Skin

Question 1

What is atopic eczema characterized by?

Answer 1

Atopic eczema is characterized by an itchy red rash, often found in skin creases like elbows and knees, associated with dry skin and a reduced lipid barrier.

Question 2

What triggers atopic eczema?

Answer 2

Triggers include irritants (soap, temperature extremes), stress, hormonal changes, and inhaled allergens (dust mites, pollens).

Question 3

What are danger symptoms of atopic eczema?

Answer 3

Secondary bacterial infection may occur, presenting as impetigo or worsening of eczema with increased redness and crusting.

Question 4

What are common differential diagnoses for eczema?

Answer 4

Psoriasis, contact dermatitis, seborrhoeic dermatitis, fungal infections, scabies, and other infestations should be considered as differential diagnoses for eczema.

Question 5

What is the aim of managing atopic eczema?

Answer 5

The aim is to control skin dryness, itching, and reduce flare-ups. Frequent application of emollients is encouraged.

Question 6

What are some triggers to avoid for managing atopic eczema?

Answer 6

Use an emollient soap substitute, wear gloves with irritants, avoid temperature extremes, use non-abrasive clothing fabrics like cotton, and reapply emollients after wetting the skin.

Question 7

What are practical tips for using bath emollients?

Answer 7

Bath emollients may create a slippery surface, so users need to take extra care in the bathroom. Cleaning the bath thoroughly after use reduces slipping risks. Bath mats or handrails can be useful.

Question 8

Is avoidance of biological washing powder necessary for eczema?

Answer 8

Avoidance is not necessary. There is no evidence supporting the idea that vitamin and mineral supplementation, such as evening primrose oil or vitamin E, helps eczema symptoms.

Question 9

What is the role of dietary exclusion in atopic eczema?

Answer 9

If food sensitivity is suspected, dietary exclusion may be practical with the advice of a dietician. Common culprits are cows’ milk, eggs, soya, wheat, fish, and nuts. Even with dietary exclusion, regular skin care with emollients remains crucial.

Question 10

What are special considerations for children with atopic eczema?

Answer 10

Children often have itchy, dry skin. Exclusive breastfeeding for at least three months may reduce the risk of eczema, especially with a family history. The routine use of emollients is crucial to prevent skin dryness and reduce itchiness.

Question 11

How can crusted yellow lesions in eczema be distinguished from impetigo?

Answer 11

Distinguishing between impetigo and a flare-up of eczema with crusted yellow lesions may be challenging. Referral to a GP is recommended for a routine appointment to assess and manage the condition, especially if there is suspicion of infection.

Question 12

What preventive effect does exclusive breastfeeding have on eczema?

Answer 12

Exclusive breastfeeding for at least three months may significantly reduce the risk of atopic eczema developing in infants, particularly those with a family history of eczema.

Question 13

What should be done if there is suspicion of infection in eczema?

Answer 13

If there is suspicion that eczema is infected, referral to a GP for antibiotic treatment is recommended to ensure proper management and resolution of the flare-up.

Question 14

What is contact dermatitis?

Answer 14

Contact dermatitis is an itchy rash that occurs in response to external irritants or allergens interacting with the skin, leading to crusting, scaling, cracking, or swelling.

Question 15

What is the difference between allergic and irritant contact dermatitis?

Answer 15

Allergic contact dermatitis is a type IV hypersensitivity reaction, while irritant contact dermatitis is a non-immune inflammatory response to skin damage, often caused by chemicals.

Question 16

What is a danger symptom of contact dermatitis?

Answer 16

Secondary bacterial infection is a possible danger symptom, particularly if the skin is broken by scratching, leading to a red, oozing, and inflamed area.

Question 17

What are common differential diagnoses for contact dermatitis?

Answer 17

Psoriasis, atopic eczema, fungal infections, and other types of dermatitis like seborrhoeic dermatitis are common differential diagnoses for contact dermatitis.

Question 18

How should dry skin associated with contact dermatitis be managed?

Answer 18

Dry skin should be managed with emollients to keep the skin moisturized.

Question 19

Can topical corticosteroids be used to treat contact dermatitis?

Answer 19

Topical corticosteroids can be used to treat localized inflammation in contact dermatitis, as long as there is no broken skin or sign of infection. They should be applied once or twice a day for up to seven days in adults and children over 10 years.

Question 20

What practical tips are advisable for managing contact dermatitis?

Answer 20

Avoidance of allergens or irritants is advisable. Other measures include rinsing with water or using soap substitutes after contact, replacing strong irritants with weaker ones, reducing contact duration, and using protective clothing and gloves.

Question 21

What are the manifestations of seborrhoeic dermatitis?

Answer 21

Red, sharply marginated lesions with greasy-looking scales. On the scalp or eyebrows, it appears as dry, flaking desquamation (dandruff) or yellow, greasy scaling with erythema.

Question 22

What is the causative organism in the majority of seborrhoeic dermatitis cases?

Answer 22

Malassezia (Pityrosporum) ovale.

Question 23

Is seborrhoeic dermatitis a chronic condition?

Answer 23

Yes, it is a chronic condition that often flares up or remits spontaneously.

Question 24

Who is more commonly affected by seborrhoeic dermatitis, men, or women?

Answer 24

It is more common in men than women.

Question 25

What skin conditions are often associated with seborrhoeic dermatitis?

Answer 25

Blepharitis, rosacea, and acne vulgaris.

Question 26

What is cradle cap?

Answer 26

It is a mild form of seborrhoeic dermatitis that most babies have in the first six months of life. It appears as dry, flaking desquamation on the scalp and resolves by about eight months.

Question 27

What are danger symptoms in seborrhoeic dermatitis?

Answer 27

Secondary bacterial infection with increased redness and crusting. Impact on self-confidence and esteem may also necessitate referral if OTC treatment is ineffective.

Question 28

What are the differential diagnoses for seborrhoeic dermatitis?

Answer 28

Psoriasis, eczema, and scalp ringworm (tinea capitis).

Question 29

What is tinea capitis?

Answer 29

Tinea capitis is a fungal infection of the scalp with red patches, hair loss or scaling, often seen in pre-pubertal children. It requires referral for systemic antifungal treatment.

Question 30

What is the treatment of choice for seborrhoeic dermatitis?

Answer 30

Ketoconazole 2% shampoo (e.g., Nizoral®) is the treatment of choice and may be supplied OTC for prevention and treatment with a maximum frequency of once every three days.

Question 31

What is an alternative second-line treatment for seborrhoeic dermatitis?

Answer 31

Selenium sulphide (Selsun®) is efficacious but less well-tolerated.

Question 32

Which shampoos containing pyrithione zinc can control mild seborrhoeic dermatitis?

Answer 32

Head and Shoulders® shampoos, used daily or every other day.

Question 33

What is the maximum frequency of application for ketoconazole 2% shampoo in seborrhoeic dermatitis?

Answer 33

Once every three days.

Question 34

What is the evidence supporting the use of tar shampoos (e.g., Polytar®, T/Gel®) in seborrhoeic dermatitis?

Answer 34

There is little evidence to support their use over antifungal preparations. They are usually applied once or twice weekly.

Question 35

How can cradle cap in infants be treated?

Answer 35

Cradle cap in infants may be treated with an oil such as olive or arachis oil to soften the plaques, followed by shampooing with a gentle baby shampoo. Proprietary cradle cap preparations are also available.

Question 36

What are some examples of proprietary cradle cap preparations?

Answer 36

Dentinox® cradle cap shampoo (containing surfactants) and Metanium® cradle cap cream (contains salicylic acid 1.5%). Gentle brushing with a baby hairbrush after shampooing may improve the appearance of the rash.

Question 37

What practical tips are recommended for managing seborrhoeic dermatitis?

Answer 37

Daily washing with soap and water helps to remove the lipid substrate used by the yeast.

Question 38

In what patient population is seborrhoeic dermatitis more common and more widespread, with a rapid onset?

Answer 38

Seborrhoeic dermatitis is more common and more widespread in patients with HIV, with a rapid onset. This possibility should be considered in patients presenting with a widespread case. Oral imidazoles may be used

Question 39

What is chronic plaque psoriasis characterized by?

Answer 39

Chronic plaque psoriasis is characterized by scaly red patches covered with silver, white scales, often located on the extensor surfaces of the body and scalp. The lesions may be itchy, crack, and bleed.

Question 40

What are the characteristics of guttate (exanthematous papulosquamous) psoriasis?

Answer 40

Guttate psoriasis involves small plaques found all over the body, often appearing after streptococcal infection. It is a self-limiting condition.

Question 41

What are some triggers for the onset or relapse of psoriasis?

Answer 41

Physical trauma, acute infection, certain medications (e.g., beta blockers, NSAIDs, lithium salts, chloroquine), stressful life events, and personal habits (cigarette smoking and alcohol consumption) are believed to trigger psoriasis.

Question 42

In approximately what percentage of psoriasis sufferers may psoriatic arthritis occur?

Answer 42

Psoriatic arthritis may occur in 1-10% of psoriasis sufferers, leading to pain, swelling in the joints, and inflammation of tendons, commonly affecting the fingers.

Question 43

When is routine referral necessary for mild to moderate psoriasis?

Answer 43

Routine referral in mild to moderate psoriasis is generally only needed for treatment failure if the patient is concerned.