Dermatology: eczema, acne and psoriasis Flashcards
(44 cards)
What is the major form of eczema?
Atopic
What makes the skin barrier dysfunctional in eczema?
Conversion of keratinocytes to protein/lipid scales in INTERRUPTED, causing water loss, hyper-reactivity and infection
- T helper cell dysregulation also thought to be involved
What are the risk factors of eczema?
- stress
- genetics
- pollen and pets
- rough clothes
- contact allergens
- soap and detergent
- extreme temperatures
- house dust mites
- certain foods
- skin infection
- hormones
What sort of disease is eczema?
A chronic disease with flares
What symptoms are experienced with eczema?
- Itchy, inflamed, dry skin (accompanied by scratching)
- Papules and plaques main features
- Can become weeping, crusted, blistered, scaling, thick
- Sleep disturbance common (itching)– big impact
Describe mild eczema and treatments
Some dry skins, some itching, a little redness
- emollients are first line treatment (improve skin barrier, reduce number of flares and have a steroid sparing effect – apply liberally)
- mild topical steroid if inflamed skin, spread thinly using FTU
Describe moderate eczema and treatments
Dry skin, itching, redness, some thickening
- increase emollient use
- moderate potency topical steroid. Start with hydrocortisone on sensitive areas. Aim for max 7-14 day use, 5 if on sensitive areas
- consider trial of non-sedating antihistamine if itch present, review 3 months after
- If needed between flares:
- Use low potency steroid (consider intermittent use)
Topical calcineurin inhibitors (tacrolimus) second line options by specialist
Review use every 3-6 months
Describe severe eczema and treatments
Widespread as above, skin thickening, bleeding, oozing, etc
- treatment: same as moderate +If itch affecting sleep, consider sedating antihistamine
Consider oral corticosteroid (prednisolone)* if severe symptoms and distress.
Consider between flares:
Use lower potency steroid (consider intermittent use)
Topical calcineurin inhibitors (tacrolimus) second line options by specialist
Review use every 3-6 months
Describe infected eczema and treatments
Weeping, crusted, pustules, +/- systemic symptoms Oral antibiotics (flucloxacillin for about 2 weeks) may be required, if localised infection use topical
Name 2 light emollients
E-45
Diprobase
Name 2 moderate emollients
Oilatum
Hydrous crm
Name Greasy emollients
50% white soft/liquid
Epaderm
Emulsifying
Name low potency topical steroids
Hydrocortisone 0.1, 0.5, 1, 2.5%
Name moderate potency topical steroids
Clobetasone butyrate 0.05%
Betamethasone valerate 0.025%
Name potent topical steroids
Betamethasone valerate 0.1%
Betamethasone dipropionate 0.05%
How should emollients be used?
- Use emollients frequently and liberally, even when skin is clear
- apply 30 mins before corticosteroids
- Some contain urea, lanolin, antiseptics. Try to avoid where possible
- Do not prescribe aqueous cream (contains SLS - irritation)
How long should you continue steroids for after inflammation has reduced?
48 hours after inflammation has reduced
What is psoriasis?
- Chronic, inflammatory disorder of skin and joints (relapsing remitting in nature)
- Vulgaris (chronic plaque) 80% of plaque psoriasis sufferers have mild-moderate severity disease managed in primary care using topical therapy.
- more of a systemic illness
What causes psoriasis
Inflammatory cells present in all layers of psoriatic skin leading to epidermal hyper proliferation and vascular changes.
Particularly important role for T cells, TNF alpha and interleukins.
- hyper proliferation of cells - 40x higher turnover
When does psoriasis present?
First presentation between 15-25 years, then 55-60
- mainly effects Caucasian people
What are the risk factors for psoriasis?
- obesity
- smoking
- alcohol
- genetics
- hormones
- medications
- skin injury
- stress
- infection
What symptoms present with psoriasis?
- Commonly affecting the buttocks, lower back, scalp, elbows, knees, nails.
- Thick, scaly skin (acanthosis and hyperkeratosis)
- May bleed if scales scraped off
What are some complications of psoriasis?
- Psoriatic arthritis – screening for symptoms and use of PEST tool
- Depression/anxiety – screening at appointments for symptoms
- Metabolic syndrome and CVD – lifestyle modification, screening
What is included in the treatment of psoriasis?
- Emollients, steroids. See patient advice/practical use sections in eczema
- Ointment for thick scale, cream/lotion/gel for larger areas, lotion/solution for scalp
- Caution with potent/very potent corticosteroids, 4 week break between courses
- Treat for 4 week blocks, importance of regular review must be stressed
