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Patient > Dermatology > Flashcards

Dermatology Flashcards

1
Q

TF: skin conditions can be linked to increased risk of CVD

A

TRUE: psoriasis and eczema in particular

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2
Q

what is the most common type of eczema? ____%

A

atopic- 80%

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3
Q

what other type of eczema can be associated with atopic?

A

lichen- thick hardened skin from scratching

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4
Q

why must you be careful using the word dermatitis?

A

means external cause which isn’t always the case

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5
Q

eczema affects what ages?

A

any age but most common in children

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6
Q

____% present in the first 6 months of life

A

50

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7
Q

TF: eczema has variations between different genders and ethnicities?

A

false

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8
Q

by the age of 7 ____% of eczema cases have cleared

A

65

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9
Q

by the age of 16 ____% of cases have cleared

A

75

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10
Q

1/___ have severe chronic eczema

A

20

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11
Q

what are features of the skin barrier in eczema?

A

dysfunctional skin barrier- altered conversion of keratinocytes to protein/ lipid scales

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12
Q

about 50% of cases have been traced back to a gene involved in…..

A

the conversion of keratinocytes to form scales

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13
Q

if the conversion of keratinocytes to scales is altered what happens?

A

water is lost from the skin
hyper-reactivity to allergens
infections

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14
Q

how is IgE related to eczema

A

Th cell dysregulation- IgE and mast cells create inflammation

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15
Q

risk factors for worsening eczema

A 
stress
genetics 
pollen and pets 
clothes 
soaps 
extreme temperatures 
house mites 
foods
infections 
hormones
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16
Q

___% of children with eczema had parents with it

A

80

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17
Q

what clothes help eczema?

A

cotton- rough clothes are bad

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18
Q

why can soaps worsen eczema?

A

alters lipid barrier

dries skin

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19
Q

winter is ____ than summer for eczema

A

worse

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20
Q

what about house mites can worsen eczema?

A

faeces

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21
Q

how would you know your eczema is infected?

A

weeping

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22
Q

first line treatments for mild eczema?

A

emollients

mild topical steroids if the skin is inflamed- FTU’s

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23
Q

what do emollients do?

A

restore skin integrity and hydrates

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24
Q

effect of emollients on steroids?

A

steroid sparing effect- dont need as much

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25
Q

features of mild eczema?

A

some dry skin
some itching
some redness

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26
Q

features of moderate eczema?

A

dry skin
itching
redness
some thickening

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27
Q

treatment if eczema develops to moderate?

A

before: emollient and mild topical steroid

now: increase emollient use
increased to moderate potency steroid
non-sedating antihistamine if itchy

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28
Q

how long should the moderate potency steroid be used for in moderate eczema? what should be used on thin skin?

A

7-14 days
5 days if on sensitive skin

hydrocortisone on sensitive areas

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29
Q

in moderate eczema what can we use to treat the itch?

A

non-sedating antihistamine

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30
Q

when should the non-sedating antihistamine for moderate eczema be reviewed? why?

A

after 3 months as there’s weak evidence for any benefit

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31
Q

what is advised for moderate eczema between flares?

A

low potency steroid intermittently (e.g. twice a week)

second line: topical calineurin inhibitors (tacrolimus)

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32
Q

in children with moderate eczema what steroids would be used

A

only mild steroids

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33
Q

features of severe eczema?

A

widespread
skin thickening
bleeding
oozing

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34
Q

treatment for severe eczema?

A

increase emollient use
potent topical steroid- moderate on sensitive areas (same treatment timeline as moderate 7-14 days and 5 on sensitive)
ns antihistamine
can consider oral corticosteroid

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35
Q

what if severe eczema itch is effecting sleep?

A

sedating antihistamine

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36
Q

example of an oral corticosteroid that could be given in severe eczema?

A

oral prednisone

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37
Q

treatment between flares of severe eczema?

A

lower potency steroid

2nd line: topical calcineurin inhibitors (tacrolimus)

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38
Q

steroid use should try to be _____ between flares

A

avoided

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39
Q

how often must you be reviewed between flares?

A

3-6 months

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40
Q

why are infections common in eczema?

A

due to skin barrier being broken down

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41
Q

features of infected skin?

A

weeping
crusted
pustules
systemic symptoms sometimes

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42
Q

TF: for skin infections in eczema only topical antibiotics can be used?

A

no oral or topical

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43
Q

first and second line antibiotics for skin infections in eczema?

A

flucloxacillin

clarithromycin

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44
Q

example of light emollient

A

E-45

Diprobase

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45
Q

example of a moderate emollient

A

oilatum

hydrous cream

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46
Q

example of a greasy emollient

A

50% white soft/ liquid

epidermis

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47
Q

example of a low potency steroid?

A

hydrocortisone 0.1, 0.5, 1, 2.5%

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48
Q

examples of a moderate steroid?

A

clobetasone butyrate 0.05%

betamethasone valerate 0.025%

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49
Q

examples of potent steroids?

A

betamethasone valerate 0.1%

betamethasone dipropionate 0.05%

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50
Q

what is another treatment that could be considered in severe eczema?

A

phototherapy

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51
Q

patient advice for eczema?

A

use emollients a lot- every 2 hours in flares
avoid scratching
avoid triggers
how to recognise infection
discard old products
advise oily products at night even though not preferred
fire warning with emollients

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52
Q

when using steroids what should you advise?

A

continue 48 hours after inflammation has reduced

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53
Q

formulations which emollients come in?

A 
creams
bath additives
ointments 
gels 
lotions
54
Q

when should you take corticosteroids in relation to emollients?

A

30 minutes later- increases penetration

55
Q

advise on emollient application?

A

don’t rub, gently stroke in along the hair follicles

56
Q

what is the most common type of psoriasis?

A

vulgaris- chronic plaques

57
Q

80% of people with vulgarisms psoriasis get…

A

scalp psoriasis

58
Q

psoriasis mainly effects?

A

knees and elbows

59
Q

features of psoriasis?

A

chronic, inflammatory disorder or skin and joints

relapsing

60
Q

when are presentations of psoriasis most common?

A

15-25 years then 55-60

61
Q

what ethnicity gets psoriasis most often?

A

caucasian

62
Q

pathophysiology of psoriasis?

A

inflammatory cells in skin layers lead to epidermal hyper proliferation and vascular changes
cell turnoverr is rapid

63
Q

how much more rapid is cell turn over in psoriasis than normal?

A

from 42 days in normal people to 7 in psoriasis

64
Q

vascular changes of psoriasis?

A

vessels are closer to the skin= bleeding when layers shed

65
Q

risk factors for psoriasis

A 
obesity 
smoking 
alcohol 
hormones- pregnancy, puberty, menopause 
medications skin injury 
stress
infection
66
Q

what medications increase chance of psoriasis?

A 
lithium 
NSAIDs 
BBs
tetracyclines 
ACEI
67
Q

what is acanthuses?

psoriasis

A

thick skin

68
Q

what is hyperkeratosis?

psoriasis

A

scaly skin

69
Q

complications of psoriasis?

A

psoriatic arthiritis
depression and anxiety
bleeding if scales come off

70
Q

how to detect psoriatic arthritis

A

PEST tool

71
Q

what is crucial in psoriasis treatment?

A

patient education and support

72
Q

topical treatments for psoriasis?

A

emollients recommended
ointments
creams/ gels/ lotions
corticosteroids

73
Q

TF: emollients are in the NICE guidelines for psoriasis treatment

A

false but are recommended

74
Q

what are ointments good for in psoriasis?

A

thick scale

75
Q

side effects of corticosteroids?

A

skin atrophy and stretch marks

76
Q

why must corticosteroids be used correctly in psoriasis?

A

can make it worse

77
Q

psoriasis treatment is in _______ blocks. why?

A

no more than 4 weeks- regular review must be stressed

2 weeks if on face, flexures and genitals

78
Q

treatment of psoriasis on the trunk and limb?

A

potent corticosteroid
Vitamin D analogue (calcipotrol)
coal tar if above not effective

79
Q

what effect does the potent corticosteroid have in treatment of psoriasis on the trunk and limb?

A

anti inflammatory effects and alleviates itch

80
Q

effect of vitamin D analogue in psoriasis?

A

modifies gene transcription and modified hyper proliferation of skin cells

81
Q

treatment of scalp psoriasis?

A

potent corticosteroid

82
Q

if potent corticosteroid isn’t effective in treating scalp psoriasis?

A

try different formulations and/or salicylic acid

combine steroid with calcipotrol (vitamin D analogue) alone if not effective

83
Q

what does salicylic acid do in scalp psoriasis?

A

helps remove some of the scales which could stop treatment getting in

84
Q

face, flexures and genital treatment time scale?

A

2 week

85
Q

face, flexures and genital psoriasis treatment

A

mild/ moderate steroid

86
Q

if face flexures and genital psoriasis treatment using mild/ moderate steroid isn’t effective, what should be used?

A

calcineurin inhibitor- tacrolimus

87
Q

how long can steroids and vitamin D analogues take to have effect?

A

1-2 weeks

88
Q

how long does coal tar take to work?

A

3-4 weeks

89
Q

psoriasis patient advice?

A 
emollient advice
skin irritation and photosensitivity with vitamin D analogues 
several weeks till effects are seen 
avoid scratching 
report joint symptoms immediately 
importance of review after 4 weeks
90
Q

if a patient experiences joint problems in psoriasis what should they do?

A

report it immediately

91
Q

why is review at 4 weeks so important in psoriasis?

A

toxicity
adherance
effectiveness
side effects

92
Q

a _____ of steroid and calcipotiol is ______ than them alone

A

combination

better

93
Q

what could be used as treatment between psoriasis flares?

A

vitamine D

94
Q

treatment in mild psoriasis?

A

emollients
topical corticosteroid alone or with Vitamin D
calcineurin inhibitor
coal tar

95
Q

treatment of moderate psoriasis

A

if mild treatment isn’t working
phototherapy plus topical treatments
oral methotrexate or ciclosporin
oral acitretin

96
Q

treatment of severe psoriasis?

A

add a biological agent
apremilast
dimethyl fumarate

97
Q

4 different types of acne?

A

vulgaris
rosacea
conglobata
fulminans

98
Q

vulgaris acne effects what parts of the body?

A

mainly face
60% back
10% chest

99
Q

which gender does acne effect more?

A

more men than women in the early years

but when older its more common in women

100
Q

1 in __ cases are severe and difficult to treat

A

5

101
Q

what follicles does acne involve?

A

pilosebaceous follicles

102
Q

pathophysiology of acne?

A

increased number of cells which produce sebum/
altered sebum composition
keratinocyte proliferation which blocks follicles and inflames

growth of cutibacterium acnes in the sebum in the hair follicles

103
Q

TF: the increased volume of sebum production is what causes acne?

A

false

its the altered composition

104
Q

what is a hallmark feature of acne?

A

comedogenesis and hypercornification

105
Q

what is comedogenesis and hypercornification?

A

hardening of the skin

106
Q

what are open comecones?

A

black heads- close to the skin

melanin interacts with the atmosphere and turns black

107
Q

what are closed comedones?

A

white heads

108
Q

what are closed comedones more likely to turn into?

A

acne legions

109
Q

risk factors for acne?

A 
family- 80% 
high glycaemic index food
medications which cause populates= acne like response 
PCOS
smoking 
stress 
cosmetics
110
Q

TF: smoking can help acne

A

true

111
Q

why does high glaecemic foods increase acne?

A

increased amount of androgens

112
Q

why does PCOS increase acne?

A

linked to increased androgens

30% of people with PCOS get acne

113
Q

what do you want your cosmetics to state if you have acne?

A

‘non comedogenic’ if not they block the PSF

114
Q

if acne is <5mm in diameter?

A

papules- small and red

pastures- yellow or white fluid

115
Q

if acne is >5mm in diameter?

A

nodules, hard and deep- usually painful

cysts

116
Q

if a large area of skin is effected by acne what isn’t practical?

A

topical treatments

117
Q

treatment for mild-moderate acne?

A 
topical retinoid od/bd
BENZOYL peroxide 
azelaic acid- milder
topical antibiotic
combination of above 
emollients (OIL FREE)
118
Q

effects of topical retinoid in acne?

A

disrupt comedones and prevent their formation , anti inflammatory

119
Q

examples of topical retinoid

A

adapaline 0.1% gel/ cream

isotretinoin

120
Q

benzoyl peroxide effect on acne?

A

similar to topical retinoid: disrupt comedones and prevent their formation , anti inflammatory

but also an antibacterial effect

121
Q

example of a topical antibiotic?

A

clindamycin 1%

122
Q

what is a topical antibiotic always used with?

A

BPO

123
Q

treatment for acne should be continued for how long?

if see no improvement?

A

6-8 weeks

refer to GP

124
Q

what can be used as maintenance in acne?

A

retinoid or bpo

125
Q

patient advice for acne?

A 
dont over clean skin- irritation 
dont pick or squeeze 
non-comedogenic and oil products
skin irritation- if severe reduce frequency 
photosensitivity- suncream is important 
apply to whole area not just legions
126
Q

how can you avoid irritation when using gels to treat acbe?

A

apply after washing and then remove a few hours later

127
Q

how to use washes when treating acne?

A

apply and leave on for a few minutes then rinse off

128
Q

advice for applying retinoids to treat acne?

A

pea sized amount to the entire effected area

wash off after 30-60 minutes

129
Q

can you use retinoids and oral antibiotics in pregnancy?

A

should be avoided

130
Q

which acne drugs can cause increases photosensitivity?

A

BPO
retinoids
oral ABs

131
Q

what should you be screened for if you have any of these conditions?

A

cardiovascular screening

mental health

132
Q

why is adherence poor in treating these conditions

A

slow onset of action
incorrect application
not educated

Patient (19 decks)

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