Please enable JavaScript.

Coggle requires JavaScript to display documents.

Atopic Eczema/Dermatitis - Coggle Diagram

- - - - Prescription; 250mg, 500mg capsules; 125mg/5mL, 250mg/5mL powder for oral liquid
      - Dose: Adult 500 mg every 6 hours for 5 days; Children 1 month-18 yrs 12.5–25 mg/kg (usually up to 500 mg; max. 1g) 4x daily
      - Belongs to a group of antibiotics called penicillins. Penicillins are antibacterials that attach to penicillin binding proteins to interrupt cell wall biosynthesis, leading to bacterial cell lysis and death
      - Adverse effects: Nausea, vomiting, diarrhoea
      - Monitoring: during prolonged treatment regular monitoring of hepatic and renal functions is recommended; with high-dose treatment >5 days, monitor full blood count and electrolyte balance (risk of hypokalaemia and sometimes hypernatremia with high doses)
      - Education points: Best taken on an empty stomach, 1h before eating food as body may absorb less flucloxacillin after a meal, making it less effective; capsules: swallow whole with a glass of water
      - If flucoxacillin is not well tolerated (i.e. taste, esp. in children), try cefalexin
    - - Pharmacy only, Pharmacist only, Prescription; 0.5%, 1% Cream
      - Dose: Apply to the affected area 1–2 times daily; prolonged or frequent use (more than 2 weeks or more than once or twice daily) should be monitored by prescriber
      - Mild inflammatory skin disorders
  - - - Atopic eczema
      - Scabies
      - Skin trauma: chickenpox, insect bite, abrasion, laceration, thermal burn, dermatitis, surgical wound
- - - - Mild
        
        Hydrocortisone
      - Moderate
        
        Triamcinolone acetonide
        
        Dose: apply to the affected area 3–4 times daily; prolonged or frequent use (more than 2 weeks or more than once or twice daily) should be monitored by prescriber
        
        0.02% Cream, Ointment
        
        Clobetasone butyrate
        
        Dose: apply to the affected area 1–2x daily for up to 4 weeks; max. 50g of 0.05% preparation per week; prolonged or frequent use (more than 2 weeks or more than once or twice daily) should be monitored by prescriber
        
        0.05% Application, Cream, Ointment
        
        Short-term treatment only of severe resistant inflammatory skin disorders such as recalcitrant eczemas unresponsive to less potent corticosteroid
      - Potent
        
        Betamethasone valerate
        
        Dose: apply to the affected area 1–2 times daily; prolonged or frequent use (more than 2 weeks or more than once or twice daily) should be monitored by prescriber
        
        0.1% Application, Cream, Ointment, Lotion
        
        Betamethasone dipropionate (Diprosone® cream/ointment; Daivobet® ointment/gel)
        
        Dose: apply to the affected area 1–2 times daily; prolonged or frequent use (more than 2 weeks or more than once or twice daily) should be monitored by prescriber
        
        0.05% Cream, Ointment
        
        Diflucortolone valerate
        
        Dose: initially apply to the affected area 2–3 times a day, reducing to once daily as condition responds; prolonged or frequent use (more than 2 weeks or more than once or twice daily) should be monitored by prescriber
        
        0.1% Cream, Ointment
        
        Hydrocortisone butyrate
        
        0.1% Cream, Ointment, Lotion
        
        Dose: apply to the affected area 1–2 times daily; prolonged or frequent use (more than 2 weeks or more than once or twice daily) should be monitored by prescriber
        
        Mometasone furoate
        
        Dose: apply to the affected area once daily; prolonged or frequent use (more than 2 weeks or more than once or twice daily) should be monitored by prescriber
        
        0.1% Cream, Ointment, Lotion
        
        Methylprednisolone aceponate
        
        Dose: apply to the affected area once daily for up to 12 weeks; prolonged or frequent use (more than 2 weeks or more than once or twice daily) should be monitored by prescriber
        
        0.1% Cream, Ointment
        
        Severe inflammatory skin disorders such as eczemas unresponsive to less potent corticosteroids
      - Very potent
        
        Clobetasol propionate
        
        Dose: apply to the affected area 1–2 times daily for up to 4 weeks; maximum 50 g of 0.05% preparation per week; prolonged or frequent use (more than 2 weeks or more than once or twice daily) should be monitored by prescriber
        
        0.05% Application, Cream, Ointment
        
        Betamethasone dipropionate (Diprosone OV® cream/ointment)
        
        0.05% Modified Cream, Modified Ointment
        
        Short-term treatment only of severe resistant inflammatory skin disorders such as recalcitrant eczemas unresponsive to less potent corticosteroids
      - Prescription except hydrocortisone
      - Adverse effects: skin thinning; Stretch marks (striae) in armpits or groin; easy bruising (senile/solar purpura) and tearing of the skin; enlarged blood vessels (telangiectasia); localised increased hair thickness and length (hypertrichosis)
      - Decrease inflammation by reducing production of inflammatory proteins (e.g. cytokines), increasing synthesis of anti-inflammatory proteins (e.g. lipocortin-1), and inhibiting the response of inflammatory cells. They produce local vasoconstriction and are immunosuppressive
      - Education points: prolonged or frequent use (>2 weeks or more than once or twice daily) should be monitored by your doctor; if an emollient and a steroid cream or ointment are prescribed at the same time, apply the emollient 15–30 minutes before the steroid; wash hands, then apply to the affected area as directed and rub in gently and wash hands again after applying the cream or ointment, unless your hands are the affected area; apply using FTU (0.5g)
    - - Prescription; 1% Cream
      - Dose: apply thinly twice daily until symptoms resolve (stop treatment if eczema worsens or no response after 6 weeks)
      - Short-term or intermittent treatment of atopic eczema when other therapy ineffective or inappropriate
      - Calcineurin inhibitor - topical steroid-free medication with immune-modulating and anti-inflammatory properties
      - Adverse effects: burning sensation, pruritus, erythema, skin infections
      - Education points: don't drink alcohol; avoid excessive exposure to sunlight and sunlamps; don't use occlusive dressings; wash hand after application
      - Monitoring: stop using pimecrolimus cream once signs or symptoms resolve, use an emollient as maintenance therapy – this can be applied immediately after using pimecrolimus cream
    - - Prescription; 2.5mg, 10mg Tablets
      - A folic acid antagonist, inhibits DNA and RNA synthesis in rapidly diving cells. Also has immunosuppressant properties.
      - Used in low doses to treat inflammatory skin conditions, including eczema/dermatitis, esp. if troublesome or extensive
      - Dose: Methotrexate - Low dose (<25mg) once a week; Folic acid - 5mg once a week taken on a different day to methotrexate
        
        MM = Methotrexate on Monday; FF = Folic acid on Friday
      - Adverse effects: due to the inhibition of folate metabolism, including nausea, stomatitis and bone marrow suppression - these symptoms can be reduced with oral folic acid tablets without affecting efficacy of methotrexate; methotrexate toxicity - bone marrow suppression, hepatoxicity, pulmonary toxicity
      - Monitoring: A full blood count, renal and liver function tests and in some cases, chest x-ray and respiratory function, need to be checked before treatment is started. Laboratory monitoring needs to be repeated at regular intervals until the patient is stabilisedand then on an ongoing basis so that the patient can be
        clinically evaluated, and to identify methotrexate toxicity
      - Contraindications: active infection, alcoholism, peptic ulcer disease, poor nutritional status, ecent exposure to chickenpox or herpes zoster infection, pregnancy and breastfeeding
      - Education points: don't take any NSAIDs or trimethoprim; limit alcohol intake to 1–2 standard drinks once or twice a week; limit the amount of time you spend in the sun - don't use sunbeds; swallow tablets whole, with food and a glass of water; may not notice effects of methotrexate straight away - it can take several weeks before you start to feel better
    - - Autoimmune or inflammatory diseases
      - Dose: 5–60 mg once daily or in divided doses; taper dose according to response; usual maintenance 5–20 mg daily; in 2–4 weeks, the dose is reduced
      - Prescription; 1mg, 2.5mg, 5mg, 20mg tablets
      - Systemic corticosteroid - suppress inflammation by regulating gene expression to reduce expression of pro-inflammatory genes and increase expression of anti-inflammatory genes, and by decreasing synthesis of pro-inflammatory proteins (e.g. cytokines)
      - Education points: best taken as a single dose in the morning, which is thought to reduce steroid-induced suppression of the pituitary-adrenal axis compared to evening dosing; take with or just after food, or a meal; if take in large doses or for a long time, it is dangerous to stop taking it suddenly. Your doctor may reduce the dose gradually when it is time to stop.
      - Adverse effects: sleep disturbance; increased appetite; weight gain; Increase in postprandial blood sugar; increase in postprandial blood sugar; psychological effects, including increased or decreased energy
      - Monitoring: Esp. with high doses, can alter mood and behaviour early in treatment = contact doctor if worrying psychological changes occur
    - - Short-term treatment of moderate to severe atopic dermatitis (including flares) in patients unresponsive to, or intolerant of conventional therapy (initiated by a specialist)
      - Dose: apply thinly twice daily until symptoms resolve, reduce to once daily use if condition allows (If no signs of improvement are seen after two weeks of treatment, consider other treatment options)
      - Prescription; 0.1% Ointment
      - Calcineurin inhibitor - topical steroid-free medication which decreases T-cell activation and inflammatory cytokine release, resulting in anti-inflammatory and immunosuppressant effects
      - Adverse effects: application site reactions; paraesthesia’s and dysesthesia’s; local skin infection; alcohol intolerance
      - Monitoring: initial treatment will be for a short period to assess the response, if effective, may be continued long-term (6-12 months) if required; once inflamed skin has returned to normal, the ointment may be discontinued, to prevent frequent recurrences, it may be helpful to apply it to previously affected areas two or three times weekly.
      - Education points: avoid excessive exposure to UV light; don't apply to mucous membranes; don't use occlusive dressings; emollients should not be applied to the same area within 2 hours of applying tacrolimus ointment.
    - - Severe atopic dermatitis
      - Dose: initially 2.5 mg/kg daily in 2 divided doses, if good initial response not achieved within 2 weeks, increase rapidly to maximum 5 mg/kg daily; initial dose of 5 mg/kg daily in 2 divided doses if very severe
      - Prescription; 25mg, 50mg, 100mg Capsules; 100mg/mL Oral liquid
      - Immunosuppressant - selectively blocks/inhibits calcineurin which reduces T-cell activation and the activity of the immune system
      - Education points: Oral liquid - mix with orange juice, apple juice, or other soft drink (to improve taste) immediately before taking (and rinse with more to ensure total dose). Do not mix with grapefruit juice; Capsules - swallow whole with a glass of water
      - Monitoring: dermatological and physical examination, including blood pressure and renal function measurements required at least twice before starting; during treatment, monitor serum creatinine every 2 weeks for first 3 months then every month, reduce dose by 25–50% if serum creatinine increases more than 30% above baseline (even if within normal range) and discontinue if reduction not successful within 1 month.
      - Drug interactions: simvastatin and atorvastatin; NSAIDs; antibiotics; anticonvulsants; antifungals; anticoagulants; St John's wort
      - Adverse effects: stomach or intestinal upset; headache and muscle aches; nephrotoxicity; hepatotoxicity; new or worsening hypertension; increased risk of infection; paraesthesia (tingling), commonly affecting the hands, feet, or lips
  - - - Wet bandages wrapped over emollients and/or topical steroid creams to areas of red, hot, weeping eczema (most often due to atopic dermatitis)
      - Cooling effect (as water gradually evaporates from bandages = cools the skin and helps relieve inflammation, itching and soreness)
      - Moisturising effect (emollients covered over with wet bandages are deeply absorbed into the skin to provide a longer lasting moisturising effect) and enhance steroid absorption (into both the superficial and deeper layers of skin where inflammation is present)
      - Bandages provide protection from the itching and scratching cycle so that skin gets a chance to heal properly