PH1122 - Dermatology Flashcards
What are some symptoms of plaque psoriasis
Plaque psoriasis typically presents with characteristic salmon-pink lesions with silvery-white scales and well-defined boundaries ( Fig. 8.3 ). On darker skin, this characteristic colour is not apparent. Lesions can be single or multiple and vary in size from pinpoint to covering extensive areas. If the scales on the surface of the plaque are gently removed and the lesion then rubbed, it reveals pinpoint bleeding from the superficial dilated capillaries. This is known as the Auspitz sign and is diagnostic.
what are some potential irritants or allergens that can’t cause contact dermatitis ?
Irritants Detergents and soaps Solvents and abrasives Oils Acids and alkalis, including cement Reducing agents and oxidising agents
Allergens Nickel (especially in jewellery) Chromate in cement Topical corticosteroids (5% of patients) Cosmetics, particularly fragrances, hair dyes, preservatives and nail varnish resin Rubber, including latex Dyes, formaldehyde and epoxy resins
What are some symptom specific questions when investigating dermatitis ?
Location The distribution of rash for contact dermatitis is closely associated with clothing and jewellery
Exposure A history of when the rash occurs gives a useful indication as to the cause; for example, a construction worker might complain of sore hands while at work but when on holiday, the condition improves, only for it to worsen when he or she goes back to work.
What are some reasons to refer dermatitis ?
CHILDREN <10 YEARS IN NEED OF CORTICOSTEROIDS
LESIONS ON THE FACE, UNRESPONSIVE TO EMOLLIENTS- Steroid use outside current OTC product licenses As soon as practicable
WIDESPREAD OR SEVERE DERMATITIS
OTC TREATMENT FAILURE Need for medical intervention
what would be the OTC treatment for dermatitis ?
In general, patients respond to a thicker emollient rather than an elegant cosmetic brand because these allow greater retention of water: for example, 50% liquid paraffin and 50% white soft paraffin. However, patient acceptability of such products needs to be considered. Cream formulations rather than ointments tend to be more readily accepted by patients because they are easier and less messy to use. In general, skin that is moderately dry to very dry will respond best to an ointment, and skin that is mildly dry will respond best to a cream. If the skin is broken or weeping, a water-soluble cream can be useful. To avoid the drying effects of soap, a soap substitute should be used.
Steroids
In the UK, hydrocortisone (classified as mild potency) and clobetasone (moderately potent) are available. Both have proven efficacy in treating dermatitis and should be considered first-line treatment for acute dermatitis.
What are some reasons to refer acne ?
Moderate or severe acne
OTC treatment failure
Suspected rosacea Generally require antibiotic therapy As soon as practicable
Prepubertal or older people Acne is uncommon in these age groups
when would you refer eczema
Referral Undiagnosed atopic eczema Other eczema types Infection evidence Severe condition (fissured, bleeding) Failed treatment No identifiable cause Dermatitis duration longer than two weeks Unusual rash features Accompanying symptoms
When is atopic dermatitis likely ?
National Institute for Health and Care Excellence (NICE) guidelines state that atopic dermatitis is likely if the person has had an itchy skin condition, plus three or more of the following:
- Onset before the age of 2 years
- History of dry skin in the last 12 months
- History of eczema in the skin creases (and also the cheeks in children <18 months)
- Visible flexural eczema involving the inside elbows or behind knees (or involvement of the cheeks or forehead and outer limbs in children <18 months)
- Personal history of other atopic disease
What are some key questions to ask when investigating dermatitis ?
Is itching present? Atopic dermatitis is typically associated with itching that can be severe. Lack of itch strongly suggests that the rash is not atopic dermatitis.
Distribution of rash Varies according to age (see Fig. 10.1 ) but in infants, the nappy area is not involved and is a useful distinction between atopic dermatitis and seborrhoeic dermatitis.
Babies: Facial involvement (the cheeks) is common, along with patchy red scaly lesions on the wrists and hands (see Fig. 10.2 ).
Toddlers and older children: The antecubital (in front or at the bend of the elbow), popliteal fossae (behind the knee), and ankles are more commonly involved (see Fig. 10.3 ).
Family history of atopy If a parent has eczema, hay fever, or asthma, the likelihood of atopic dermatitis rises.
What are some clinical features of atopic dermatitis ?
A typical presentation is an irritable child with dermatitis of varying severity. Itching is the predominant symptom, which can induce a vicious cycle of scratching, leading to skin damage, which in turn leads to more itching – the so-called itch scratch itch cycle.
What is a reason to refer dermatitis ?
Children with moderate or severe atopic dermatitis
Medication failure – patient suffers two or more flare-ups per month Outside scope of community pharmacist; patient probably needs corticosteroid therapy As soon as practicable
Presence of secondary infection (weeping and crusting lesions) Potentially needs systemic antibiotics Same day referral to GP
