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Derm - Eczema and Psoriasis - Coggle Diagram

- - - - Erythematous, scaly, oozing
      - After contact with allergen
    - - Types 4 hypersensitivity
    - - Nickle allergy
  - - - Non-allrgic
      - Substance directly damages skins outer layer
    - - Soaps
      - Chemicals
  - - - Chronic venous disease in lower legs
    - - Erythematous scaly itchy rash
      - Lower legs
    - - Blood pooling - leaking - irritates skin
  - - - Cradle cap in adults
      - Adults
    - - Fungla Masezesia
    - - Scaly
      - Oily
      - Itchy
    - - Anti fungal shampoo
  - - - First few years of life - 6months
      - More likely to have allergic asthma / Allergic rhinitus later in flie, food allergy
      - 1 in 5 children, 1 in 10 adults
    - - ITCH - unbearable
      - Interrupted sleep 84%
      - High incidence depression
      - Impacts QoL / wider family
    - - Infants
        
        Face / cheeks
        
        Extensor surfaces of the limbs
        
        Nappy area is spared
        
        Can be in other places -
      - Children / Adolescents
        
        Flexural folds
      - Adults >16
        
        Lichenified and excoriated plaques
        
        Flexures
        Wrists
        Ankles
    - - Acute
        
        Severe itch
        
        Vesiculation
        
        Ooze
        
        Oedema
        
        Intense erythema
      - Sub acute
        
        Erythema
        
        Moderate itch
        
        Scaling
      - Chronic ⭐
        
        Thickened lichenified skin
        
        Fissuring
        
        Focal areas of intense itch
    - - Less erythema
      - More lichenification
      - Pigmentary change - hypo or hyperpigmentation
      - NB absence of erythema can lead to underscoring of AD in darker skin types with the typically sed scoring system
    - - Lifestyle
        
        No perfumed product
      - Skin barrier
        
        Emollients
      - Managment of Flare ⭐
        
        Topical Steroids
        
        Two weeks daily use
        Wean to maintenance
        
        Topical Tacrolimus
        
        Oral steroids
        
        very severe cases
      - Severe Eczema
        
        Phototherapy
        
        Systemic Agents
        
        MXT
        
        Ciclosporin - not as much - renal problems s/e
        
        Azathioprine - not much - skin cancer s/e
        
        Biologics
        
        Dupilumab
        
        JAK inhibitor
    - - Infection
        
        Baceterial
        
        Viral
        
        HSV - Eczema herpeticum
        
        Mx
        
        Swab
        
        Treat
        Abx
        Antiviral
        Aggreive topical tx - emolients, topical steroids
- - - - Scalp
      - Face
      - Flexures of armpit, genitals
      - Elbows / knees
  - - - Most common
      - Sharply demarcated plaques with silvery scales
    - - Small red spots with scale
        Often legs arms torso
      - Streo throat trigger
      - Clears in few months
      - Can recure with another strep throat
    - - Rare
      - Intense redness of large areas of skin
        Often affects nearly whole body
      - Can be life threatening
    - - VEry common in those with plaque psoriasis
    - - Deep inflamed red skin in folds
        Without scale
    - - Pitting
      - Discolouration - oil drop sign
      - Seperation from the nail bed
      - Thickening
      - Deformation
  - - - Topical Treaments
        
        Synthetic vit D
        
        Tar based tx
        
        Topical steroids
        
        Salicylic acid
        
        Topical tacrolimus
    - - Biologics
        
        Very effective
        
        PASI - Psoriasis Area and Severity Index
        Aim for PASI90 (90% clearance from baseline)
      - Systemic agents
        
        MTX
        
        Ciclosporins
        
        Acitretin
  - - - Needs systemic treatments
      - Chronic inflammatory joint disease
      - 30% of those w/ psoriasis
      - PEST SCORE
    - - HTN
      - Dyslipidaemia
      - Insulin resistant diabetes
      - Obesity
      - Incrased CVD risk
    - - reactive depression
      - Higher suicidal ideation
      - Alcohol