Eczema
Trigger
Think occupation
FH atopy
Emollient
Soap sub
Steroids moderate to body mild to face and eyelids
Consider calitonin inhibitors eg tacrolimus
Refer if not respond to steroids, ? Allergic/ occ, uncertain diagnosis, infected
Eczema hepeticum- hSV infected severe straight to hospital
Psoriasis
Plaques
Silvery on red
Itchy
Associated metabolic health
Plaque, scalp, guttatae, flexural, pustular, erythrodermic
Triggers- meds, b blockers, nsaids ace i
Nail changes
Joint involvement
FH
Explanation: psoriasis a skin condition that occurs because there is a faster alternative skin cells than usual this results in a buildup of cells on the top left of the skin which causes plaque to form. It’s not really understood why it also has sushi to skin inflammation.
Triggers can include stress, infection, medication, smoking sunlight, and injury
Some people get nail and joint involvement
It is a chronic conditioner with no definitive cure
Treatment avoid triggers
Emollient
Corticosteroids and vitamin D for up to 4 weeks
If not satisfactory control just vitamin D applied twice daily
It’s still not adequate control 8 to 12 weeks of potent steroids or cold
Specialist- dithranol
Scalp psoriasis treat thick Plex then apply steroids or combination agents of calcipotriol and steroid
Nail psoriasis, topical steroids and salicylic acid or vitamin D analog (calcipitriol)
Specialist initiation PUVA or biological therapy
Refer erythroderma to Hospital

Acne
Acne
Common
Face neck back
Teenage-often improve
PCOS association
Blackheads, pustules, papules
Mild: topical combination
Antibiotic/retinoid/ BpO
Epiduo should be first choice
Duac antibiotic BPO
Epiduo BPO and retinoids
Treclin retinoid antibiotics
Review 12 weeks- can take 6 -8 weeks to have effect
- stop oral antibiotics at 3 months - continue topical tx for another 3 months then stop all at 6 months
- long term can be considered if request relapses -epiduo but review every 3 months
See effects dry skin and irritation- reduced by titrating application
Mod
Oral antibiotic - lymecycline, doxycycline with Epiduo
-Cocp - 3rd generation, diabetes can be used if failed other for 3 months only- increased VTE risk.
PCDS recommend Eloine or Mercilon
- or 20mcg oestrogen
-spironolactone- women only, need contraception, u&e for potassium
-start 50mg
Severe- refer
-oral retinoids- dermatology initiate
-give PiL about
- do lfts and cholesterol
- side effects- eyes, ??mental health, cholesterol , dry skin
-teratogenic
-sexual dysfunction
If wanting pregnancy can have just BPO monotherapy.
Acne questions
Distribution
Duration
Affect on quality of life and mental health
PCOS symptoms- hirsuitism, periods, family history, BMI
Plans for fertility / contraception
Other medication
Steroids
Smoking
Rosacea
Facial flushing
Papules and pustules
Triggers such as sunlight, caffeine, alcohol exercise , spicy food, emotional stress
No blackheads
Often occurs more in the >30 peak 40-50 yrs
F:M 3:1
Effects 5-10% population
DD- acne perineal dermatitis
Tx- for 8-12 weeks-topical Invermectin for papules, topical metronidazole, topical azeliac acid( 8/52 only)
Moderate combine with oral antibiotic- lymecycline 8-12 weeks or doxycycline- low dose MR once daily
For flushing-brimonidine
- only 70% effective
-in some can cause rebound flushing or worsen symptoms
- gradual increase it
- not on broken skin can cause systemic dizziness and bradycardia
If not successful refer for oral
isotretinoin
Rosacea is a common chronic relapsing inflammatory skin condition affecting the centrofacial region (i.e. the glabella of the forehead, cheeks, nose and chin with sparing of the perioral and periocular skin).
Commonly relapsing remitting with 50% of people having recurrence by six months
Thought to be related to a commensal on the skin a type of mite that causes irritation and inflammation
examination erythema, papules,telengectasia,
If these are not present, there needs to be two major clinical features which are both present to diagnose rosacea:
Transient erythema is temporary facial flushing which affects the centrofacial area and can extend to the neck and anterior chest wall, or
Inflammatory papules and pustules in the centrofacial area, or
Telangiectasia: in the centrofacial area; telangiectasia are multiple dilated small blood vessels (broken capillaries) that blanch on pressure, or
Ocular manifestations: 58% of patients with rosacea have ocular involvement which can include lid margin telangiectasia, blepharitis, conjunctivitis, keratitis or anterior uveitis.
Tx-
Avoid trigger
UV protection
Review medication- no topical steroids, calcium channel blockers can worsen.
Perioral dermatitis
In periorificial dermatitis, symmetrical papules and pustules are seen around the perioral +/- the periocular area with sparing of the vermillion border of the lip (rosacea does not tend to affect the perioral and periocular skin).
Background erythema with occasional surface scale is seen
Seborrhoic dermatitis
Seborrhoeic dermatitis is the overproduction of the Malassezia yeast.
This yeast causes a background erythema with an associated yellow/white surface scale with a greasy appearance.
Seborrhoeic dermatitis affects sebum-rich areas of the scalp, glabella, medial aspect of the eyebrows, eyelids, ear canal/post-auricular areas and nasolabial folds. These sebum-rich areas are spared in rosacea.
