Psoriasis Triggers and Medications

Psoriasis is a chronic skin condition that can be triggered or worsened by various factors. One of the triggers is a streptococcal infection, which can cause guttate psoriasis. Stress, cigarette smoking, and alcohol consumption are also known to be implicated in the development of psoriasis. In addition, certain medications have been identified as potential triggers, including lithium, indomethacin, chloroquine, NSAIDs, and beta-blockers. Among these medications, lithium is considered the most likely culprit. It is important for individuals with psoriasis to be aware of these triggers and to avoid them whenever possible to manage their condition effectively.

Pityriasis versicolor is a skin condition caused by an overgrowth of Malassezia yeast, which commonly affects young males. It results in multiple patches of discolored skin, mainly on the trunk, which can appear pale brown, pink, or depigmented. The condition often occurs after exposure to humid, sunny environments.

According to NICE guidelines, the first-line treatment for pityriasis versicolor is either ketoconazole shampoo applied topically for five days or selenium sulphide shampoo for seven days (off-label indication). While topical antifungal creams like clotrimazole are effective, they are not typically used as first-line treatment unless the affected area is small due to their higher cost.

Understanding Pityriasis Versicolor

Pityriasis versicolor, also known as tinea versicolor, is a fungal infection that affects the skin’s surface. It is caused by Malassezia furfur, which was previously known as Pityrosporum ovale. This condition is characterized by patches that are commonly found on the trunk area. These patches may appear hypopigmented, pink, or brown, and may become more noticeable after sun exposure. Scaling is also a common feature, and mild itching may occur.

Pityriasis versicolor can affect healthy individuals, but it may also occur in people with weakened immune systems, malnutrition, or Cushing’s syndrome. Treatment for this condition typically involves the use of topical antifungal agents. According to NICE Clinical Knowledge Summaries, ketoconazole shampoo is a cost-effective option for treating large areas. If topical treatment fails, alternative diagnoses should be considered, and oral itraconazole may be prescribed.

In summary, pityriasis versicolor is a fungal infection that affects the skin’s surface. It is characterized by patches that may appear hypopigmented, pink, or brown, and scaling is a common feature. Treatment typically involves the use of topical antifungal agents, and oral itraconazole may be prescribed if topical treatment fails.

The cause of itch during pregnancy can be identified by observing the timing of symptoms and the appearance of the rash. Polymorphic eruption of pregnancy is a common condition that usually occurs in the third trimester and is more likely to affect first-time pregnant women with excessive weight gain or multiple pregnancies. The rash is characterized by itchy urticarial papules that merge into plaques and typically starts on the abdomen, particularly on the striae, but not on the umbilicus region. The rash may remain localized, spread to the buttocks and thighs, or become widespread and generalized. It may later progress to non-urticated erythema, eczematous lesions, and vesicles, but not bullae.

Skin Disorders Associated with Pregnancy

During pregnancy, women may experience various skin disorders. The most common skin disorder found in pregnancy is atopic eruption, which presents as an itchy red rash. However, no specific treatment is needed for this condition. Another skin disorder is polymorphic eruption, which is a pruritic condition associated with the last trimester. Lesions often first appear in abdominal striae, and management depends on severity. Emollients, mild potency topical steroids, and oral steroids may be used. Pemphigoid gestationis is another skin disorder that presents as pruritic blistering lesions. It often develops in the peri-umbilical region, later spreading to the trunk, back, buttocks, and arms. This disorder usually presents in the second or third trimester and is rarely seen in the first pregnancy. Oral corticosteroids are usually required for treatment.

To enhance his immunity and minimize the likelihood of recurrent shingles, it is recommended that he receive the shingles vaccination. The vaccine is believed to provide protection against shingles for a minimum of 5 years.

Varicella-Zoster Vaccination: Protection Against Chickenpox and Shingles

Varicella-zoster is a herpesvirus that causes Chickenpox and shingles. There are two types of vaccines available to protect against these infections. The first type is a live attenuated vaccine that prevents primary varicella infection or Chickenpox. This vaccine is recommended for healthcare workers who are not immune to VZV and for individuals who are in close contact with immunocompromised patients.

The second type of vaccine is designed to reduce the incidence of herpes zoster or shingles caused by reactivation of VZV. This live-attenuated vaccine is given subcutaneously and is offered to patients aged 70-79 years. The vaccine is also available as a catch-up campaign for those who missed out on their vaccinations in the previous two years of the program. However, the shingles vaccine is not available on the NHS to anyone aged 80 and over because it seems to be less effective in this age group.

The main contraindication for both vaccines is immunosuppression. Side effects of the vaccines include injection site reactions, and less than 1 in 10,000 individuals may develop Chickenpox. It is important to note that vaccination is the most effective way to prevent varicella-zoster infections and their complications.

Serologic studies reveal that adults aged 60 years and above have been exposed to Chickenpox to a great extent. Hence, it is recommended that individuals within the age range of 70-79 years should receive the vaccine, irrespective of their memory of having had Chickenpox. However, the vaccine may not be as efficacious in individuals above 80 years of age.

Varicella-Zoster Vaccination: Protection Against Chickenpox and Shingles

Varicella-zoster is a herpesvirus that causes Chickenpox and shingles. There are two types of vaccines available to protect against these infections. The first type is a live attenuated vaccine that prevents primary varicella infection or Chickenpox. This vaccine is recommended for healthcare workers who are not immune to VZV and for individuals who are in close contact with immunocompromised patients.

The second type of vaccine is designed to reduce the incidence of herpes zoster or shingles caused by reactivation of VZV. This live-attenuated vaccine is given subcutaneously and is offered to patients aged 70-79 years. The vaccine is also available as a catch-up campaign for those who missed out on their vaccinations in the previous two years of the program. However, the shingles vaccine is not available on the NHS to anyone aged 80 and over because it seems to be less effective in this age group.

The main contraindication for both vaccines is immunosuppression. Side effects of the vaccines include injection site reactions, and less than 1 in 10,000 individuals may develop Chickenpox. It is important to note that vaccination is the most effective way to prevent varicella-zoster infections and their complications.

Understanding Different Epidermal Conditions: Distinguishing Features and Diagnosis

When it comes to epidermal conditions, eczema and psoriasis are often the first to come to mind. However, there are other conditions that produce scale and have distinct features that set them apart. One such condition is ringworm, which is characterized by asymmetrical lesions with an active scaly edge and central clearing. To diagnose ringworm, skin scrapings should be taken and sent for fungal analysis, as it is often caused by the dermatophyte Trichophyton rubrum.

It is important to note that treating a potential tinea infection with potent steroids can alter the appearance of the lesion and even produce pustules. Therefore, it is crucial to have a negative skin scraping before using strong steroids. Additionally, tinea infections may also be present on the feet with nail involvement.

Other epidermal conditions, such as pityriasis rosea and pityriasis versicolor, have their own distinct features. Pityriasis rosea begins with a herald patch followed by smaller oval red scaly patches mainly on the chest and back. Pityriasis versicolor, on the other hand, affects the trunk, neck, and/or arms and is caused by a yeast infection rather than a dermatophyte infection.

In summary, understanding the distinguishing features and proper diagnosis of different epidermal conditions is crucial in providing effective treatment.

Kawasaki Disease Treatment and Follow-Up

Patients diagnosed with Kawasaki disease typically require hospitalization for treatment with intravenous immunoglobulin and to monitor for potential myocardial events. Due to the risk of cardiac complications, follow-up echocardiograms are necessary to detect any coronary artery aneurysms. It is important to note that Kawasaki disease is not a notifiable disease.

Allergic Reactions to Natural Rubber Latex

Natural rubber latex (NRL) is commonly found in healthcare products, including gloves. However, NRL proteins can cause a type I immediate hypersensitivity allergic reaction, which can be severe. In addition, some products made with NRL may contain chemical additives that cause an irritant contact dermatitis, resulting in localized skin irritation. This is not an allergic response to NRL.

Another type of allergic reaction, a type IV allergic contact dermatitis, can occur due to sensitization to the chemical additives used in NRL gloves. This type of reaction may take months or even years to develop, but once sensitized, symptoms usually occur within 10-24 hours of exposure and can worsen over a 72 hour period. It is important for healthcare workers and patients to be aware of the potential for allergic reactions to NRL and to take appropriate precautions.

Prognostic Factors for Malignant Melanoma

Malignant melanoma is a type of skin cancer that can be staged based on several prognostic factors. The Breslow thickness, measured in millimetres from the dermo-epidermal junction, is a key factor. A thickness greater than 3.5 mm is associated with a poor prognosis, while a thickness less than 1.5 mm has a 5-year survival rate of over 90%. The diameter of the melanoma, however, has not been found to be a significant factor.

Clarke’s level is another important factor, measured from I to IV based on the level of invasion through the dermis. A Clarke’s level of I indicates that the melanoma has not invaded past the basement membrane, which is associated with a better outcome for the patient.

Microsatellite metastases, which are cutaneous metastases around the primary melanoma, can increase the TNM staging score and result in a worse prognosis. Therefore, the lack of microsatellite metastasis is a positive prognostic factor.

Surface ulceration, or the presence of an open sore on the skin, is a poor prognostic indicator and is accounted for in TNM scoring. The absence of surface ulceration is a positive factor for the patient’s prognosis.

Overall, these factors can help predict the prognosis for patients with malignant melanoma and guide treatment decisions.

NICE Guidance on Assessing Pigmented Skin Lesions

NICE guidance on Suspected cancer: recognition and referral (NG12) recommends using the ‘7-point weighted checklist’ to evaluate pigmented skin lesions. This checklist includes major and minor features of lesions, with major features scoring 2 points each and minor features scoring 1 point each. Lesions scoring 3 or more points are considered suspicious and should be referred for further evaluation, even if the score is less than 3 and the clinician strongly suspects cancer.

For example, if a patient has a pigmented skin lesion that has changed in size and has an irregular shape, they would score 2 points for each major feature. Additionally, if the lesion has a diameter of 8 mm or more, it would score a single point for a minor feature. Therefore, the overall score for this lesion would be 5, indicating that it is suspicious and requires further evaluation.

It is important for clinicians to use this checklist when assessing pigmented skin lesions to ensure that potential cases of skin cancer are not missed.

Treatment Options for Palmoplantar Pustulosis

Palmoplantar pustulosis is a skin condition that is linked to psoriasis and is more common in women over 50. It is characterized by erythematous skin with yellow pustules that settle to form brown macules on the palms and soles of the hands and feet. Here are some treatment options for this condition:

Betamethasone Ointment: This is a potent topical steroid that is effective in treating palmoplantar pustulosis.

Calcipotriol + Betamethasone: While the steroid component would be beneficial, calcipotriol is not used to treat palmoplantar pustulosis, which is where the management differs from plaque psoriasis.

Barrier Cream: A barrier cream is used to create a barrier between the skin and a potential irritant, so is useful in conditions such as contact dermatitis. Palmoplantar pustulosis is not caused by an irritant, so this would not be helpful.

Flucloxacillin Capsules: There is no indication that this is a bacterial infection, so there would be no role for antibiotics in this patient’s management.

Terbinafine Cream: A fungal infection would not cause pustules, so there is no indication for using an antifungal treatment.

Understanding Venous Leg Ulcers: Causes, Symptoms, and Treatment Options

Venous leg ulcers are a common condition in the UK, accounting for approximately 3% of new cases seen in dermatological clinics. These ulcers are more prevalent in patients who are obese, have a history of varicose veins, or have experienced deep vein thrombosis. The underlying cause of venous leg ulcers is venous stasis, which leads to an increase in capillary pressure, fibrin deposits, and poor oxygenation of the skin. This, in turn, can result in poorly nourished skin and minor trauma, leading to ulceration.

Treatment for venous leg ulcers focuses on reducing exudates and promoting healing using dressings such as Granuflex® or Sorbisan®. Compression bandaging is the primary treatment option, and preventive therapy may include weight loss, wearing support stockings, or surgical treatment of varicose veins.

It is important to note that other conditions may present with similar symptoms, such as absent pulses, widespread purpura on the legs, injury, or diabetes. Therefore, a proper diagnosis is crucial to ensure appropriate treatment.

The sudden appearance of linear, well-defined skin lesions with a lack of concern from the patient may indicate dermatitis artefacta, a condition where the lesions are self-inflicted. A punch biopsy has ruled out other potential causes, and the patient’s history of psychiatric disorders supports this diagnosis. Atopic dermatitis is a possibility, but typically presents with additional symptoms such as pruritus and scaly erythematous plaques. Cutaneous T-cell lymphoma cannot be ruled out without a biopsy, and lichen planus is unlikely due to the patient’s lack of distress from pruritus.

Understanding Dermatitis Artefacta

Dermatitis artefacta is a rare condition that affects individuals of any age, but is more common in females. It is characterised by self-inflicted skin lesions that patients typically deny are self-induced. The condition is strongly associated with personality disorder, dissociative disorders, and eating disorders, with a prevalence of up to 33% in patients with bulimia or anorexia.

Patients with dermatitis artefacta present with well-demarcated linear or geometric lesions that appear suddenly and do not evolve over time. The lesions may be caused by scratching with fingernails or other objects, burning skin with cigarettes, or chemical exposure. Commonly affected areas include the face and dorsum of the hands. Despite the severity of the skin lesions, patients may display a nonchalant attitude, known as la belle indifference.

Diagnosis of dermatitis artefacta is based on clinical history and exclusion of other dermatological conditions. Biopsy of skin lesions is not routine but may be helpful to exclude other conditions. Psychiatric assessment may be necessary. Differential diagnosis includes other dermatological conditions and factitious disorders such as Munchausen syndrome and malingering.

Management of dermatitis artefacta involves a multidisciplinary approach with dermatologists, psychologists, and psychiatrists. Direct confrontation is unhelpful and may discourage patients from seeking medical help. Treatment includes providing occlusive dressing, topical antibiotics, and bland emollients. Selective serotonin reuptake inhibitors and cognitive behavioural therapy may be helpful, although evidence is limited.

In summary, dermatitis artefacta is a rare condition that requires a multidisciplinary approach for management. Understanding the clinical features, risk factors, and differential diagnosis is crucial for accurate diagnosis and appropriate treatment.

Understanding Erythema Multiforme: Symptoms and Characteristics

Erythema multiforme is a self-limiting skin condition that is characterized by sharply demarcated, round, red or pink macules that evolve into papular plaques. The lesions typically develop a central blister or crust and a surrounding paler pink ring that is raised due to oedema, creating the classic target appearance. However, atypical targets may also occur, with just two zones and/or an indistinct border. Mucous membranes may also be involved.

The most common cause of erythema multiforme is Herpes Simplex Virus Type 1, followed by Mycoplasma, although many other viruses have been reported to cause the eruption. Drugs are an infrequent cause, and conditions such as Stevens-Johnson syndrome and toxic epidermal necrolysis are now considered distinct from erythema multiforme.

Unlike monomorphic eruptions, the lesions in erythema multiforme are polymorphous, meaning they take on many forms. The rash may also involve the palms and soles, although this is not always the case. While there may be a mild itch associated with the condition, intense itching is more commonly seen in Chickenpox in children.

Lesions in erythema multiforme typically start on the dorsal surfaces of the hands and feet and spread along the limbs towards the trunk. The condition usually resolves without complications.

Stevens-Johnson syndrome is a rare but known negative effect of lamotrigine treatment. This skin condition typically manifests within a few days of starting the medication and can cause flu-like symptoms such as fever, malaise, myalgia, and arthralgia. Painful erythema with blisters or ulcers is a hallmark of the syndrome, which can progress to areas of confluent erythema with skin loss. Mucosal involvement is also common, affecting the eyes, lips, mouth, oesophagus, upper respiratory tract (causing cough and respiratory distress), genitalia, and gastrointestinal tract (resulting in diarrhoea).

Other drugs, such as aspirin, macrolides, opiates, and cyclosporin, can also cause drug rashes. Exanthematous eruptions are a common type of drug rash, characterised by pink-to-red macules that blanch on pressure.

Urticaria and erythema multiforme are other types of drug-related rashes. Aspirin and anticonvulsants are associated with erythema multiforme, which typically presents as spot or target lesions and doesn’t involve mucosal tissues.

Lamotrigine is a medication that is primarily used as an antiepileptic drug. It is typically prescribed as a second-line treatment for a range of generalised and partial seizures. The drug works by blocking sodium channels in the body, which helps to reduce the occurrence of seizures.

Despite its effectiveness in treating seizures, lamotrigine can also cause a number of adverse effects. One of the most serious of these is Stevens-Johnson syndrome, a rare but potentially life-threatening skin condition. Other possible side effects of the drug include dizziness, headache, nausea, and blurred vision. It is important for patients taking lamotrigine to be aware of these potential risks and to report any unusual symptoms to their healthcare provider.

If a patient complains of intensely itchy bumps on their arms, torso, or legs, it may be a sign of a bed bug infestation. This is especially true if the patient has recently stayed in a hotel, hostel, or other temporary accommodation, as bed bugs can easily travel on clothing and luggage.

While scabies is a possible differential diagnosis, it is less likely if the patient doesn’t have involvement of the finger webs or linear burrows beneath the skin. Bed bug bites tend to appear as lumps or welts, rather than small spots.

If the lesions are aligned in a line or curve, this is also suggestive of a bed bug infestation, as the insects tend to move across the skin in a linear fashion.

Dealing with Bed Bugs: Symptoms, Treatment, and Prevention

Bed bugs are a type of insect that can cause a range of clinical problems, including itchy skin rashes, bites, and allergic reactions. Infestation with Cimex hemipterus is the primary cause of these symptoms. In recent years, bed bug infestations have become increasingly common in the UK, and they can be challenging to eradicate. These insects thrive in mattresses and fabrics, making them difficult to detect and eliminate.

Topical hydrocortisone can help control the itch. However, the definitive treatment for bed bugs is through a pest management company that can fumigate your home. This process can be costly, but it is the most effective way to eliminate bed bugs.

Referral for oral retinoin is recommended for patients with scarring.

Acne vulgaris is a common skin condition that usually affects teenagers and is characterized by the obstruction of hair follicles with keratin plugs, resulting in comedones, inflammation, and pustules. The severity of acne can be classified as mild, moderate, or severe, depending on the number and type of lesions present. Treatment for acne typically involves a step-up approach, starting with single topical therapy and progressing to combination therapy or oral antibiotics if necessary. Tetracyclines are commonly used but should be avoided in certain populations, and a topical retinoid or benzoyl peroxide should always be co-prescribed to reduce the risk of antibiotic resistance. Combined oral contraceptives can also be used in women, and oral isotretinoin is reserved for severe cases under specialist supervision. Dietary modification has no role in the management of acne.

Understanding Pompholyx Eczema

Pompholyx eczema, also known as dyshidrotic eczema, is a type of skin condition that affects both the hands and feet. It is often triggered by humidity and high temperatures, such as sweating. The main symptom of pompholyx eczema is the appearance of small blisters on the palms and soles, which can be intensely itchy and sometimes accompanied by a burning sensation. Once the blisters burst, the skin may become dry and crack.

To manage pompholyx eczema, cool compresses and emollients can be used to soothe the affected areas. Topical steroids may also be prescribed to reduce inflammation and itching. It is important to avoid further irritation of the skin by avoiding triggers such as excessive sweating and using gentle, fragrance-free products. With proper management, the symptoms of pompholyx eczema can be controlled and minimized.

For managing the symptoms of oral lichen planus, benzydamine mouthwash can be used as a locally-acting non-steroidal anti-inflammatory. In severe cases, systemic steroids or topical steroids can also be considered. It is important to note that sodium lauryl sulphate, a common ingredient in healthcare products, may be associated with aphthous ulceration in certain patients. Chlorhexidine and hydrogen peroxide mouthwashes are primarily used for oral hygiene and not for addressing oral discomfort.

Lichen planus is a skin condition that has an unknown cause, but is believed to be related to the immune system. It is characterized by an itchy rash that appears as small bumps on the palms, soles, genital area, and inner surfaces of the arms. The rash often has a polygonal shape and a distinctive pattern of white lines on the surface, known as Wickham’s striae. In some cases, new skin lesions may appear at the site of trauma, a phenomenon known as the Koebner phenomenon. Oral involvement is common, with around 50% of patients experiencing a white-lace pattern on the buccal mucosa. Nail changes, such as thinning of the nail plate and longitudinal ridging, may also occur.

Lichenoid drug eruptions can be caused by certain medications, including gold, quinine, and thiazides. Treatment for lichen planus typically involves the use of potent topical steroids. For oral lichen planus, benzydamine mouthwash or spray is recommended. In more severe cases, oral steroids or immunosuppressive medications may be necessary. Overall, lichen planus can be a challenging condition to manage, but with proper treatment, symptoms can be controlled and quality of life can be improved.

The recommended first-line treatment for scabies is the application of permethrin cream to all skin, including the scalp, which should be left on for 12 hours before rinsing off. This treatment should be repeated after 7 days. Malathion is a second-line treatment that should be rinsed off after 24 hours. Steroids may be used by dermatologists in cases of resistant scabies or scabies pruritus, but only under specialist guidance. Salt water bathing is not recommended as a treatment for scabies. Mupirocin cream is used to eliminate MRSA in asymptomatic hospital inpatients.

Scabies: Causes, Symptoms, and Treatment

Scabies is a skin condition caused by the mite Sarcoptes scabiei, which is spread through prolonged skin contact. It is most commonly seen in children and young adults. The mite burrows into the skin, laying its eggs in the outermost layer. The resulting intense itching is due to a delayed hypersensitivity reaction to the mites and eggs, which occurs about a month after infection. Symptoms include widespread itching, linear burrows on the fingers and wrists, and secondary features such as excoriation and infection.

The first-line treatment for scabies is permethrin 5%, followed by malathion 0.5% if necessary. Patients should be advised to avoid close physical contact until treatment is complete and to treat all household and close contacts, even if asymptomatic. Clothing, bedding, and towels should be laundered, ironed, or tumble-dried on the first day of treatment to kill off mites. The insecticide should be applied to all areas, including the face and scalp, and left on for 8-12 hours for permethrin or 24 hours for malathion before washing off. Treatment should be repeated after 7 days.

Crusted scabies, also known as Norwegian scabies, is a severe form of the condition seen in patients with suppressed immunity, particularly those with HIV. The skin is covered in hundreds of thousands of mites, and isolation is essential. Ivermectin is the treatment of choice.

The MHRA recommends discontinuing co-cyprindiol (Dianette) 3-4 cycles after acne has cleared due to the increased risk of venous thromboembolism. It should not be used solely for contraception. However, the patient still requires contraception, and a combined pill may offer better contraceptive coverage than a progesterone-only pill, while also providing some benefit for her skin. Other contraceptive options should also be considered.

Acne vulgaris is a common skin condition that usually affects teenagers and is characterized by the obstruction of hair follicles with keratin plugs, resulting in comedones, inflammation, and pustules. The severity of acne can be classified as mild, moderate, or severe, depending on the number and type of lesions present. Treatment for acne typically involves a step-up approach, starting with single topical therapy and progressing to combination therapy or oral antibiotics if necessary. Tetracyclines are commonly used but should be avoided in certain populations, and a topical retinoid or benzoyl peroxide should always be co-prescribed to reduce the risk of antibiotic resistance. Combined oral contraceptives can also be used in women, and oral isotretinoin is reserved for severe cases under specialist supervision. Dietary modification has no role in the management of acne.

Hydroxychloroquine Monitoring Requirements

Shared care protocols are commonly used between primary and secondary care to monitor and prescribe DMARDs. Hydroxychloroquine, used to treat rheumatoid arthritis and systemic lupus erythematosus, requires monitoring of visual symptoms as it can cause retinal damage. The Royal College of Ophthalmologists recommends that patients be assessed by an optometrist prior to treatment if any signs or symptoms of eye disease are present. During treatment, visual symptoms should be enquired about and annual visual acuity recorded. If visual acuity changes or vision is blurred, patients should be advised to stop treatment and seek advice. The BNF and NICE Clinical Knowledge Summaries provide further information on the monitoring requirements for hydroxychloroquine.

Antiviral therapy, such as aciclovir, can effectively reduce the severity and duration of shingles. It can also lower the incidence of post-herpetic neuralgia, especially in older patients. However, for antivirals to be effective, they must be administered within 72 hours of rash onset.

Individuals with chronic diseases such as diabetes mellitus, chronic kidney disease, inflammatory bowel disease, asthma, chronic obstructive pulmonary disease, rheumatoid arthritis, autoimmune diseases, and immunosuppressive conditions like HIV are at a higher risk of developing post-herpetic neuralgia.

Older patients, particularly those over 50 years old, are also at an increased risk of developing post-herpetic neuralgia. However, the relationship between gender and post-herpetic neuralgia is still unclear, with some studies suggesting that females are at a higher risk, while others indicate the opposite or no association.

Unfortunately, having a shingles rash on either the trunk or face is associated with an increased risk of post-herpetic neuralgia, not a reduced risk.

Shingles is a painful blistering rash caused by reactivation of the varicella-zoster virus. It is more common in older individuals and those with immunosuppressive conditions. The diagnosis is usually clinical and management includes analgesia, antivirals, and reminding patients they are potentially infectious. Complications include post-herpetic neuralgia, herpes zoster ophthalmicus, and herpes zoster oticus. Antivirals should be used within 72 hours to reduce the incidence of post-herpetic neuralgia.

Aqueous Cream May Cause Skin Irritation, Warns Drug Safety Update

The use of aqueous cream as an emollient has been widely prescribed in the UK. However, a report published in the March 2013 issue of the Drug Safety Update (DSU) warns that it may cause burning and skin irritation in some patients, particularly children with eczema. The report showed that 56% of patients attending a paediatric dermatology clinic who used aqueous cream as a leave-on emollient reported skin irritation, typically within 20 minutes of application. This compared to 18% of children who used an alternative emollient. Skin irritation was not seen in patients using aqueous cream as a soap substitute. It is believed that the high sodium lauryl sulfate content in aqueous cream may be the cause of the irritation. The DSU doesn’t suggest that aqueous cream should not be prescribed, but advises that patients and parents should be warned about possible side-effects. It is recommended to routinely prescribe alternative emollients.

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Kawasaki’s Disease: A Rare but Serious Condition in Children

Kawasaki’s disease (KD) is a rare but serious condition that primarily affects children between 6 months to 4 years old. The exact cause of KD is unknown, but it is believed to be caused by a bacterial toxin acting as a superantigen similar to staphylococcal and streptococcal toxic shock syndromes.

The hallmark symptom of KD is a sustained fever lasting more than five days, accompanied by cervical lymphadenopathy, conjunctival infection, rash, mucous membrane signs (such as dry fissured lips, red ‘strawberry’ tongue, and pharyngeal injection), and erythematous and oedematous hands and feet with subsequent peeling of the fingers and toes.

It is crucial to make a clinical diagnosis of KD as about a third of those affected may develop coronary artery involvement, which can lead to the formation of coronary artery aneurysms. Early treatment with intravenous immunoglobulin within the first 10 days can help reduce the risk of this complication. Aspirin is also an important treatment in this condition, used to reduce the risk of thrombosis.

In conclusion, KD is a rare but serious condition that can have severe consequences if not diagnosed and treated promptly. It is important for healthcare professionals to be aware of the symptoms and to consider KD in children presenting with a prolonged fever and other associated symptoms.

If the initial topical treatment for athlete’s foot is unsuccessful, it is recommended to use oral antifungal treatment. Continuing with topical treatment is not the best approach, and referring the patient to a dermatologist is another option. Topical corticosteroids should only be used in cases of severe inflammation and irritation to alleviate symptoms. Flucloxacillin, being an antibiotic, is not appropriate for this condition.

Understanding Athlete’s Foot

Athlete’s foot, medically known as tinea pedis, is a common fungal infection that affects the skin on the feet. It is caused by fungi in the Trichophyton genus and is characterized by scaling, flaking, and itching between the toes. The condition is highly contagious and can spread through contact with infected surfaces or people.

To treat athlete’s foot, clinical knowledge summaries recommend using a topical imidazole, undecenoate, or terbinafine as a first-line treatment. These medications work by killing the fungi responsible for the infection and relieving symptoms. It is important to maintain good foot hygiene and avoid sharing personal items such as socks and shoes to prevent the spread of the infection. With proper treatment and prevention measures, athlete’s foot can be effectively managed.

Lithium has been found to potentially worsen psoriasis symptoms.

Psoriasis can be worsened by various factors, including trauma, alcohol consumption, and certain medications such as beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs, ACE inhibitors, and infliximab. Additionally, the sudden withdrawal of systemic steroids can also exacerbate psoriasis symptoms. It is important to note that streptococcal infection can trigger guttate psoriasis, a type of psoriasis characterized by small, drop-like lesions on the skin. Therefore, individuals with psoriasis should be aware of these exacerbating factors and take steps to avoid or manage them as needed.

NICE Guidelines on the Use of Potent Corticosteroids

Potent corticosteroids should not be used continuously at any site for longer than 8 weeks, according to the National Institute for Health and Care Excellence (NICE) guidelines. It is important to note that the potency of steroid formulations can be difficult to remember from the trade name, so it is recommended to have a reference on hand. The Eczema Society provides a helpful table of commonly used topical steroids. Remembering these guidelines can help ensure safe and effective use of potent corticosteroids.

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Potent corticosteroids should not be used continuously at any site for longer than 8 weeks, according to the National Institute for Health and Care Excellence (NICE) guidelines.

It is important to note that the potency of steroid formulations can be difficult to remember from the trade name, so it is recommended to have a reference on hand. The Eczema Society provides a helpful table of commonly used topical steroids.

Remembering these guidelines can help ensure safe and effective use of potent corticosteroids.

A common presentation of granuloma annulare involves the development of circular lesions on the skin. In contrast, tinea often presents as a rash with scales.

Understanding Granuloma Annulare

Granuloma annulare is a skin condition characterized by papular lesions that are slightly hyperpigmented and depressed in the center. These lesions typically appear on the dorsal surfaces of the hands and feet, as well as on the extensor aspects of the arms and legs. While there have been associations proposed between granuloma annulare and conditions such as diabetes mellitus, the evidence for these links is weak.

Despite the lack of clear associations with other conditions, granuloma annulare can still be a frustrating and uncomfortable condition for those who experience it. The lesions can be unsightly and may cause itching or discomfort. Treatment options for granuloma annulare include topical or oral medications, as well as light therapy in some cases.

Switching from the combined contraceptive pill to a progesterone only pill can potentially decrease melasma, as it is believed that elevated levels of estrogen stimulate melanocytes. Given her irregular work schedule, Cerazette, which has a 12-hour usage window, may be a better option for her than norethisterone.

Understanding Melasma: A Common Skin Condition

Melasma is a skin condition that causes the development of dark patches or macules on sun-exposed areas, especially the face. It is more common in women and people with darker skin. The term chloasma is sometimes used to describe melasma during pregnancy. The condition is often associated with hormonal changes, such as those that occur during pregnancy or with the use of hormonal medications like the combined oral contraceptive pill or hormone replacement therapy.