Skin conditions Flashcards
Eczema
Atopic - A group of conditions which consist of asthma, eczema and hay fever
Eczema/Dermatitis - Red, dry, itchy skin which can sometimes become weeping, blistered, crusty, scaling
Causes of eczema
- Skin cells tightly held together allowing the penetration of allergens
- Ingress of allergens causes inflammation
- Increased loss of water and fat
- Abnormal inflammatory or allergen response (IgE released)
Trigger factors
Materials (wool, synthetic fabrics)
Hormones, teething, sleep deprivation
Cow’s milk, eggs, food colouring
Inhalant allergens (Dust mite, mould, pollen, animal dander)
Symptoms of eczema
Intense itching, red and cracked, dry and flaky, undergoing lichenification, change in colour
During a flare up: Moist, weepy and crusting around edges, Small water blisters may develop on hands and feet, may result in sleep disturbance, tiredness and irritability
Lifestyle advice for eczema
- Moisturise 2-3 times per day
- Replace soap with emollient
- Protective clothing
- Avoid aggravating clothing
- Avoid triggers
- Keep cool
- Do not scatch (pat skin dry not RUB)
- Keep nails short
Emollients for eczema
OTC available
1st Line
Hydrates and soothes the skin
Apply frequently and liberally
Apply several times a day
Use daily even when there is no flare up
Apply to damp skin (during and after washing)
Replace soap with emollient
Most contain no API whereas some do (urea, lanolin, antiseptic)
Creams/lotions for red inflamed skin
Topical corticosteroids for eczema
2nd line
Reduces inflammation, redness and itching
Some lower strengths available OTC
Ointments preferred to creams
Apply thinly once or twice daily
Available topical corticosteroids OTC
Hydrocortisone 1% cream 15g (mild to moderate eczema in 10 years or older)
Clobetasone 0.05% cream 15g - over 12 years (eczema and dermatitis only)
Max treatment for 7 days
Referral for eczema
- Under 10 years
- Pregnant
- Application to face, anogenital region
- Broken skin
- Infected skin (cold sores, acne, athlete’s foot)
Contact dermatitis
Inflammation of the skin 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
Symptoms of contact dermatitis
Most commonly affects hands and face
Redness, Itchy, Blistered, Dry and cracked, scaly
Irritant contact dermatitis - Stinging or burning sensation from one exposure to strong irritant or multiple exposure to weak irritant
Treatment for contact dermatitis
Avoid irritant or allergen
1st line: Emollient
2nd line: Topical corticosteroid
3rd line: Oral corticosteroid
Psoriasis
Common inflammatory skin disease that affects the skin, joints and nails
Caused by rapid replacement of skin cells leading to a build up of excess skin cells to form ‘raised’ plaques on the skin
Appearance of psoriasis
Inflamed areas of skin
Raised red and scaly patches/plaques in appearance
Scales are white/silvery
Itchy
Painful
Symmetrical patches
Pitted finger nails
Factors increasing psoriasis flare ups
Infections
Hormonal changes
Skin injury
Stress and anxiety
Alcohol
Smoking
Medications - beta blockers, lithium, antimalarials
Treatment for psoriasis
1st line: Emollient - reduces scale and relieves itching
2nd line: Topical corticosteroids - once stopped may cause rebound psoriasis
3rd line: Topical vitamin D preparations at max quantity to slow down rate of skin cell division
Coal tar preparations for psoriasis
Helps to remove loose scales, slows down skin overgrowth
Messy to apply
Unpleasant smell
May stain clothing
Can cause light sensitivity
Dithranol
Ideal for chronic, scaly psoriasis
Apply sparingly
Stains clothing
Messy to use
Vitamin A analogues
i.e. Tazarotene
Not to be used on face or in skin folds
Salicylic acid preparations
Reduces excessive scaling
Moderate to severe psoriasis treatments
- Acitretin - hospital only
It is a retinoid so avoid giving to child-bearing women - Ciclosporin
3-4 weeks until the benefit seen - Methotrexate
Slows down rapid division of skin cells and reduces inflammation
Causes of acne vulgaris
Sebaceous glands form sebum (oil)
More sebum leads to greasy skin and worsens acne
What worsens acne
Progesterone only pill
Hormonal changes
Picking or squeezing spots
Heavy sweating
Tight clothing
Medicines - phenytoin, steroid creams
Anabolic steroids
Referral for acne
Moderate to severe condition
No response to OTC medicine after 8 weeks
Drug induced acne
Acne rosacea
Suspected carcinoma - raised edges
Lifestyle advice for acne
Do not wash face more than twice a day
Avoid excessive washing, scrubbing and exfoliating
Use mild soap and lukewarm water
Use a soft wash cloth and fingers instead
Avoid oil rich moisturisers - can clog pores
Benzoyl peroxide for acne
OTC for mild to moderate acne in strengths 2.5-10%
Apply to all affected area of skin, not just each spot
Start with lowest strength and titrate upwards - start OD then start BD if well tolerated
Apply 30 minutes after washing skin
Releasing oxygen when contact with skin so can bleach clothes, hair etc.
Side effects: skin dryness, irritation, burning sensation
Azelaic acid for acne
Mild to moderate acne
Unplugs blocked pores
Less skin irritation than benzoyl peroxide
PGD required
Topical antibacterials for acne
Clindamycin gel or erythromycin gel
Prescription required
Moderate to severe acne treatments
- Oral antibiotics
First choice: Oxytetracyline 500mg BD or tetracycline 500mg BD
Second choice: Doxycycline OD or lymecycline OD
Use for 3 months, switch if no improvement - Hormone treatment
Co-cyprindiol
For women only
Continue taking 3-4 weeks after acne has resolved - Topical retinoids
Adapalene (PGD)
Topical retinoids counselling points
May develop skin redness and peeling - settles over time
Spots become a little worse before improving
Sensitive to light - use a suncream
Should not be pregnant or plan on getting pregnant
