Skin Flashcards
How does eczema herpeticum present
deterioration of eczema
pain
lethargy
systemic upset
what would you expect to see in eczema herpeticum
- most common involvement is the limbs
- vesicular rash often with crusting and punched out lesions that coalesce
how do you confirm diagnosis of eczema herpeticum
- viral swab in first 48 hours of vesicles
- serum viral pcr is better but costly so not done
- a bacterial swab for staph aureus should also be done
What is the management of eczema herpeticum
- Oral (IV if systemic upset) aciclovir for 5 days- don’t await swab
- dermatology opinion
- opthalmology opinion
When should you get an opthalmology opinion in eczema herpeticum
If peri-orbital involvemnt
What is the atopic march
- eczema
- allergic rhinitis
- asthma
- food allergy
Why does eczema occur
Fillagrin is an epidermal protein that plays a vital role in skin barrier function. Mutations of this protein lead to a deficiency of fillagrin leading to development of atopic dermatitis
how do you diagnose atopic dermatitis
- Hx of ill defined, dry erythematous patches
- commonly flexure areas although non-flexure areas are affected in the young
- FH of atopy.
What is he management of eczema
- emollients
- topical steroids
- topical calcineurin inhibitorss
- wet/dry bandage applications with topical treatment
how should emollients be used
- un-perfumed, used on a daily basis for washing/moisturising.
- Should use 250mg-500mgs weekly
- Available at home, nursery and schools.
What is the role of emmolients
- provides an effective barrier to the skin
- decreases moisture loss
- protects against irritants
How do you use topical steroids in eczema
- applied to active areas of eczema to induce remission
- Used BD for 5-7 days then reduce frequency/potency
Local side effects of steroid cream
- telangiectasia on cheeks
- striae
- thinning of skin
All of these generally avoided if the correct strength is used
Which topical steroid should you use for mild eczema and eczema on face
hydrocortisone
Which topical steroid should you use for moderate eczema
Clobetasone butyrate 0.05%
Which topical steroid should you use for severe eczema
betametasone 0.1%
What is a topical calcineurin inhibitors
- third line
- tacrolimus or pimecrolimus
- need to be 2years or older
What features of eczema can impact QoL
- itching/scratching and sleep deprivation can impair functioning
- regular applications of topical medications is time consuming
Which bacteria causes impetigo
Staphylococcus aureus or Streptococcus pyogenes
What are the clinical findings of non-bullous impetigo
- tiny pustules or vesicles that evolve rapidly into honey-coloured crusted plaques
- under 2 cm in diameter
- usually start on the face
- little or no surrounding erythema or oedema
- regional lymph nodes are often enlarged
What is Ecthyma
- non-bullous impetigo but ulcerates and becomes necrotic.
- deeper and may occur with lymphadenitis
What are the clinical findings of bullous impetigo
- Thin roof that rupture spotaneously
- on the face, trunk, extremities, buttocks, or perineal region
- more common if underlying disease e.g. atopic eczema
- associated with pain and malaise
- most commonly in neonates
how long should children with impetigo stay of school
- until lesions are all dry and scabbed over,
- antibiotics for 48 hours
What is the management of impetigo
- topical fusidic acid TDS for 7 days
- Mupirocin if MRSA positive.
What is the management of impetigo
- topical fusidic acid TDS for 7 days
- Mupirocin if MRSA positive.
- 7 days oral fluclox if systemic upset (clari/erythro if pen allergic)
