Wk 30 - Dermatology OTC (Eczema) Flashcards
What is seborrhoeic eczema?
Affects scalp, eyebrows, ears + axillae - yellow greasy scales
What is gravitational eczema?
- Oedematous legs
- Skin fragile + ulcerate if scratched
What is asteatotic eczema?
- Legs of elderly
- V dry + red superficial blisters
What is pompholyx eczema?
Vesicles/blisters on palms, fingers or soles of feet
What is discoid eczema?
Multiple coin shaped, itchy lesions in men - stress related
What is atopic eczema?
- Hypersensitivity to common anv allergens
- Linked to asthma, hayfever + Hx
How does eczema occur?
- Barrier lipids in lower part of stratum corneum not formed
- Barrier function impaired, inc water loss from SC
- Cells shrink + crack open
- Skin = dry, doesn’t retain water
- Soap removes more lipid + red barrier function further
What are the complications of eczema?
- Scratching causes 2’ infection w/ staph a
- Inc susceptibility to viral infections: warts or molluscum contagiosum
What happens when you have a secondary infection to bacteria?
- Weeping, crusting, treatment failure, fever + malaise
- Treat w/ potassium permanganate
What happens when you have a secondary infection to viruses?
Herpes - Refer
What is used for mild eczema?
- Emollients
- Mild potency topical steroids
What is used for moderate eczema?
- Emollients
- Topical steroids: body (mod 7-14 days), face/neck (mild 3-5)
- Topical calcineurin: tacrolimus
What is used for severe eczema?
- Emollients
- Topical steroids: body (mod 7-14 days), face/neck (mild 3-5)
- Topical calcineurin: tacrolimus
- Phototherapy
- Systemic therapy: ciclosporin
What are common allergens for allergic contact dermatitis?
Involves t-cell mediated immunity:
- Nickel
- Topical antibiotics
- Preservative chemicals
- Fragrances
What are commons irritants for irritant contact dermatitis?
- Water
- Urine
- Strong acid acid/alkali
- Bleach
- Detergents
How do you manage irritant contact dermatitis?
- Avoid irritant
- Gloves, take off regularly bc sweat aggravates
- Use soap substitution
- Heavy emollient + topical corticosteroids
How does allergic contact dermatitis occur?
- Chemical penetrates epidermis, taken up by langerhans cells, presentation to T lymphocytes
- Rash starts: 6-12 hrs
- Peaks: 48-72 hrs
- Red, inflammation, dry
What is first line for eczema?
Emollient
- Frequent application
- Bath oil
- Avoid regular soaps
- Creams = infected, ointment = dry skin
- Apply 30-60 mins before steroid
- Apply direction of hair growth to red folliculitis
- Fire hazard
After emollients, what is used to treat eczema?
Hydrocortisone cream 1%
- Hydrocortisone (10 yrs)
- Clobetasone (12 yrs)
- Finger tip unit
- BD 7 days
- Not above neck unless earlobes
- Not for pregnant/anogenital
When would you use hydrocortisone cream 1%?
- Mild/mod eczema
- Contact dermatitis
- Insect bites
What are the side effects of topical corticosteroids?
- Atrophy: skin thin + easily bruised
- Stretch marks + telangiectasia
- Mask infection
- Acne
- Depigmentation
- Cushing + adrenal suppression
What are other treatments of atopic eczema?
- Wet wrapping: emollient cover dw/ wet cotton bandage + leave overnight
- Phototherapy
- Systemic immunosuppression: ciclosporin, aza + MXT
What is tacrolimus/pimecrolimus?
- Inhibit calcineurin phosphatase
- S/e: rash, irritation, lymphoma + skin cancer risk
- For ST, not first line
