Arhp Gpep Adult Eczema + Emollients + Steroids

Front 1

What are some important things to consider when assessing Adult eczema

Back 1

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

Front 2

In terms of epidemiology when you can Eczema start

Back 2

As a child or for the first time is an adult

Front 3

What are symptoms or signs of an eczema flare

Back 3

Redness

Weeping

Vesiculation

If patient has more pigmented skin type, this may present as darkening of the affected skin.

Front 4

What are the common areas affected by adults who get eczema

Back 4

face, neck, skin flexures, nipples, and hands but may be present either diffusely or locally.

Front 5

After resolution of an eczema flare what can happen to the skin

Back 5

Hypo or hyper pigmentation

Front 6

What are some irritants that can trigger and eczema flare

Back 6

Irritants allergens infections and occupational irritatants

Front 7

What is the differential for eczema

Back 7

tinea, psoriasis, scabies, drug reactions

Other forms of dermatitis

Front 8

When questioning the effect of eczema on the patience quality of life what should you focus on

Back 8

everyday activities and psychosocial wellbeing

Front 9

What is the general management structure for eczema in adults

Back 9

General management,

infection and

treatment failure

Front 10

What is the general management for Adult eczema

Back 10

General measures

Emollients (moisturisers)

Bathing elements

Topical steroids

Oral antipruritics

Oral or systemic steroids

Front 11

What general measures should you advise the patient regarding general management of adult ezcema

Back 11

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.

Front 12

When considering emollients for adult eczema what should you remember

Back 12

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.

Front 13

In terms of dozing for emollients an adult eczema What should you remember

Back 13

Sufficient amount,

liberal use and

regular use

Front 14

How do you apply emollients

Back 14

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

Front 15

What are some general rules when bathing or washing in regards to the use of emollients

Back 15

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.

Front 16

If the patient has chronic relapsing eczema after a flare can you advise them to continue taking the emollient

Back 16

Yes

Front 17

Is there any evidence that one particular emollient is better than another

Back 17

No

Front 18

What are key factors to consider when prescribing emollients

Back 18

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.

Front 19

What is the difference between lotions creams and ointments

Back 19

Do you amount of oil and water in them

Front 20

Oil content is the lowest in what Topical agents

Back 20

Lotion has the lowest amount then intermediate is creams and ointment has the most oil

Front 21

The higher the oil content of a topical agent then the greasier it is

Back 21

True

Front 22

As a general rule is it more Effective for a topical agent to be greasier In treating eczema

Back 22

Yes so ointments would theoretically be more effective

Front 23

Ointments are more affective for managing eczema because they have the highest amount of oil but what else should you consider

Back 23

may be more suitable for those with sensitivities.

Can exacerbate acne.

Can cause folliculitis when overused.

They also have fewer preservatives

Front 24

In terms of creams and gels for eczema management what benefit are there

Back 24

More cosmetically acceptable than oil‑based moisturisers.

Front 25

ointments are more affective for managing eczema because they have the highest amount of oil but what else should you consider

Back 25

may be more suitable for those with sensitivities.

Can exacerbate acne.

Can cause folliculitis when overused.

Front 26

In terms of creams and gels for eczema management what benefit are there

Back 26

More cosmetically acceptable than oil‑based moisturisers.

Front 27

Lotions have more water and is less effective But what are some benefits

Back 27

Easier to spread

May be preferred for mildly dry skin, as well as for hairy areas.

Front 28

What are humectants

Back 28

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.

Front 29

Are aqueous creams containing sodium laurel recommended for eczema

Back 29

No not any more because they have the highest risk of skin irritation

Front 30

What are some examples of emollients

Back 30

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.

Front 31

In terms of Bathing for the management of adult eczema what should you consider

Back 31

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.

Front 32

How should you use topical steroids for managing adult eczema?

Back 32

before prescribing consider skin thickness, formulation, potency, combination preparations, side effects, amount (use) and compliance

Front 33

does diluting a potent topical steroid by half alter its potency or reduce the risk of topical or systemic side effects when used inappropriately

Back 33

no

Front 34

what are some examples of mild topical steroids

Back 34

Hydrocortisone (0.5%)

Hydrocortisone (1%)

Hydrocortisone with lanolin oil and paraffin liquid (Paraffin warning)

Front 35

hydrocortisone 1% is considered

Back 35

Pharmacist-only medicine (restricted to pack size ≤ 30 g), purchased after consultation with a pharmacist

Front 36

hydrocortisone with lanolin and paraffin liquid is dangerous why

Back 36

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.

Front 37

what are some examples of moderate topical steroids (2 to 25 times as potent as hydrocortisone)

Back 37

Clobetasone butyrate (partial subsidy) and

Triamcinolone acetonide (fully subsidised)

Front 38

what are some examples of potent topical corticosteroids(100 to 150 times as potent as hydrocortisone)

Back 38

Betamethasone valerate

Diflucortolone valerate (partial)

Hydrocortisone 17-butyrate

Mometasone furoate

Methylprednisolone aceponate

Front 39

All potent topical corticosteroids are fully subsided except

Back 39

Diflucortolone valerate

Front 40

what are some examples of very potent topical corticosteroids - both of which are fully subsidised

Back 40

Clobetasol proprionate and

Betamethasone diproprionate

Front 41

what type of antihistamines help with itching

Back 41

sedating antihistamines

Front 42

does non sedating antihistamines help with itch

Back 42

no

Front 43

what is a good sedating antihistamine to use for itch

Back 43

promethazine - available OTC or via prescription but only at the pharmacy

Front 44

if prescribing a sedating antihistamine what do you need to be careful

Back 44

caution in the elderly, or patients with other significant comorbidities, or are taking other sedative or CNS acting medication

Front 45

can you use oral also known as systemic steroids for eczema

Back 45

only for very severe eczema or in urgent situations then use a short course of prednisone

Front 46

what is the recommendation for providing oral steroids for very severe eczema

Back 46

short course of prednisone, starting at 0.5 mg per kg per day and tapering over 1 to 2 weeks.

Front 47

is oral steroids a substitute for topical therapy

Back 47

no, continue topical steroids and emollients while patient is using oral steroids

Front 48

should you give a repeat course of oral steroids if a patient is having ongoing severe eczema

Back 48

it is discouraged (e.g., more than 1 course every 6 months).

Front 49

if eczema is not adequately controlled by topical therapy what should you do

Back 49

seek dermatology advice

Front 50

if you suspect occupation hand dermatitis what should you do

Back 50

follow the occupational disease notification

Front 51

what does the occupational disease notification process entail

Back 51

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

Front 52

What is eczema herpeticum

Back 52

eczema infected with HSV-1 or HSV-2) and is a dermatological emergency

Front 53

What should you do if you suspect eczema herpticum

Back 53

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

Front 54

bacterial infections in eczema is commonly caused by what organism

Back 54

staphylococcus

Front 55

what symptoms and signs should you expect to find in bacterial infections of eczema

Back 55

weepy, crusted, and erythematous skin.possible vesicles, bullae, or fissuring of the skin.

Front 56

how common is eczema herpticum

Back 56

rare

Front 57

what antibiotic should you use to treat eczema

Back 57

flucloxacillin 500mg QID but if penicillin allergy use erythromycin

Front 58

if you have concerns of cellulitis related to eczema then refer to

Back 58

cellulitis guidelines

Front 59

if considering IV antibiotics for eczema who should you speak to before administering

Back 59

infectious diseases

Front 60

is it advisable to give prolonged courses of antibiotics for eczema patients who have a bacterial infection

Back 60

avoid as little evidence for benefit in most cases and increased risk of bacterial resistance

Front 61

if a patient with eczema has weepy skin what should you consider

Back 61

potassium permanganate to help dry it out.

Front 62

how do you use potassium permanganate

Back 62

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.

Front 63

What should you check if a patient fails to respond to treatment

Back 63

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

Front 64

what should you consider a non acute dermatology assesssment for eczema

Back 64

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.