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(in all severity, emollients are to be applied)

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Avoid environmental irritants e.g Wool, detergents, sands, grass, raised temperature, sweating

Avoid environmental allergens e.g animal hair/fur, preservatives, deodorants

Ensure skin is sufficiently hydrated with the regular use of moisturisers

Avoid soap & bubble bath. Take lukewarm baths/showers . Use unscented, mild soap/soap-free cleansers to cleanse the skin.

Keeping finger nails short; not to scratch when it is itchy.

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Anti-inflammatory agents -- Topical Corticosteroids

Examples

Hydrocortisone (mild potency)

Betamethasone (moderate potency)

Mometasone furoate (moderate potency)

Clobetasol propionate (very potent)

Contraindications

Cannot be used alone for fungal/bacterial/viral skin lesions

Factors to consider

Potency and Formulation of preparation

increasing potency: ointment --> cream --> gel/lotion --> spray/applications

Condition and Severity of disorder being treated

Area of body being affects

Extent to which the body is affected

Age of person

Patient's preference

Emollient preparations (Moisturisers)

Emulsifying ointment

White soft paraffin

Aqueous cream

Urea

should be applied and allowed to be absorbed first (for about 10 - 15 mins) before applying topical corticosteroids --> as skin needs to be moist but not slippery
however, corticosteroid can also be applied first before emollient , wait 15mins after applying corticosteroids

Other preparations

Coal tar

Oral steroids

E.g. Prednisolone

To be used short-term

Oral cyclosporine

Immunosuppressant

For immune-mediated eczema only

If topical is not enough

If phototherapy is contraindicated

Antihistamines

To reduce itching

up to 3 weeks

Examples

Hydroxyzine (mainly indicated for pruritus)

Chlorpheniramine

Cetirizine

Fexofenadine

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Inflammatory skin disorders

Idiopathic or immune-mediated (hypersensitivity reaction)

Commonly found

Face

Hands

Feet

Inside of elbows

Creases of writsts

Back of knees

Worsen by

Allergens and/or irritants

Changes in weather

Cold and dry vs Hot and humid

Stress

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affect areas where sebaceous glands are most active + occasionally other area

Signs and Symptoms:

Yellow greasy scales over an eczematous lesions

Usually occurs along the scalp line, nasolabial fold, eyebrows, eyelashes, ears and over the sternum accompanied with itching redness and inflammation -> resulted in dandruff

Risk Factors:

Stress and the presence of other neurological conditions (e.g. parkinsons)

Weakened immune system

Causes:

Excess yeast that lives under the surface of the skin

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sharp demarcated inflammation and irritation of the skin

caused by contact (touch) with skin sensitive (allergens/irritants) substances --> see inflammation at contact area

risk factors
prolonged exposure to known allergens and irritants
not wear protective clothing when handling sensitive substances
after being exposed --> did not wash immediately

2 types:
irritant contact dermatitis

- wool

- soaps

- detergent

- sweating

raw, red and dry skin --> prolonged contact with irritating/drying substance

allergic contact dermatitis

- preservatives

- fragrances

- deodorants

- animal fur

- photosensitizing drugs (tetracycline, fluoroquinolone, sulfonamide)

eczematous, popular red or vesicular lesion seen
commonly appears as blisters

signs and symptoms
mild irritants & allergens: erythema & small vesicles that ooze, scale and itch

Strong  irritants: blisters and ulceration

classic allergic response: clearly defined lesions with straight lines following point of contact

severe allergic reaction: marked oedema of affected areas

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chronic, pruritic (itchy) inflammatory skin disease
most common in children --> can last into adulthood

Signs and Symptoms

Dry, flaky skin

Intense itch

Redness

Blisters

Lichenification (leather like)

Risk Factors

Family or personal history of the atopic triad (asthma and allergic rhinitis)

Infants and children

Hot and humid climates

Vasodilation which pushes immune cells to surface activating them easily

Sweating can cause itch