sparing

A

Bone marrow suppression, allergic reaction (‘flu-like symptoms’), GI upset,
Prolonged use: Increased risk of skin cancer and some other cancers, lymphomas

25
Q

describe pre-treatment screening required in use of azathioprine

A

Pre-treatment screening: TPMT test (severe increased risk of BM toxicity if deficient)

26
Q

what monitoring is needed in azathioprine use + what should be avoided

A

Monitoring: FBC, LFTs, U&Es

Avoid live vaccines

27
Q

what is ciclosporin, when is it used

A

Immunosuppressant
Used in:
Licensed: Psoriasis, Atopic eczema

28
Q

what are the side effects of ciclosporin

A

: Gingival hyperplasia, GI upset, fatigue, tremor, excessive hair growth
Longterm: Reduced renal function, Hypertension

29
Q

what should be avoided in azathioprine

A

Avoid live vaccines, ideally try not to get pregnant, don’t breast-feed and check for drug interactions

30
Q

summary for management of psoriasis and eczema

A

Emollients + Avoidance of triggers
Initial treatment for flare-ups: Topical steroids + skin swabs +/- sedating antihistamines
Maintenance: Emollients, (low potency) topical steroids, bandages/dressings
Frequent flare-ups: Steroid weekend regimens, check compliance, skin & nasal swabs
Immunomodulators e.g. Protopic
Referral to secondary care: Light therapy / Oral immunosuppression

31
Q

describe management of comedonal acne + SE

A

First line: Topical retinoid (Adapalene, Isotretinoin) +/- benzoyl peroxide

Will dry the skin and cause local irritation
Avoid in pregnancy

Second line: Azelaic acid

32
Q

what is the difference between white heads and black heads

A

white heads = closed comedones

black heads = open comedones

33
Q

describe management of Mild-moderate papular / pustular acne:

A

Risk of scarring

Fixed dose combination treatment of benzoyl peroxide (to reduce bacterial resistance) with either a topical retinoid OR topical antibiotic

First line: Epiduo ® gel(adapalene + BPO)

Second line- Duac ® gel (clindamycin + BPO)

34
Q

if acne not responding what other drugs can be used

A

Combine systemic antibiotics with a topical agent,preferably BPO or a topical retinoid

First line: Tetracycline (less bacterial resistance than others)

Macrolides (first line in pregnancy and children <12yo but high levels of P.acnes resistance): Erythromycin, Clarithromycin

Trimethoprim for young children who may not tolerate macrolides (but has bacterial resistance)

In primary care: Stop oral antibiotic course after 3 months, can repeat antibiotic course in the future if required

Dermatologist: Continue oral antibiotics post 3 months if papules / pustules are present

35
Q

when are topical antibiotics used, examples and se

A

Used in: Acne, bacterial skin infections
Example: Fucidin cream / ointment (contains Fusidic acid)
Side effects: Local skin irritation / allergy

36
Q

when are oral antibiotics used , examples and se

A

Used in: Acne (Tetracyclines / Macrolides), bacterial skin infections
Examples:
Lymecycline / Doxycycline for Acne
Flucloxacillin / Clindamycin (if penicillin allergic) for bacterial skin infections

dermatology (6 decks)

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