PT8: POM Eczema & Psoriasis Treatment Flashcards
what is psoriasis
chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations
what are the characteristics of psoriasis
scaly, itchy lesions, which can be inthe form of patches, papules or plaques
what are the skin lesions of psoriasis
hyperproliferation of the epidermis, abnormal keratinocyte differentiation
dilation and proliferation of blood vessels in the dermis
accumulation of inflammatory cells, particularly neutrophils and T-lymphocytes
when the number of neutrophils in the stratum corneum is sufficient to be clinically obvious, the condition is termed pustular psoriasis
what are the less common types of psoriasis
nail psoriasis, guttate psoriasis, erythrodermic psoriasis, generalised pustular psoriasis
what can trigger an episode of psoriasis
streptococcal infection, drugs, sunlight, trauma, stress, alcohol, smoking, climate change, hormone changes, HIV/AIDS
what are the complications of psoriasis
psychological and social, physical, pregnancy
what is the treatment for plaque psoriasis
emollient, potent topical corticosteroid applied once daily and a vitamin D analogue applied once daily
how is scalp psoriasis treated
potent topical corticosteroid
possibly combined with vitamin D analogue applied to scalp
coal tar treatments can be considered if treatment failure still occurs
what treatment is used for face/flexural/genital psoriasis
emollient and short-term mild or moderate topical corticosteroid for up to two weeks
what treatment is used for guttate psoriasis
resolves within 3-4 months
topical treatments can be used if patient is still concerned
if lesions are widespread, pt should be referred to dermatologist
what is pustular psoriasis
should be referred to dermatologist
what advice is given to a patient with nail psoriasis
keep nails short to avoid the nail detaching
avoid manicures that can cause infection
refer if severe but nails are poorly treated
why are vitamin D preparations used in psoriasis
bind to vitamin D receptors which inhibits keratinocyte proliferation and enhance keratinocyte differentiation
how are coal tar treatments used in psoriasis
coal tar is a distillation product of coal and has anti-inflammatory and anti-scaling properties
can be applied long term
what is dithranol
prevents T-lymphocyte activation and normalises keratinocyte differentiation
should not be used in people with acute or pustular or inflamed psoriasis
how is UV light therapy used to treat psoriasis
reduces inflammation in the skin
narrowband UVB is often used to treat guttate or chronic plaque psoriasis
what is PUVA
combination of UVA and psoralen
can be used if UVB has not worked
what are psoralens
drugs activated by long wave UV light
they interfere with DNA synthesis hence reduce epidermal cell turnover, enhancing the effect of irradiation
how is methotrexate used to treat psoriasis
folic acid antagonist used for severe psoriasis affecting high impact sites, when phototherapy has failed
causes bone marrow suppression and should be taken weekly
what happens to the skin in atopic eczema
reduction in lipid barrier of the skin, leading to an increase in water loss and a tendency towards dry skin
what causes atopic eczema
in genetically susceptible individuals when exposed to environmental irritants or allergens
can be exacerbated by stress or hormones
what happens when eczema becomes infected
bacterial infection with staphylococcus aureus, which may present as typical impetigo or as worsening of eczema with increased redness, oozing, and crusting
risk of herpes simplex and fungal infections
what are the psychosocial affects of eczema
distress, missed school, self image, sleep disturbances
what happens in erythroderma
generalised redness of the skin
severe skin condition that can result in complications such as dehydration, heart failure, infection and death
what infection is common in patients with eczema
conjunctivitis
what treatment is used for mild eczema
use of emollients, mild corticosteroid for short term use
what treatment is used for moderate eczema
emollient use, intensive treatments of moderately potent corticosteroids
topical antibiotics used if infected
how is moderate eczema controlled
avoid triggers, frequent and liberal emollient use, topical corticosteroids for flare prone areas,, topical calcineurin inhibitors
what treatment is used for severe eczema
intensive treatment until flare is controlled
use of emollients, potent steroid, moderate potency steroid for delicate areas, occlusive bandage may be beneficial
oral corticosteroids used in really severe cases
how are topical calcineurin inhibitors used
immunomodulating drugs, inhibit calcineurin production which is responsible for inflammation in the skin
how is tacrolimus used
can treat moderate or severe atopic eczema
used if the most potent corticosteroid has not been effective
how is pimecrolimus used
considered to treat moderate atopic eczema on the face and neck if the maximum strength corticosteroid has not been effective
what is recommended to treat severe hand eczema
alitretinoin
should be stopped as soon as eczema is almost or completely cleared
