RTS - Eczema, Psoriasis

Question 1

What is eczema? What are the symptoms?

Answer 1

inflammatory skin condition
- most commonly affects skin creases = hands, knees, elbows, neck

mild symptoms
- red and inflamed skin, itchy skin, dry and flaky, undergoing lichenification, change in skin pigmentation

severe symptoms
- moist, weeping and crusting around edges, small water blisters, sleep disturbances, tiredness, irritability

Question 2

What are the triggers for eczema?

Answer 2

Materials e.g. Wool (lanolin)
Synthetic fabrics
Hormones
Teething
Sleep deprivation
Cow’s milk, eggs, food colourings

Inhalant allergens
- house dust mite, moulds, pollen, animal dander

Question 3

What is first line treatment for eczema? What is the counselling?

Answer 3

emollients
- apply frequently and liberally = several times per day
- apply to damp skin
- wait 15-30mins after emollient, before applying corticosteroid

Some contain active ingredients
- urea (keratin softener, hydrating agent)
- lauromacrogols (local anaesthetic properties)
- lanolin or derivatives
- antiseptic

Do not use Aqueous Cream

Question 4

What is the second line treatment for eczema?

Answer 4

topical corticosteroids
- apply THINLY once or twice daily to affected areas only

1. Hydrocortisone 1% cream 15g (P) - over 10 years
2. Clobetasone 0.05% cream 15g (P) – over 12 years
   Max treatment 7 days

Ointments preferred to creams but creams better tolerated

Question 5

What is contact dermatitis? What are the different types?

Answer 5

Inflammation of the skin that occurs when you come into contact with a particular substance

Irritant
A substance that directly damages the epidermis

Allergen
A substance that triggers the immune system to respond in a way that affects the skin

Question 6

What are the symptoms of contact dermatitis?

Answer 6

Skin Appearance:
- red
- may appear dark brown/purple/grey in darker skin
- itchy (dominant in allergic)
- burning/stinging (dominant in irritant)
- blistered (more in allergic)
- dry and cracked
- scaly

Question 7

What is psoriasis?

Answer 7

immune-mediated, inflammatory skin disease affecting the skin, joints and nails

Question 8

What are the symptoms of psoriasis?

Answer 8

inflamed areas of skin

raised, red and scaly patches/plaques in appearance
- in darker skin, plaques usually purple/dark brown with grey scales and may cause post-inflammatory hyperpigmentation

scales are white/silvery
oval, irregular lesions (1-5cm diameter)
may be itchy/sore
symmetrical patches
pitted fingernails

Question 9

What factors trigger psoriasis?

Answer 9

Infections e.g. strep throat

Hormonal changes

Skin injury (up to 20% affected = Koebner phenomenon)

Stress and anxiety

Alcohol (altering immune function and keratinocyte activity, impairing skin barrier function)

Smoking (oxidative damage)

Medications – beta blockers, lithium, antimalarials

Question 10

What are the treatment options for psoriasis?

Answer 10

emollients
- moisturise dry skin, reduce scaling, and relieve itching

potent topical corticosteroids e.g betamethasone
- long term use can lead to irreversible skin atrophy and striae
= applied BD

topical vitamin D preparation e.g. calcipotriol, calcitriol
- slows rate at which skin cells divide
= applied BD

topical calcineurin inhibitors e.g. tacrolimus, pimecrolimus

coal tar preparations
- anti-inflammatory, antipruritic, and anti-scaling properties

dithranol
- slows production of skin cells

salicylic acid preparations
- reduces excessive scaling for scalp psoriasis

topical retinoids e.g tazarotene:

Question 11

What is phototherapy?

Answer 11

UV light delivered in a controlled way
- targeting skin immune cells and keratinocytes, causing epidermal remodelling and reducing inflammation

Duration: 8 -10 weeks
Sessions per week: 2 – 3

Question 12

What treatments are used for?

Answer 12

Methotrexate = first choice
- slows down rapid division of skin cells and reduces inflammation

Ciclosporin
= first choice if flare up or considering conception or palmoplantar pustulosis

Acitretin (retinoid)
– avoid giving to women of childbearing age or PPP
- only after considering both methotrexate and ciclosporin

Biologics
- monoclonal antibodies (tumour-necrosis factor-alpha inhibitors) e.g. infliximab, adalimumab, etanercept
- used after phototherapy when conventional systemic therapies were ineffective/not tolerated/contraindicated

Question 13

What is first line treatment for psoriasis?

Answer 13

topical vitamin D preparation + topical potent corticosteroid
- review after 4 weeks