Dermatology Flashcards
(146 cards)
1
Q
What are the 3 layers of skin called?
A
- Epidermis
- Dermis
- Hypodermis
2
Q
What is the structure + function of the epidermis?
A
- Outermost layer of skin + thinnest layer of the skin
-✅ protects the skin from pathogens 🦠 - ✅ Vitamin D production
- ✅ melanocytes present give skin colour
3
Q
What is the structure and function of the dermis?
A
- thickest layer of the skin
- contains vasculature 🩸 and sweat glands 💦 and nerve endings ✋
- 🥵 involved in thermoregulation
4
Q
Describe the structure and function of the hypodermis?
A
- deepest layer of the skin , made up of connective tissue, subcutaneous tissue 🧈 and adipose tissue
- 🤝 connects the skin to the deep muscles
- ✅ shock absorber (due to adipose tissue), and energy storage
5
Q
List the 5 layers of the epidermis from superficial to deep?
A
- Stratum corneum
- Stratum lucidum
- Stratum granulosum
- Stratum spinosum
- Stratum basale
6
Q
What is the cell major cell type in the epidermis?
A
Keratinocytes
7
Q
What is keratinisation?
A
The process by which keratinocytes mature and die , increasing the (n) of keratin they have within them and also their strength and integrity.
They change shape to become flatter as they mature and die
8
Q
At which layer of the epidermis does keratinisation occur?
A
The stratum granulosum
9
Q
Describe the process by which keratinocytes migrate from the basal layer to the stratum corneum?
A
- At the stratum basale, keratinocytes stem cells rapidly divide and increase in number via mitosis. As the new generation of keratinocytes stem cells are produced, those produced are pushed superiorly into the next layer…
- The stratum spinosum. Here the keratinocytes attatch to eachother via desmosomes (proteins which make their surface prickly). Dendritic cells which have an immune function are also present in this layer
- As more keratinocyte stem cells are produced, the cells in the stratum spinosum move up a layer to the stratum granulosum, where they begin keratinisation. ere the cells begin apoptosis and begin to flatten. The cells also produce hard granules with keratin inside them, and lipids which form a waterproof barrier tro prevent fluid loss.
- In the soles and palms of our feet - cells enter the stratum lucidum layer which is made up of dead keratinocytes, and is very thick and clear. It provides protection from external trauma. ❌ it’s NOT present in the thin skin that covers the rest of the body.
- As more feels are produced, and pushed up the layers, the cells move into the stratum corneum where htey are dead and and flat and eventually flake off as dead skin cells r dandruff. The structure of the stratum corneum is that of brick and mortar - where died keratinoctes exist within a matrix of glycolipids (which also provide waterproof properties!)
10
Q
What are desmosomes?
A
Inter cellular junctions which provide strong adhesion between stratum spinosum cells
11
Q
Name a condition that arises due to damage to desmosomes?
A
Pemphigus - an auto immune condition in which immune cells attack cadherin - family adhesion proteins (desmogleins) between stratum spinosum cells.
As a result there is a loss of cell - cell adhesion in the keratinocytes in this layer —> results in :
- ❌ loss of epidermal integrity
- ❌ px presenting with skin blistering 😩
12
Q
What are Langerhans cells and where are they found in the skin ?
A
- 🗺️ found in the epidermis
- 👮 🦠 they are sentinel cells - hve an immune function where they assess the epidermal microenvironment for any foreign bodies
- ✅ if there IS a danger signal or infection, or integrity of skin has been compromised —-> they 🚨 alert the T immune cells to precipitate a response
- ❌ if there is NO danger signal or infection or the skin integrity is fine - they coordinate a continuous state of immune tolerance and prevent unnecessary and harmful immune activation
13
Q
What are Merkel cells and where are they found?
A
- 🗺️ in the epidermis
They are responsible for sensing light sensation/touch
14
Q
Which cells give the skin its pigment and which skin layer are they found in?
A
- melanocytes
- epidermis
UV radiation stimulates melanogenesis (ie melanin production)
15
Q
The uncontrolled growth of pigment forming cells —> melanoma.
How can ppl prevent melanoma skin cancer?
A
- ☀️ staying safe in the sun (sun cream, covering up body with light coloured, non occlusive clothes) , sitting in shade
- ⚡️ avoid using UV tanning / sun beds
16
Q
What are the ABCDE signs of melanoma?
A
Asymmetry - normal moles are symmetrical in shape and have a even shape
Border - normal moles have defined edges that are smooth and regular
Colour - normal moles are one colour, those that have 2 colours usually symmetrical across the halves
Diameter (size) - usually <6mm
Evolving/expert care - ensure all suspicious moles are examined by a GP or dermatologist
17
Q
MAST cells are tissue resident granulocytes found on mucosal surfaces including skin, lung and gut. What is their function in the skin?
A
- release immune mediators upon granulation (ie histamine, cytokines (IL3, IL4), serotonin, pro - inflammatory chemokines
As a result they initiate early neutrophil recruitment, they trigger blood vessel dilation, they increase permeabilty of blood vessels and cause oedema formation
- histamine release - indicated in urticaria in allergy
18
Q
What is the hypodermis role in the skin?
A
It plays a role in insulation 🧤 and protection against mechanical injury 😩
Some injuries may cause capillaries int he SC/hyperdermis to BURST 💥—> bruising
💉 site of SC injection
19
Q
What are the 3 appendages of the skin?
A
- hair 👩🏾🦱
- glands 👩🏻
- nails 💅
20
Q
What are the two main types of glands?
A
- sweat glands 💦
- sebaceous glands 🧈
21
Q
What are the two main types of sweat glands?
A
- apocrine
- eccrine
22
Q
What is the difference between apocrine and eccrine sweat glands?
A
💧 Eccrine glands
- found everywhere, essp on palms and soles of feet + head
- non - odorous
- present / active since birth - primary function is to cool the skin 👶
- secretion is watery
- secretions are directly on the skin surface
🍑 Apocrine glands
- found in the armpits and anorectal (groin) area
- evaporate slowly and liable to feeding by bacteria - malodour 🤢
- active after puberty
- secretion is often thicker and oily/milky
- secretions typically into the hair follicle
23
Q
Sweat glands are under the control of which part of the central nervous system - autonomic or somatic?
A
Autonomic
24
Q
What is the name of the condition in which px sweats excessively?
A
Hyperhydrosis
- can be localised or can affect the whole body!
25
What is the cause of hperhydrosis (pathology)?
Overstimulation of the eccrine sweat glands by Ach
26
What are some factors that may trigger hyperhidrosis?
- anxiety and stress, menopause and body temp (however the actual cause is not known!)
27
Give some examples of some medications that may cause hyperhidrosis?
- SSRIs, TCAs, opioids, NSAIDS,, cephalosporins, anti virals
- nb TCA - anti cholinergic - which typically cause *drying* thus the xs sweat production may be a result of compensatory sweat - ie the px may have dry hands but a sweaty torso and face
28
What do the sebaceous glands secrete?
Sebum - a mixture of lipid molecules incl Tgs, cholesterol, fatty acids
29
What kinds of glands are sebaceous and and sweat glands?
- sebaceous - (exocrine) - holocrine - the sebum is released after a cell bursts
- sweat - exocrine - however apocrine releases sweat into nearby structures ie hair follicles and eccrine releases sweat onto the skin tissue surface (sweat is released by excocytosis)
30
31
Which layer of the skin are hair follicles and hair bulbs found?
- hair follicle - epidermal
- hair bulb - dermis
32
Where does hair grow from?
Germinative cells found in hair bulbs found in the deeper layers of the *dermis*
33
What are the nearby structures associated with hair follicles and what are their functions?
- **sebaceous glands** - secrete sebum to nearing hair follicles - acts as a natural conditioner
- **erector pili muscle** - contracts to pull hair to stand up straight to conserve heat in the cold
34
What is alopecia?
- hair loss
35
What is alopecia areata?
An *auto - immune* disease where the hair follicles are no longer recognised as self and are destroyed/ removed.
Common cause of hair loss - can manifest as small bald patches , or the loss of scalp hair (alopecia total is) or whole body loss of hair (alopecia universalis)
36
What s **alopecia androgenetica**?
Male / female pattern hair loss - associated with a genetic predisposition to the effect of androgens on scalp hair growth.
37
Which medication can be used to treat alopecia androgenetica?
Minoxidil 5% on the affected areas of the scalp
38
What are some reversible causes of alopecia?
- localised skin infections (tinea capitis) - fungal infection that causes hair loss
- localised skin disease (ie psoriasis, eczema),
- systemic diseases (SLE, thyroid insufficiency)
- drug associated hair loss
39
What is **scarring alopecia**?
This is alopecia (hair loss) that results from injury to the hair follicles due to an inflammatory reaction in the dermis or hypodermis.
- ❌ NO hair follicles can be detected upon inspection of the affected areas
Eg include traction alopecia, surgery, injury, superficial burns, skin infections and inflammatory skin diseases ie lupus)
40
What is the nail plate made out of?
Keratin
41
What gives the nails their colour?
The blood vessels in the nail bed beneath the nail plate
42
What is the name of a common fungal infection of the (toe) nails?
ONYCHOMYCOSIS
- common in older people 👵 vs young ppl 👩🏻
🙄 it’s not rlly that serious BUT it an be unpleasant and difficult to treat!
43
How do we typically treat onychomycosis?
Topical anti fungal are an option however *systemic treatment is preferred*
API - **amorolfine or tioconazole**
44
Why is systemic treatment preferred to topical when it comes to treating nail conditions?
The efficacy of topical treatment is limited by poor drug penetration in the keratinised nail plate - this means that the treatment must be continued for a prolonged period of time.
45
How are most topical anti fungal medications formulated and explain the basic drug release mechanism?
**transungal administration (ie a nail lacquer)**
- after application to the nail, the liquid phase evaporates leaving a water insoluble film on the nail which will release the drug.
46
What are the normal functions of the sebum?
- to reduce water loss from the skin surface
- to protect the skin from infection by bacteria and fungi
- contribute to body odour
- immune system regulation (?)
47
**What are the functions of the skin?**
- ⚔️ physical protection - it is a barrier
- 🦠 protection against microorganisms
- ☀️ UV protection + vitamin D synthesis
- 💃 elasticity permits movement
- 🥵 thermoregulation
- 🖐️ sensation
** the integrity of the skin and the stratum corneum essp, must be maintained for it to fulfil its protective roles**
48
What is an abscess?
A local accumulation of pus
49
What is “dermatosis”?
A general term for skin disease
50
What is dermatitis?
Inflammation of the skin
51
What is a skin lesion?
A region where the skin is damaged or abnormal - one or more areas of the skin can be damaged.
52
What is a skin plaque?
An **elevated** skin lesion - they can be formed by a grouping of papules or nodules.
53
What is a rash?
An eruption of lesions on the skin
54
What is desquamation?
peeling of the skin
55
What is erosion?
The loss of the **epidermis** - ie the outer and uppermost layer of the skin!
56
What is an ulcer?
The loss of the epidermis and dermis and possibly the hypodermis too!
57
What is scaling?
Flaking of the stratum corneum
58
What is erythema?
Red colouration of the skin as a result of increased blood flow - it typically blanches (turns white) when pressure is applied.
59
What is erythodema?
Widespread inflammation of the skin - ie a large surface area of the skin is red!
It is a serious complication of psoriasis and atopic dermatitis amongst others - it can also be drug induced (red man syndrome in vancomycin
60
What are purpura?
Bleeding under the skin
- usually does NOT blanche
- it includes petechial (red / purple spots due to haemorrhage of capillary vessel) and ecchymoses, or bruises which are formed when larger amounts of blood leave the blood vessels.
61
What is a comedome?
A **blocked hair follicle containing sebum, cell debris and bacteri**
62
What are the two types of comedomes?
- **blackhead** - open comedome, only appears black bc of the surface pigment
- **whitehead** - closed comedome, the follicle is completely blocked
63
What is a macule?
A **flat** area of discolouration
(<10-15mm)
64
What is a **papule**?
A raised, solid dome - shaped lesion (<10mm)
65
What is a nodule?
A *LARGER and DEEPER* papule
(>10mm)
66
What is a vesicle?
A lesion filled with a **CLEAR** liquid (<5mm)
- they are *small* blisters
67
What is a BULLA?
A lesion filled with a **CLEAR** liquid
- larger blisters (>5mm)
68
What is a PUSTULE?
- a papule with a PUS head - could be white, yellow, green - yellow coloured
69
What is a wheal?
An evanescent (ie will rapidly disappear) papule, nodule, plaque due to dermal swelling (ie oedema).
- often red and itchy - ie urticaria !
70
What is an excoriation?
**- traumatic loss of epidermis (ie erosion due to trauma)**
(rmb this is the uppermost layer of skin!) (ie skin picking disorder)
71
What is a fissure?
- a crack in the epidermis due to EXTREME skin dryness! (Watis feet lmao)😝 🦶
72
Give 5 examples of dermatoses that may present in childhood?
- atopic dermatitis (eczema)
- nappy rash (napkin dermatitis)
- tinea infections (fungal infections)
- seborrheic dermatitis (cradle cap)
- alopecia are at
- impetigo
- viral diseases and rashes
- alopecia areata
73
Give me 5 examples of dermatoses that may occur in adults?
- eczema (atopic dermatitis)
- psoriasis
- Alopecia
- acne and rosacea
- infections
- skin cancer
- ADRs
- urticaria
74
What is Seborrheic dermatitis?
An inflammatory skin condition affecting areas with lots of sebaceous glands (ie the scalp), face and trunk.
It presents as scaly patches on inflamed skin (erythema) with stubborn dandruff.
75
What is cradle cap?
Seborrheic dermatitis in infants - characterised by an **overproduction of sebum on the baby’s scalp leading to greasy itchy scales and erythema**
🍄 sometimes a yeast infection may be involved
⏰ usually self limiting
76
How do we typically treat seborrheic dermatitis in **infants and children?**👶
- parents should *massage a topical emollient onto the scalp to loosen the scales and remove them with an infant brush*
- advise the parent to bathe the infant daily using an emollient as a soap substitute to loosen scales as well as moisturise the skin of other area of the body are affected
- consider offering a topical imidazole cream (ie anti fungal)or a mild topical corticosteroid
77
How do we typically treat seborrheic dermatitis in **adults**?
- ketoconazole 2% cream (*for adults only*) or other other topical imidazole creams AND and anti fungal shampoo as a body wash if appropriate.
- consider adding a short course of a mild topical corticosteroid cream such as hydrocortisone % for flares to settle inflammation
78
How do we manage Seborrheic dermatitis on the **scalp and beard?**
Offer ketoconazole 2% shampoo or an OTC anti - dandruff shampoo (ie contains coal tar or salicylic acid)
- consider adding a topical corticosteroid such as betamethasone vale rate 0.1% scalp application) to reduce itching and inflammation of the scalp.
79
What is nappy rash, napkin dermatitis?
A type of contact dermatitis *(ie inflammation of the skin after coming in contact with a substance/thing)* located in the nappy area.
80
What are some causes of nappy rash?
It is caused by the interaction of several factors :
- 💦 skin maceration as a result of excessive hydration (ie leaving baby in same wet and spoiled nappies)
- 🛀 bath baby daily but dont over do it - can dry out the skin!
- ⏰ prolonged contact of the baby’s skin with urine and fancies
- 🔥 friction between the nappy and skin
- resultant increase in skin pH
- 😩 irritation from fragranced baby wipes or wipes containing alcohol
81
What are some general therapeutic management strategies for the management of nappy rash?
- barrier creams (ie zinc pastes, white soft paraffin)
- antibacterial or anti fungal creams if infection confirmed
**- steroid creams or ointments to help with the redness and soreness**
82
What is chickenpox? 🐔
A viral infection of the skin caused by the *varicella zoster virus*. 🦠
Px present with a blistered rash around the whole body 😩, fever 🥵, malaise 🤢 and can last for abt 7 - 10 days.
83
When is a person most infective with chickenpox?
Upto 24hrs before presenting symptoms until all lesions have crusted over.
84
Is chickenpox serious?
It is typically self limiting in healthy children 👧🏽 , however, complications may occur from scratching - 2ndar bacterial infection of the skin and pneumonia! 🦠
85
Which group of patients are more liable to more serious complications of chickenpox?
Teenagers, adults , neonates, pregnant women and immunocompromised people
86
What is Shingles?
A unilateral rash caused by reactivation o the Herpes Zoster virus. It typically targets one dermatome often on the thorax or the abdomen.
87
Describe the characteristics of shingles pain?
- patients often experience shingles pain before the rash and lesions appear.
- the pain is neuropathic - often described as a shooting, stabbing or burning pain
- post hermetic neuralgia may occur - Rx gabapentinoids or pregabalin
88
What is the typical timeframe for how long shingles lasts for?
Vesicles typically dry up an crust over a few days ad for most patients, the eruption clears up within 2 weeks.
89
How do we generally therapeutically manage chickenpox?
- antipyretics and antihistamine for the pain and inflammation and fever (ie paracetamol)
- ⚠️ avoid ibuprofen and aspirin - increased risk of secondary infections (ibuprofen) and Reye’s syndrome (aspirin).
- calamine lotion for topical application
**For severe cases and at risk patients**
- immunoglobulins
- antivirals
90
What are some counselling, non pharmacological points to manage Chickenpox?
- 💧 adequate fluids intake to avoid dehydration
- 👕 dress appropriately to avoid overheating or shivering
- 👗 wear smooth cotton fabrics - avoid irritation
- 😩 avoid scratching lesions, and keep nails short to minimise damage from scratching
- avoid pregnant women 🤰🏾, 🦠 immunocompromised ppl, infants under 4 weeks 👶 and school or nursery essp in most infections period.
91
What is Molluscum Contagiosum?
🦠 This is a **viral** skin infection common in children mostly 👧🏽
It presents as small, painless, papules and is usually self limiting, thus not really requiring treatment.
92
Are the papules seen in mollascum contagiosum contagious?
YES!
93
Should px be excluded from school or work due to mollascum contagiosum?
NO - this is not necessary, however the lesions should be covered with waterproof bandages or clothes essp prior to using swimming pools
94
Which virus is responsible for the manifestation of cold sores (*herpes labialis*)?
Herpes Simplex Virus 1 (HSV1) 🦠
95
How do cold sores manifest?
- They’re vesicular blistered located on the upper or lower lip👄
- **Their appearance may be preceded with a tingling or a burning sensation 😩 🔥**
- with time the blisters will dry, forming a crust.
96
Are cold sores contagious?
YES until the lesions have healed and crusted over.
They are *self limiting though*
97
What factors may trigger the development of a cold sore?
- stress 😣
- injury 🤕
- systemic infection (fever) 🥵
- immunosupression 💊 🦠
- tiredness 🥱
- menstruation 🩸
- sunlight ☀️
98
What are some therapeutic management strategies for cold sores?
💊**analgesia for pain and fever if needed**
- topical antiviral creams , lip barrier preps, mouthwashes etc - **not** routinely recommended (the virus is self limiting) however some px find that they hep
-
**- oral antivirals - for ppl who are healthy with frequent or persistent or severe lesions, or immunocompromised etc**
- lip sunblock for px whose cold sores are triggered by the sun
99
What are the prodromal symptoms of herpes simplex (cold sores)?
- fever 🥵
- sore throat 😩
- lymphadenopathy 🟢
- initial feelings of pain, burning and tingling ⚡️ and itching may precede visible lesions and can last for 6 - 8hrs 🔥
100
What is some self care advice you can give to patients with cold sores?
- paracetamol or ibuprofen if they are in pain or have a fever
- reassure the px that oral herpes simplex is usually self limiting and lesions should heal without scarring
- adequate fluid intake to avoid dehydration
- advice about spread - its easily spread to other ppl and so avoid kissing and oral sex until lesions have FULLY healed
- do NOY share items that come into contact with the lesions, ie makeup and lip balms
- avoid touching the lesions, other than when applying topical preparations - these should be dapped on rather than robed to minimise the amount of mechanical trauma to the area
- do not share topical treatments with others
No need to avoid work or school because of the lesions
101
What is Urticaria?
Hives
A **non infections dermatitis** characterised by the presence of **wheals and itchy skin**
102
What triggers the developement of hives
- the release of histamine and other inflammatory messengers in the skin - this may result from an allergic reaction, exposure to cold or heat or infections (ie common cold) or they can be drug induced.
103
Urticaria is evanescent - what does this mean?
The hives suddenly appear and then disappear after a few hrs
- the presentation is very short lived
104
105
Which layer of the skin does Urticaria typically affect?
The dermis; papillary (upper) dermis - this is where histamine and other inflammatory mediators that cause vasodilation and increased permeability are found
- hence wheals and itching
106
What is angiodema?
A deeper swelling of the skin (lower dermis and the hypodermis/sc tissue) and the mucous membranes caused by fluid leakage from leaky blood vessels.
107
What typically causes angiodema and urticaria?
Allergic reaction and anaphylaxis
108
Is the epidermis involved in angiodema or urticaria?
NO - hence there is no scarring. Also the epidermis remains intact thus there is no blistering or peeling, just raised itchy areas
109
Where does angiodema commonly present?
- the eyes (eyelids) 👀
- lips 👄
- hands ✋
- feet 🦶
‼️ if it affects the tongue 👅 or throat 🐐 the px may experience difficulty swallowing or breathing - rx **adrenaline autoinjectors**
110
What are some therapeutic treatments for urticaria?
1. Identify and avoid triggers
2. Advise px that it’s typically self limiting without treatment
3. Can offer a non sedating antihistamine (ie fexofenadine, cetirizine, for up to 6 weeks if necessary
4. If symptoms are severe- short course of oral corticosteroids (ie oral prednisolone)
5. Calamine lotion may help to relieve itch if 1st line option not working
111
What is acne vulgaris?
A pilosebaecous (involves hair follicle and sebaceous gland) skin disease.
It can present as open or closed comedomes (blackheads, whiteheads), pustules, nodules and cysts.
112
What causes acne?
**An overproduction of sebum** 🧈 accompanied by a **blockage of the pores by a mix of sebum and dead cells.**
- **the blocked pores can then become contaminated by usually harmless commensalism bacteria which causes the inflammation of production of pus**
113
Is treatment for acne instantaneous?
NO - it will need to be continued for a long period of time before the patient notices improvement.
114
What are some agents that can b used to treat acne vulgaris?
- keratolytics ie (salicylic acid)
- benzoyl peroxide (acnecide)
- azeilic acid 20% cream
- topical retinoids - potentially irritant
Topical antibiotics - however there is a risk or resistance and this is for inflammatory acne
- oral ABx - must be lipid soluble
-hormone treatment (COC)
- isotretinoin (2ndary care)
115
What are some common myths and misconceptions about acne?
- **caused by having poor hygiene and dirty skin** - actually due to biological reactions beneath the skin (overproduction of sebum) and blockage of the pores
- **squeezing blackheads and whiteheads and pustules is the best way to get rid of spots** - will be painful, may lead to scarring and can increase (n) of spots in affected area
- **infectious** - it is not
- **toothpaste will dry it out** - will damage skin and can be irritant
116
Which topical antibiotics can be used for acne?
Macrolides such as :
- erythromycin
- clindamycin
117
Which oral ABx can be used for acne and when/ what is the rationale?
If acne fails to respond to topical preparations - lymecycline and doxycycline (tetracyclines) can be used in conjunction with other medications (ie benzoyl peroxide or topical retinoid)
⚠️ do NOT use topical and oral ABx together - increased risk of ABx resistance
118
Give two examples of retinoids that can be used to treat acne and their general mechanism of action?
💊 Tretinoin, adapalene - available as gels or creams
MOA - they work by removing dead skin cells from the surface of the skin which helps to prevent them from clogging pores and building up within hair follicles (they are exfoliative).
119
What is some general advice to give to a px initiated on oral tetracyclines for acne?
- they make your skin more sensitive to sunlight and UV light - wear sunscreen and avoid tanning beds
- they can make the contraceptive pill much less effective in the first few weeks of treatment - need to wear an alternative contraception during this time
120
What are some general counselling tips to give to a px just started on a retinoids for acne?
- apply OD before bed
- use sparingly
- avoid excessive exposure to UV or sunlight - wear sun cream
- may cause mild irritation and stinging of the skin bc its an exfoliant
- ❌ not suitable in pregnancy - may cause birth defects
121
Which hormonal treatment is recommended for acne?
Combined oral contraceptive pills - even if the woman is not sexually active they may benefit.
⚠️ small risk of developing a blood clot.
122
Can a pharmacist prescribe and initiate treatment using Isotretinoin for acne vulgaris in clinic?
NO - it must be initiated by a specialist only
123
What is some self care advice you can give to patients with acne?
- 🧼 avoid over cleaning the skin - may cause dryness and irritation (acne is not caused by poor hygiene)
- 💧 to use a non - alkaline, pH neutral skin detergent cleansing product BD on acne prone skin
- 🧈 avoid oil - based comedogenic skin care products, make up and sun screen
- 💄 makeup should be removed by the end of the day
- 😩 persistent picking and scratching at the lesion can increase the risk of scarring
- 🧴 treatments may initially irritate the skin
- maintain a balanced and healthy diet
124
What are the risks associated with Isotretinoin capsules?
- 🤱 🤰🏾 teratogenic - avoid in pregnancy and breastfeeding
- 😔 🍆 risk of erectile dysfunction and reduced libido
- 😢 🧠 risk of neuropsychological SE - depression, anxiety, changes to mood and behaviour
- ☀️ avoid direct exposure to sunlight and UV - wear sun cream
💳 ensure px hae a Patient Reminder Card
125
What is eczema?
Eczema is a broad term used to encompass a variety f skin conditions characterised by **dry itchy and irritated skin**.
There are different types of eczema.
126
What are the different types of eczema
- **atopic dermatitis**- most common - dry , red itchy skin
- **seborrheic dermatitis** - associated with sebaceous glands and fungus/yeast - typically on scalp
- **contact** - occurs when skin comes into contact with an allergen - avoid! There are different types of this such as allergic contact and irritant contact dermatitis
*irritant dermatitis* - inflamed, red and itchy skin that occurs after the skin surface is breached by a substance. Typical irritants include chemicals, shampoos, hair dyes etc
*allergic dermatitis*- this is a delayed type.4 hypersensitivity reaction carried out by T lymphocytes in the epidermis. They are triggered by the presentation of an antigen and provide an immune mediated, allergic reaction. Some causes include dhesives, certain topical ABx, clothing, nickel, and other metals, rubber or latex, poison ivy etc
Others include …
- varicose
- photo aggravated
- chronic actinic
- discoid
- lichennitidisu
- pytiriasis all a
127
What does “atopic” mean?
A genetic tendency to develope an allergic disease (ie hay fever, asthma, eczema)
128
What are the characteristics of atopic dermatitis ?
- **red, inflamed itchy skin - may be on the face, arms, trunk, fingers , in some px - may get fissures (severely dry skin) etc** ⚠️ in some cases px may get BLISTERS!
- px may fluctuate between latent and active flare ups
- chronic condition - usually present in childhood and may disappear in paediatric px as they get older
- cause unknown - multifactorial- however has been found that disruption in the flaggrin protein (used to maintain skin barrier function) may be a contributing factor
- ‼️
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Give some examples of some triggers that may trigger atopic dermatitis?
Hormonal changes 😔
Food allergies 🤧 🥜
Exposure to irritants and allergens 🧼
Exposure to some materials and fabrics 👕
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Outside active phases ( flare ups of eczema) the skin of a px with atopic dermatitis may appear normal. How is this maintained?
- adequate and frequent skin hydration, using *emollients*
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What are some complications of atopic dermatitis?
- psychosocial - ie due to physical appearance and the burden of having to manage skin all the tie
- secondary infections due to the loss of barrier function associated with eczema skin
- ⚠️ erythema atopic dermatitis - severe complication where the skin has widespread redness, can also occur in association with other Inflamm skin conditions
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What are two major reasons we need to be careful when rx **oral corticosteroids** 👄 to treat atopic dermatitis in **children** 👧🏽
- 🧈 increases central obesity
- 📉 reduced growth speed
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What is the 1st line therapeutic management for eczema?
- topical emollients (ie creams,lotions, ointments, sprays) - **usually topical corticosteroids**
- 🌅 these need to be applied after baths and showers and frequently during the day to keep the skin moisturised and smooth over time
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Which dosage form of emollients are typically used in eczema?
- ✅ ointments are oilbased products and have a longer contact time with the skin resulting in a greater extent of drug absorption, however creams and lotions which have >er content are preferred by px as they do not leave an oily and greasy film on the skin
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Why is prolonged use of corticosteroids not recommended?
- change in skin colour
- decreased efficacy with use of
- withdrawal
- cataracts and glaucoma
- systemic absorption
- acne or worsening of acne
- skin atropy - ie thinning of the skin
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How do we typically measure dosing for use of topical corticosteroids?
Finger tip units - one FTU is abt 500mg of product and is typically sufficient to treat a surface area equal to 2x the area of adult palm
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What is the 2nd line treatment for atopic dermatitis?
- calcineurin inhibitors (ie Tacrolimus and picrolimus)
- ⚠️ can be prescribed only by consultant dermatologists and GPs with specialist interest in dermatology
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What is the mechanism of action for calcineurin inhibitors in atopic dermatitis?
- they inhibit calcineurin and prevent inflammatory reactions associated with atopic dermatitis
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What is the benefit of using calcineurin inhibitors ore topical corticosteroids for the treatment of atopic dermatitis?
:) the benefit vs topical corticosteroids is they **do not cause skin thinning**
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What is psoriasis?
An inflammatory condition of the skin characterised by red, flaky, crusty plaques (elevated skin) covered with silver scales!
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How does the physical/visual manifestation of inflamed skin differ in eczema vs psoriasis?
- **eczema** - dry, red, itchy and flaky however may weep too - no scales
- **psoriasis** - scaly and often associated with erythema (red skin) and plaques, where the skin, lesions are raised
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What is the mechanism of pathology for psoriasis?
The exact cause is not known however it is associated with an accelerated turnover of epidermal cells (taking days instead of weeks)
It is considered a T lymphocyte auto - immune condition where T cells accumulate in the skin. Upon activation following antigen presentation, the T cells trigger an immune reaction - cytokine release - promotes fast growth and maturation of the epidermal cells.
- this causes the **epidermis to THICKEN** whilst the increased blood supply to the area is responsible for the reddening of the lesions d
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What are the different types of psoriasis?
Plaque - raised erythematous patches of skin with silvery scales
Guttate - lots of circular patches of erythematous scaly skin around the whole body (the lesions are smaller and thinner than plaque, often following a bacterial infection
Scalp - present on the scalp and or perimeter of scalp and nape of neck
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What are some therapeutic treatments for the treatment of psoriasis?
- 🧴 topical treatments - emollients, corticosteroids, vitamin D analogies, coal tar,
- ☀️ light therapy , ie UVB, PUVA
- 💊 systemic therapy (MTX, cyclosporin )
- 💉 biologics - anti - TNFA , anti - interleukins
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what should a patient do to prevent the spread of mollascum contagiousum?
Thus the px should **avoid sharing towels, clothing or bedding until the lesions resolve**
The px should also **avoid scratching and squeezing the lesions to avoid the spread of infection and also reduce risk of superinfection**
