Name 8 possible causes of Erythema nodosum
- Group A beta-haemalytic streptococcus
- Sarcoidosis
- Leprosy
- Pregnancy
- Primary TB
- Malignancy
- IBD
- Chlamydia
Name 3 skin conditions that can have a feature of nail pitting
- Psoriasis
- Eczema
- Alopecia areata
What topical alternative can be given to treat atopic dermatitis (eczema) if topical steroids cannot be used?
Topical Tacrolimus (Calcineurin is inhibited so less IL2 is produced so less T cells are produced so you get less of an immune response)
What would you prescribe for symptomatic relief of atopic dermatitis?
What route and name of drug?
Oral Chlorphenamine (antihistamines)
Name 3 possible secondary viral complications of eczema
- Molloscum contagiosum (pearly papules with central umbilication)
- Eczema herpeticum
- Viral warts
What is the name of an inflammatory disease of the pilosebaceous follicle?
Acne vulgaris
Name 3 causes of Acne vulgaris
- Androgens
- Increased sebum production
- Bacterial colonisation(e.g. Propionibacterium acne)
Acne:
If a comedone is open, what is the layman term for it?
If a comedone is closed, what is the layman term for it?
Open comedones: blackheads
Closed comedones: whiteheads
How do you treat mild ance vulgaris (non-inflammatory lesions) (3)?
What lesions are present in mild acne?
(Open and closed) comedones
Treatment:
- Topical Benzoyl peroxide
- Topical antibiotics (e.g. Fusidic acid)
- Topical retinoids (comedolytic and anti-inflammatory properties)
What are 2 treatment options for moderate to severe acne vulagris?
Name 4 lesions that may be present in this type of acne.
Papules, nodules, pustules, cysts
Treatment:
1. Oral antibiotics
- Oral anti-androgens (for women)
Name 1 treatment option for severe acne vulgaris
- Oral retinoid - Isotretinoin
What is Auspitz sign?
Name a condition it is seen in
Seen in psoriasis.
Scratch and gentle removal of scales, leasing to capillary bleeding
Name 2 nail deformities seen in psoriasis
- Nail pitting
2. Onycholysis (nail plate detaching from nail bed)
After checking nails, scalp and mucous membranes, in a psoriasis examination, what do you want to check next?
Why?
What are 3 signs in this condition?
Joint - psoriatic arthritis (is pauciarticular, asymmetrical, inflammatory signs - early morning spine stiffness)
What is the difference between Cellulitis and Erysipelas (via definitions and upon examinations)?
Cellulitis is inflammation of deep subcutaneous tissue, where as Erysipelas is inflammation of the dermis and upper deep subcutaneous tissue.
Clinically: Erysipelas has well defined raised red border
Describe your full treatment plan for mild atopic eczema
Emollients (paraffin): use as a soap substitute and a cream (for very dry skin can use every 2-3 hours). Can use creams during the day and then ointments (for very dry skin) at night time. Ointments are more oily. Examples: Dermol 500, Hydromol, Xeroderm, Doublebase, (E45, Aveeno + CeraVe are also emollients)
Advise: Keep using emollient, even when flare up is not present or eczema seems to have gone, highly flammable (due to the paraffin) so keep body and cream bottle away from open flames, apply emollient on damp (not wet) skin and smooth it in, don’t rub it in. After putting on the emollient, wait 30 minutes before putting on the steroid.
General advise: avoid triggers (e.g. soaps, perfumes), don’t change your diet unless you have been advised to by a nutrition specialist
Mildly potent topical corticosteroid - Hydrocortisone (0.1, 0.5, 1 and 2.5%): put only on the red/flared up skin once a day; continue using it for 48 hours after flare up has gone. Don’t abuse the use of steroids as can lose pigment and thin out the skin (so use within limits to avoid these side effects). Highly unlikely to get moon face as you are using the topical version so hardly anything enters your system and if you don’t abuse the use of it, you will be fine.
Refer: if eczema is found on the face
Describe your full treatment plan for moderate atopic eczema (5)
- GENEROUS use of Emollients (same advice as mild AE)
- Also give a topical moderately potent corticosteroid: Betnovate RD (0.025%) (same advise as mild EA)
- If the eczema is itchy or has urticaria, give a non-sedating antihistamine (Certrizine)
- Apply dry bandages if needed - to protect the skin
- Same general advice as mild EA
If the moderate eczema is on delicate regions, describe the topical steroid treatment plan
If the moderate eczema is on the face or flexure areas - consider giving a mildly potent topical steroid. You can then step up to a moderately potent topical steroid if it doesn’t work.
Aim for a maximum of 5 days treatment.
Describe the preventative treatment options, in moderate and severe eczema (if flare ups are common) (2).
(Treatment plan is the same)
1st option: Step down approach of topical steroids to be used on eczema areas (apart from axilla, genitals and groin)
2nd option: If steroids can’t be used, then they can use a Calcineurin inhibitor (Tacrolimus)
Describe how you will treat Infected eczema
- Extensive area of eczema
- Localised area of eczema
Extensive area of eczema:
1st line is oral Flucloxacillin. 2nd line is Erythromycin if patient has had a poor history with Flucloxacillin. If patient has had previous nausea/cramps with Erythromycin, then can give Clarithromycin instead.
Localised area of eczema:
Can give a topical antibiotic - should not be used for more than 2 weeks.
(Can also use steroids whilst using this antibiotic).
Describe your full treatment plan for severe atopic eczema (5)
- GENEROUS amount of Emollient (same advice as mild AE)
- Also give a potent topical steroid (Betnovate 0.1%)
- For face and flexures (delicate areas), should give a moderately potent topical steroid, then can step up if it doesn’t work
- Dry bandages
- Uriticaria, itching + sleep is not affected = Certirizine (non sedating antihistamine)
- Urticaria, itching + sleep is affected = Chlorphenamine (sedating antihistamine)
If there is severe, extensive eczema causing psychological distress, what additional treatment should you give?
Oral 30mg Prednisolone every morning for 1 week
An alternative diagnosis to urticaria is vasculitis urticaria.
Describe how vasculitis urticaria will present.
(4 descriptions for the lesion)
(3 descriptions for the systemic symptoms)
Lesions:
- remain for longer than 24 hours
- are painful
- non-blanching
- and palpable (leaving a residual pigmented lesion, such as petechial haemorrhage, purpura, or bruising)
Person also has systemic symptoms:
- fever
- malaise
- arthralgia
What should be your treatment for mild to moderate urticaria?
Cetirizine (non-sedating antihistamine) for up to 6 weeks
