Inflammatory Skin Conditions

Question 1

What is atopic eczema commonly associated with?

Answer 1

Hayfever

Asthma

Question 2

Describe the epidemiology of atopic eczema

Answer 2

Childhood condition - can resolve during teenage years
20% prevalence in <12yo
Runs in families

Question 3

What are the exacerbating factors of eczema?

Answer 3

Infections
Allergens - chemicals, food, dust, pet fur
Sweating
Heat
Severe stress

Question 4

What genetic defect is associated with atopic eczema?

Answer 4

Skin barrier function defect - loss of function of filaggrin proteins

Question 5

What are the main symptoms of eczema?

Answer 5

Itch!!! - must have this
Cyclic symptoms - get worse and better
Flexural surfaces

Question 6

What signs are seen in eczema?

Answer 6

Acute lesions are erythematous, vesicular and weepy

They may have a discoid appearance or a follicular pattern

Question 7

What can happen if lesions are chronically scratched?

Answer 7

Excoriations

Lichenification

Question 8

What nail changes can be seen in eczema?

Answer 8

Nail pitting and ridging

Question 9

How is mild eczema treated?

Answer 9

Reduce exposure to the trigger
Regular use of emollients - generous use!
Intermittent corticosteroids - 1% hydrocortisone

Question 10

How long should 1% hydrocortisone be used for in mild eczema?

Answer 10

48 hours after the flare up has calmed down

Question 11

How is moderate eczema treated?

Answer 11

as above
Moderately potent topical steroid - 0.025% betamethasone
Non-sedating anti-histamine to help with itch
Topical calcineurin inhibitors for prevention- tacrolimus

Question 12

How is severe eczema treated?

Answer 12

Potent corticosteroid - 0.1% betamethasone or 0.05% clobetasone

Flexural areas and face - 0.025% betamethasone
Antihistamine

Question 13

What are betnovate and dermovate?

Answer 13

Betnovate - betamethasone

Dermovate - clobetasone

Question 14

What other therapies can be used?

Answer 14

Phototherapy

Question 15

How are infected wounds in eczema treated?

Answer 15

Swab all infected area
Empirical Antibiotics - flucloxacillin or clarithromycin if pen allergic

Pick antibiotic based on sensitivity from swab

Question 16

What are the complications of eczema?

Answer 16

Secondary infection - bacterial or viral

Question 17

What can secondary viral infections due to eczema be caused by and lead to?

Answer 17

Molluscum contagiosum

Lead to viral warts and eczema herpeticum

Question 18

What is acne vulgaris? How common is it?

Answer 18

Inflammatory disease of pilosebaceous follicle

Over 80% of teenagers 13-18

Question 19

Why is acne vulgaris particularly common in teenagers?

Answer 19

Androgens increase with puberty

Question 20

What factors can contribute to acne vulgaris?

Answer 20

Increased sebum production
Abnormal follicular keratinisation
Bacterial colonization - propionibacterium acnes
Inflammation

Question 21

How does mild acne vulgaris present?

Answer 21

Non-inflammatory lesions with mixed open and closed comedones (blackheads and whiteheads)

On face, chest and upper back

Question 22

How does moderate-severe acne vulgaris present?

Answer 22

Inflammatory lesions - papules, pustules, nodules and cysts

On face, chest and upper back

Question 23

How is acne managed?

Answer 23

General measures
Topical therapies for mild acne
Oral therapies for moderate to severe acne
Oral retinoids

Question 24

What general measures are suggested for acne?

Answer 24

Don’t over clean
Choose make up cleaners appropriately
Avoid squeezing spots - scar
Maintain healthy diet

Question 25

What topical therapies can be given for acne?

Answer 25

Benzoyl peroxide Topical clindamycin (antibiotic based on guideline) Topical retinoids

Question 26

What oral therapies can be given for acne?

Answer 26

Oral abx - doxycycline | Anti-androgen - female

Question 27

What do you have to be aware of with prescribing oral retinoids?

Answer 27

Oral retinoids such as Isotretinoid are teratogenic - girls must be on contraception and have regular LFT and lipid checks

Question 28

What complications are associated with acne vulgaris?

Answer 28

Post inflammatory hyperpigmentation Scarring Deformity Psychological and social effects

Question 29

What is psoriasis?

Answer 29

Chronic inflammatory skin disease due to hyper-proliferation of keratinocytes and inflammatory cell infiltration Affect 2% of population

Question 30

What are the types of psoriasis?

Answer 30

``` Chronic plaque psoriasis (most common) Guttate - raindrop lesions Sebhorrhoeic - nasolabial and retroauricular Flexural - body folds Pustular - palms and soles of feet Erythrodermic - total body redness ```

Question 31

What can precipitate psoriasis?

Answer 31

``` Trauma - Koebner phenomenon Infections - tonsilitis Drugs Stress Alcohol ```

Question 32

What is koebner phenomenon?

Answer 32

Skin lesions appearing on lines of trauma

Question 33

How does psoriasis present?

Answer 33

Well demarcated erythematous scaly plaques Common on extensor surfaces and over scalp Auspitz sign 50% have nail changes 5-8% have psoriatic arthropathy

Question 34

What is auspitz sign?

Answer 34

Scratching and gentle removal of scales leads to bleeding

Question 35

What nail changes are seen in psoriasis?

Answer 35

Onycholysis - nail detach from nail bed | Pitting

Question 36

What general measures are suggested for psoriasis?

Answer 36

Avoid precipitating factors | Emollients - reduce scales

Question 37

What topical therapies can be given for psoriasis?

Answer 37

``` Vit D analogues Topical corticosteroids Coal tar preparations Dithranol Topical retinoids Keratolytics Scalp preparations ```

Question 38

What can be used in psoriasis management?

Answer 38

General measures Topical therapies Phototherapy Oral therapies

Question 39

What oral therapies can be used for psoriasis?

Answer 39

``` Methotrexate Retinoids Ciclosporin Mycophenolate Fumaric acid esters Biological agents ```

Question 40

What complications are associated with psoriasis?

Answer 40

Erythroderma | Psychological and social effects