Wk 30 - Dermatology OTC (Eczema)

Question 1

What is seborrhoeic eczema?

Answer 1

Affects scalp, eyebrows, ears + axillae - yellow greasy scales

Question 2

What is gravitational eczema?

Answer 2

• Oedematous legs
• Skin fragile + ulcerate if scratched

Question 3

What is asteatotic eczema?

Answer 3

• Legs of elderly
• V dry + red superficial blisters

Question 4

What is pompholyx eczema?

Answer 4

Vesicles/blisters on palms, fingers or soles of feet

Question 5

What is discoid eczema?

Answer 5

Multiple coin shaped, itchy lesions in men - stress related

Question 6

What is atopic eczema?

Answer 6

• Hypersensitivity to common anv allergens
• Linked to asthma, hayfever + Hx

Question 7

How does eczema occur?

Answer 7

• 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

Question 8

What are the complications of eczema?

Answer 8

• Scratching causes 2’ infection w/ staph a
• Inc susceptibility to viral infections: warts or molluscum contagiosum

Question 9

What happens when you have a secondary infection to bacteria?

Answer 9

• Weeping, crusting, treatment failure, fever + malaise
• Treat w/ potassium permanganate

Question 10

What happens when you have a secondary infection to viruses?

Answer 10

Herpes - Refer

Question 11

What is used for mild eczema?

Answer 11

• Emollients
• Mild potency topical steroids

Question 12

What is used for moderate eczema?

Answer 12

• Emollients
• Topical steroids: body (mod 7-14 days), face/neck (mild 3-5)
• Topical calcineurin: tacrolimus

Question 13

What is used for severe eczema?

Answer 13

• Emollients
• Topical steroids: body (mod 7-14 days), face/neck (mild 3-5)
• Topical calcineurin: tacrolimus
• Phototherapy
• Systemic therapy: ciclosporin

Question 14

What are common allergens for allergic contact dermatitis?

Answer 14

Involves t-cell mediated immunity:

• Nickel
• Topical antibiotics
• Preservative chemicals
• Fragrances

Question 15

What are commons irritants for irritant contact dermatitis?

Answer 15

• Water
• Urine
• Strong acid acid/alkali
• Bleach
• Detergents

Question 16

How do you manage irritant contact dermatitis?

Answer 16

• Avoid irritant
• Gloves, take off regularly bc sweat aggravates
• Use soap substitution
• Heavy emollient + topical corticosteroids

Question 17

How does allergic contact dermatitis occur?

Answer 17

• Chemical penetrates epidermis, taken up by langerhans cells, presentation to T lymphocytes
• Rash starts: 6-12 hrs
• Peaks: 48-72 hrs
• Red, inflammation, dry

Question 18

What is first line for eczema?

Answer 18

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

Question 19

After emollients, what is used to treat eczema?

Answer 19

Hydrocortisone cream 1%

• Hydrocortisone (10 yrs)
• Clobetasone (12 yrs)
• Finger tip unit
• BD 7 days
• Not above neck unless earlobes
• Not for pregnant/anogenital

Question 20

When would you use hydrocortisone cream 1%?

Answer 20

• Mild/mod eczema
• Contact dermatitis
• Insect bites

Question 21

What are the side effects of topical corticosteroids?

Answer 21

• Atrophy: skin thin + easily bruised
• Stretch marks + telangiectasia
• Mask infection
• Acne
• Depigmentation
• Cushing + adrenal suppression

Question 22

What are other treatments of atopic eczema?

Answer 22

• Wet wrapping: emollient cover dw/ wet cotton bandage + leave overnight
• Phototherapy
• Systemic immunosuppression: ciclosporin, aza + MXT

Question 23

What is tacrolimus/pimecrolimus?

Answer 23

• Inhibit calcineurin phosphatase
• S/e: rash, irritation, lymphoma + skin cancer risk
• For ST, not first line