Skin - Eczema, Psoriasis Flashcards
(14 cards)
What is eczema?
types of eczema are irritant, allergic contact, atopic, venous and discoid
Dry, flaky skin that may be inflamed
and have small red spots
- can be itchy and irritated
skin may be broken and weepy
and sometimes thickened
What is the first line treatment for eczema?
What are the treatment options?
1st line - emollients: frequent and liberal use
topical corticosteroids
- hydrocortisone: >10 yrs
- clobetasone: >12 yrs
- can use mild on face and genitals
antihistamines: NOT in atopic eczema
pimecrolimus: mild to moderate eczema
tacrolimus: moderate to sever eczema
ciclosporin, azathioprine (unlicensed) and mycophenolate mofetil (unlicensed): severe refractory eczema
What are the potencies for topical corticosteroids?
mild: hydrocortisone (>10yrs)
moderate: alclometasone, clobetasone (>12yrs), hydrocortisone butyrate
potent: beclometasone, betamethasone, mometasone, fluticasone, fluocinonide
very potent: clobetasol
What is psoriasis?
chronic relapsing inflammatory disorder
salmon-pink lesions with silvery white scales and well-defined boundaries
- epidermal thickening and scaling
What medications can trigger psoriasis?
lithium
chloroquine and hydroxychloroquine
beta-blockers
NSAIDs
ACE inhibitors
What are the treatment options for psoriasis?
1st line: topical treatment
- emollients, topical corticosteroids, coal tar preparations, and topical vitamin D or vitamin D analogues
What is the recommended treatment duration for topical corticosteroids in psoriasis and why?
potent corticosteroids
- 8 weeks consecutive use: max
very potent corticosteroids
- 4 weeks consecutive use: max
can be restarted after a 4-week ‘treatment break’
non-steroid treatments may be continued during this time.
long term use may cause psoriasis to become unstable, and lead to irreversible skin atrophy and striae
wide spread use (>10% of BSA) may cause systemic and local side-effects
What is used for psoriasis if topical treatment has failed?
phototherapy
- UVA +/- UVB
systemic treatment
- methotrexate, ciclosporin, acetriten (2nd line)
What is the treatment for psoriasis of the trunk and limbs?
1st line
- potent topical corticosteroid and a topical vitamin D or vitamin D analogue applied ONCE daily (at DIFFERENT times of the day) for up to 4 weeks as initial treatment (8 weeks maximum)
2nd line
- topical vitamin D or vitamin D analogue alone applied TWICE daily for 8-12 weeks
3rd line
- potent topical corticosteroid applied TWICE daily for up to 4 weeks, or a coal tar preparation
4th line
- dithranol
What is the treatment for scalp psoriasis?
1st line
- potent topical corticosteroid applied ONCE daily for up to 4 weeks as initial treatment.
2nd line
- consider different FORMULATION of potent topical corticosteroid +/- topical agents (e.g. salicylic acid, emollients, oils) for 4 weeks
- apply these agents first
3rd line
- calcipotriol with betamethasone for up to 4 weeks
4th line
- very potent corticosteroid applied TWICE daily for 2 weeks, or a coal tar preparation, or refer
What is treatment for facial, flexural, and genital psoriasis?
1st line
- mild or moderate potency topical corticosteroid as initial treatment for 1-2 weeks/month
2nd line
- topical calcineurin inhibitor, such as pimecrolimus or tacrolimus [unlicensed indications], for up to 4 weeks
What are the different topical vitamin D drugs?
calcipotriol
calcitriol
tacalcitol
What are the cautions for vitamin D topical preparations?
avoid excessive exposure to sunlight and sunlamps
avoid use on face
erythrodermic exfoliative psoriasis - enhanced risk of hypercalcaemia
generalised pustular psoriasis - enhanced risk of hypercalcaemia
When are vitamin D and analogues contraindicated?
hypercalcaemia
- monitor calcium levels
