Transcript BLISTERING CONDITIONS, DRUG REACTIONS

ECZEMA
DR SIVANIE VIVEHANANTHA
DERMATOLOGY STR
AIMS
 Brief overview of eczema
 Enable early recognition & effective management
ECZEMA
CLASSIFICATION OF ECZEMA
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ENDOGENOUS
Atopic
Seborrheic
Discoid
Pompholyx / dyshidrotic
Varicose / venous / stasis
/ gravitational
EXOGENOUS
 Allergic contact
 Irritant contact
 Photosensitive /
photoaggravated
PATCH TEST
MANAGEMENT OF EXOGENOUS
EZCEMA
 Avoidance of offending agent
 Topical steroids +/- prednisolone
 Patch testing for allergic contact dermatitis or photopatch testing for photo-allergic dermatitis
 Soap substitutes and emollients
HISTORY
 Age of onset?
 H/O childhood eczema?
 Any evidence of worsening eczema with diet? If so,
which type of food?
 Areas affected?
 Worsening / improving / static disease?
 Eczema free days?
 Pruritus? If so, does it keep the patient up at night?
 Antibiotics? Hospitalisation for infective flare ups?
 H/O eczema herpeticum?
 H/O erythroderma?
 PMH: Atopy?
 FH:
- Atopy?
- Ask specifically if any siblings. If has siblings, atopy?
 DH:
- What meds?
- Previous treatments? Helpful / unhelpful?
- Current treatment? Helpful / unhelpful?
- Always ask about:
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Frequency of application and quantities used!
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SS , shampoo, emollient, topical steroid, steroid
sparing agent, scalp applications, suits,
antihistamines
 Days off school / work?
MANAGEMENT
 Bath additives (antibacterial?)
 Soap substitute (antibacterial?) and shampoo
 Emollient
 Topical steroid (combination with topical antibiotic?)
 Steroid sparing agents eg. topical tacrolimus
 Scalp application
 Potassium permanganate soaks
 Suits
 Bandaging eg. viscopaste, tubigrip
 Antihistamines (driving advice!)
 Allergen avoidance
 Dietitician involvement?
 Occupational health involvement
 IgE levels? (inteprete with caution!)
 Systemic treatment eg. prednisolone, ciclosporin etc
 Tailor treatment to each INDIVIDUAL patient’s needs and
adapt management plan to increase compliance!
 Remember Afrocaribbean / Black people only wash their
hair once a week and may be reluctant to use certain
topical treatment if hair relaxed.
Ask patient if they are willing to change hairstyle.
 Nurse involvement in skin care regimen
 REMEMBER:
1 FTU = 0.5 grams
= Covers surface area equivalent to 2 palms
Ensure patient is aware of this and
prescribe adequate amounts of topical treatment!
ERYTHRODERMA
 > 90% involvement of inflammatory skin disease
 Causes:
- Eczema
- CTCL (Sezary syndrome)
- Lymphoma / leukaemia
- HIV
- Psoriasis
- Drugs
- GvHD
- Idiopathic
 Consequences:
- Heat loss
- Fluid loss (Hypovolaemia and renal failure)
- Electrolyte imbalance
- High output cardiac failure
- Hypoalbunaemia
- Hyperuricaemia
- Death!
 Mx (Symptomatic):
- Rx underlying condition / remove offending drug
- Temperature control
- IV fluids
- Dietician input
+/- ITU admission
SUMMARY
 Brief overview of eczema
 Early recognition and effective management
 Early involvement of Dermatologist when eczema is
poorly controlled +/- erythrodermic or if patch test is
required
THANK YOU