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64 Cards in this Set
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What are some important things to consider when assessing Adult eczema |
Skin features family history of atopy Triggers Occupational irritants Response to previous and current treatment Consider other types of dermatitis or skin lesions Effect on quality of life in terms of epidemiology |
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In terms of epidemiology when you can Eczema start |
As a child or for the first time is an adult |
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What are symptoms or signs of an eczema flare |
Redness Weeping Vesiculation If patient has more pigmented skin type, this may present as darkening of the affected skin. |
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What are the common areas affected by adults who get eczema |
face, neck, skin flexures, nipples, and hands but may be present either diffusely or locally.
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After resolution of an eczema flare what can happen to the skin |
Hypo or hyper pigmentation |
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What are some irritants that can trigger and eczema flare |
Irritants allergens infections and occupational irritatants |
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What is the differential for eczema |
tinea, psoriasis, scabies, drug reactions Other forms of dermatitis |
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When questioning the effect of eczema on the patience quality of life what should you focus on |
everyday activities and psychosocial wellbeing |
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What is the general management structure for eczema in adults |
General management, infection and treatment failure |
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What is the general management for Adult eczema |
General measures Emollients (moisturisers) Bathing elements Topical steroids Oral antipruritics Oral or systemic steroids |
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What general measures should you advise the patient regarding general management of adult ezcema |
Avoid: irritants, e.g., soaps, detergents, solvents, ink, vegetable juice, gardening, flour scratching overheating wool and scratchy fabrics next to the skin Keep nails short. Use cotton bedding and underclothes. |
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When considering emollients for adult eczema what should you remember |
Consider flammability of paraffin-based emollients Paraffin-based emollients e.g., emulsifying ointment, are flammable. Warn patients to avoid fire and not smoke while using. Consider the fire risk when prescribing large quantities. |
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In terms of dozing for emollients an adult eczema What should you remember |
Sufficient amount, liberal use and regular use |
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How do you apply emollients |
Wash hands and apply the emollient thinly (just so the skin glistens), gently and quickly in smooth downward strokes in the direction of hair growth to reduce the risk of folliculitis. • Apply as often as needed to keep the skin supple and moist, usually at least 3 - 4 times a day but some people may need to increase this to up to every hour if the skin is very dry. • As a rule, ointments need to be applied less often than creams or lotions for the same effect. Apply emollients within 3 minutes of washing to trap moisture in the skin. • Avoid massaging creams or ointments in or applying too thickly as this can block hair follicles, trap heat and cause itching. • Emollients can be applied before or after any other treatments e.g. steroid creams but it is important to leave at least 30 minutes before applying the next treatment. • Don’t stop using your emollient if your skin looks better as skin can flare up again quickly |
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What are some general rules when bathing or washing in regards to the use of emollients |
Avoid bubble baths and soaps as they can be irritating and dry the skin. • Bathe regularly in tepid (lukewarm) water only. Regular bathing cleans and helps prevent infection by removing scales, crusts, dried blood and dirt. • Use an emollient as a soap substitute (most emollients apart from Duoleum can be used in this way). • Apply the emollient prior to washing and directly afterwards onto damp skin. • When drying do not rub with a towel but pat the skin dry to avoid damage to the skin. • Take care when entering the bath/shower after applying emollients as they make surfaces slippery. |
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If the patient has chronic relapsing eczema after a flare can you advise them to continue taking the emollient |
Yes |
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Is there any evidence that one particular emollient is better than another |
No |
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What are key factors to consider when prescribing emollients |
known physiological properties of emollients, acceptability to the patient, dryness of skin, area of skin involved, how creams and lotions are packaged (pump dispensers may reduce the risk of antimicrobial contamination), and acquisition cost. |
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What is the difference between lotions creams and ointments |
Do you amount of oil and water in them |
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Oil content is the lowest in what Topical agents |
Lotion has the lowest amount then intermediate is creams and ointment has the most oil |
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The higher the oil content of a topical agent then the greasier it is |
True |
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As a general rule is it more Effective for a topical agent to be greasier In treating eczema |
Yes so ointments would theoretically be more effective |
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Ointments are more affective for managing eczema because they have the highest amount of oil but what else should you consider |
may be more suitable for those with sensitivities. Can exacerbate acne. Can cause folliculitis when overused. They also have fewer preservatives |
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In terms of creams and gels for eczema management what benefit are there |
More cosmetically acceptable than oil‑based moisturisers. |
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ointments are more affective for managing eczema because they have the highest amount of oil but what else should you consider |
may be more suitable for those with sensitivities. Can exacerbate acne. Can cause folliculitis when overused. |
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In terms of creams and gels for eczema management what benefit are there |
More cosmetically acceptable than oil‑based moisturisers. |
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Lotions have more water and is less effective But what are some benefits |
Easier to spread May be preferred for mildly dry skin, as well as for hairy areas. |
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What are humectants |
Are hygroscopic substances that bind with water molecules to increase the water content in the skin. Emollients containing humectants such as urea can also be applied to severely dry skin, e.g., ichthyosis. |
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Are aqueous creams containing sodium laurel recommended for eczema |
No not any more because they have the highest risk of skin irritation |
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What are some examples of emollients |
Example emollients and charges
Cetomacrogol Cream – fully subsidised Sorbolene (cetomacrogol with 10% glycerine) – fully subsidised Oil in water emulsion (healthE fatty cream) – fully subsidised Urea Cream (10%) (proprietary product available) – fully subsidised Emulsifying ointment (paraffin liquid 20% with paraffin soft white 50% and wax emulsifying 30%) - fully subsidised Glycerol (5%) with paraffin (5%) and cetyl alcohol (2%) (cetyl alcohol + glycerol + paraffin soft white) – approx $18.00 per 250 mL Wool fat with mineral oil (lotion hydrous 3% with mineral oil): Paraffin liquid + lanolin – approx $15.00 to $35.00 per 1000 mL (partially subsidised) Wool fat + water purified – approx $5.00 per 5 g (unsubsidised) Part-charges may vary between pharmacies as they depend on the mark-up and any other charges individual pharmacies may apply during calculations. Part-charges are in addition to the usual patient co-payment e.g., A4 = $5.
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In terms of Bathing for the management of adult eczema what should you consider |
Take a short shower or bath once a day. Avoid prolonged contact with water. Avoid soap and detergents. Use a soap substitute, e.g. emulsifying ointment. Apply before bathing and then wash off. Give patient information. Bleach baths can be used once or twice a week – use diluted bleach (sodium hypochlorite) and follow Bleach Bath instructions. After bathing, pat the skin dry and immediately reapply moisturisers. |
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How should you use topical steroids for managing adult eczema? |
before prescribing consider skin thickness, formulation, potency, combination preparations, side effects, amount (use) and compliance |
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does diluting a potent topical steroid by half alter its potency or reduce the risk of topical or systemic side effects when used inappropriately |
no |
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what are some examples of mild topical steroids |
Hydrocortisone (0.5%) Hydrocortisone (1%) Hydrocortisone with lanolin oil and paraffin liquid (Paraffin warning) |
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hydrocortisone 1% is considered |
Pharmacist-only medicine (restricted to pack size ≤ 30 g), purchased after consultation with a pharmacist |
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hydrocortisone with lanolin and paraffin liquid is dangerous why |
Paraffin-based emollients are flammable, and clothing they have contact with can be ignited by a naked flame. Advise patients to keep away from fire and not to smoke when using paraffin‑based emollients. Consider the risk of fire when using large quantities. |
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what are some examples of moderate topical steroids (2 to 25 times as potent as hydrocortisone) |
Clobetasone butyrate (partial subsidy) and Triamcinolone acetonide (fully subsidised) |
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what are some examples of potent topical corticosteroids(100 to 150 times as potent as hydrocortisone) |
Betamethasone valerate Diflucortolone valerate (partial) Hydrocortisone 17-butyrate Mometasone furoate Methylprednisolone aceponate |
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All potent topical corticosteroids are fully subsided except |
Diflucortolone valerate |
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what are some examples of very potent topical corticosteroids - both of which are fully subsidised |
Clobetasol proprionate and Betamethasone diproprionate |
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what type of antihistamines help with itching |
sedating antihistamines |
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does non sedating antihistamines help with itch |
no |
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what is a good sedating antihistamine to use for itch |
promethazine - available OTC or via prescription but only at the pharmacy |
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if prescribing a sedating antihistamine what do you need to be careful |
caution in the elderly, or patients with other significant comorbidities, or are taking other sedative or CNS acting medication |
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can you use oral also known as systemic steroids for eczema |
only for very severe eczema or in urgent situations then use a short course of prednisone |
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what is the recommendation for providing oral steroids for very severe eczema |
short course of prednisone, starting at 0.5 mg per kg per day and tapering over 1 to 2 weeks. |
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is oral steroids a substitute for topical therapy |
no, continue topical steroids and emollients while patient is using oral steroids |
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should you give a repeat course of oral steroids if a patient is having ongoing severe eczema |
it is discouraged (e.g., more than 1 course every 6 months). |
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if eczema is not adequately controlled by topical therapy what should you do |
seek dermatology advice |
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if you suspect occupation hand dermatitis what should you do |
follow the occupational disease notification |
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what does the occupational disease notification process entail |
WorkSafe is the work health and safety regulator in New Zealand. They use a Notifiable Occupational Disease System (NODS) to assess and manage workplace safety. Complete WorkSafe New Zealand NODS form |
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What is eczema herpeticum |
eczema infected with HSV-1 or HSV-2) and is a dermatological emergency |
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What should you do if you suspect eczema herpticum |
perform viral swab from the base of a fresh blister or vesicle. treat with empiric oral valaciclovir 1 gram three times a day for five days give antibiotics if signs of bacterial infection |
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bacterial infections in eczema is commonly caused by what organism |
staphylococcus |
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what symptoms and signs should you expect to find in bacterial infections of eczema |
weepy, crusted, and erythematous skin.possible vesicles, bullae, or fissuring of the skin. |
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how common is eczema herpticum |
rare |
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what antibiotic should you use to treat eczema |
flucloxacillin 500mg QID but if penicillin allergy use erythromycin |
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if you have concerns of cellulitis related to eczema then refer to |
cellulitis guidelines |
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if considering IV antibiotics for eczema who should you speak to before administering |
infectious diseases |
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is it advisable to give prolonged courses of antibiotics for eczema patients who have a bacterial infection |
avoid as little evidence for benefit in most cases and increased risk of bacterial resistance |
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if a patient with eczema has weepy skin what should you consider |
potassium permanganate to help dry it out. |
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how do you use potassium permanganate |
usually applied to weepy areas for 10 minutes, twice a day. As a compress, use 1 ml of 1% solution in 1 litre of water. For legs, soak in a bucket using 4 litres of water with 4 ml of 1% solution. A plastic bin liner in a bucket or bowl can be easiest. Potassium permanganate crystals are useful in a bath, but stain the bath. If crystals are used for compresses or soaks, dilute until rose pink. |
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What should you check if a patient fails to respond to treatment |
adherence to treatment assess for infection Revise diagnosis e.g., scabies, psoriasis, fungal infections, drug reactions. Arrange additional investigations as appropriate. Request non acute dermatology assessment if - inadequate control despite treatment - further treatment needed - uncertainty about diagnosis - significant impact on quality of life or occupation |
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what should you consider a non acute dermatology assesssment for eczema |
1. if inadequate control of eczema despite treatment 2. further therapy is necessary, e.g., phototherapy or immunosuppressants 3. uncertainty about diagnosis 4. significant impact on quality of life or occupation. |