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Chapter 13 - Skin > 1. Skin > Flashcards

1. Skin Flashcards

1
Q

Differences between skin formulations

A

Ointments are more greasy, therefore most hydrating and more be

Creams are less greasy, more cosmetically acceptable. Less hydrating than ointments so more frequent applications are required

Lotions have a cooling affect, better for larger/hairy areas. They have an alcoholic base so sting broken skin.

Gels have high water content, so more suitable for scalp and face application.

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2
Q

Skin excipients and sensitisation

A
  • Patch test beforehand
  • Preparations that contain salicylate - beware in neonates can cause toxicity if applied to large areas
  • Benzyl alcohols should be AVOIDED in neonates, as benzyl peroxide is associated with fatal toxicty syndrome
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3
Q

Emollients counselling

A

Emollients should be applied as often as required to maintain moisturisation

Apply emmolients in direction of hair growth

Apply after washing/bathing to maximize hydration

Bath additives should be soaked for at least 10-20 minutes to improve hydration

Remove from tubs using clean spoons to avoid contamination

Paraffin-based skin emollients hold a fire risk. AVOID smoking upon applicatiion

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4
Q

Skin conditions topical corticosteroids ARE used in

A

Eczema, dermatitis

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5
Q

Skin conditions topical corticosteroids ARE NOT used in

A

Acne, rosacea, skin infections as corticosteroids may exacerbate it

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6
Q

Mild topical corticosteroids

A

Hydrocortisone <2.5%

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7
Q

Moderate topical corticosteroids

A
  • Clobetasone (Eumovate)
  • Betamethasone 0.025% (Betnovate RD)
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8
Q

Potent topical corticosteroids

A
  • Betamethasone 0.1% (Betnovate)
  • Hydrocortisone Butyrate
  • Mometasone
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9
Q

Very potent

A

Clobetasol (Dermovate)

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10
Q

Topical steroid applications counselling

A
  1. Apply thinly to affected areas no more than twice daily
  2. Avoid prolonged use - can cause skin thinning, hypo or hyper-pigmentation
  3. Apply emoliient first, 30 minutes then apply steroid for maximum absorption, prevents the emolient from diluting the steroid
  4. Keep away from eyes
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11
Q

Fingertip units

A

FTU (about 500mg) is the amount needed to squeeze a line from the tip of an adult finger to the first crease

FTU’s
0.5 - Genitals
1 - Hands, elbows and knees
1.5 - Feet including soles
2.5 - Face and neck
3 - Scalp
4 - A hand, arm or buttocks
8 - Legs and chest, or legs and back

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12
Q

Rosacea

A

Common skin condition that causes flushing or long-term redness on the face. May also cause enlarged blood vessels and small, pus-filled bumps.

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13
Q

Rosacea Treatment
- facial erythema

A

For facial erythema (facial redness):
* Brimonidine; 6-12 week course

! Risk of systemic cardiovascular effects:
bradycardia, hypotension, dizziness. To prevent systemic absorption avoid applying to irritated or damaged skin, especially after laser therapy

Small amount of gel should be applied for one week and then increased gradually depending on tolerability/response. Maximum dose should not be exceeded.

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14
Q

Rosacea Treatment
- pustules and papules

A

Topical preparations: metronidazole, azelaic acid, ivermecitin

OR

Oral preparations: oxytetracycline, tetracycline, erythromycin

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15
Q

Oral isotretinoin

A

Prescribed underspecialist supervision, as all retinoids or vitamin A derivatives are teratogenic.

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16
Q

Isotretinoin and contraception

A

Contraception must be used before, during and 1 month after treatment.

Ideally two methods should be used: combined + barrier method. Progestogen-only contraceptives are not an effective form of contraception.

Pregnancy test must be negative

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17
Q

Isotretinoin and pregnancy tests

A
  • The pregnancy test should be taken within the first three days of the menstrual cycle AND up to 3 days before treatment.
  • Treatment should be started on the 2nd or 3rd day of menstrual cycle
  • Pregnancy test must be repeated every month and for 5 weeks weeks after stopping.

SEEK UGRENT MEDICAL ADVICE IF FALL PREGNANT DURING TREATMENT

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18
Q

Pregnancy prevention programme

A
  1. At least two negative pregnancy tests to exclude pregnancy
  2. Prescription is only valid for 7 days
    3.** Max 30 day supply**
    4.Repeat prescriptions/fax should not be accepted
  3. Emergency supply can only be given on specialist request with negative pregnancy test
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19
Q

Isotretinoin side effects

A

Hyperglycaemia, hypertriglycerides, high cholesterol, pancreatitis, hepatotoxicity, visual disturbances. Can also cause skin peeling, redness, severe dryness of skin and mucous membranes.

Risk of pancreatitis if triglycerides are above 9 mmol/litre

STOP if uncontrolled hypertriglyceridaemia or pancreatitis

STOP if severe skin peeling, haemorrhagic diarrhoea

Expert referral/possible withdrawal needed for visual disturbances

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20
Q

Isotretinoin patient counselling

A

Avoid waxing, and laser treatment during and 6 months after treatment

Photosensitivity - avoid UV light and use high factor SPF sunscreen and emollient, including lip balm. (applies to oral and topical isotretinoin)

STOP if psychiatric reactions, depression, anxiety, suicidal ideation begin to develop

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21
Q

Acne OTC products

A

Only limited to use on the face

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22
Q

Acne referral

A

OTC failure > 8 weeks
Children below 12 (as acne In this age group is uncommon)
Acne rosacea
If acne appears on back or chest
Medication: phenytoin, lithium, progestogens

23
Q

Acne 1st line treatment OTC

A

Benzoyl peroxide
(Acnecide, Panoxyl)
This product is ant-bacterial, anti-inflammatory, anti-comedogenic

Start as low as 2.5%, 5% then slowly increase from once to twice daily, then 10% after some time

Alternative: Nicotinamide (Freederm)

24
Q

Acne advice

A

Avoid oil-based cosmetics. Stick to water-based cosmetics

Avoid over-scrubbing.

Do not squeeze spots as this can cause scarring.

24
Q

Benzoyl peroxide counselling

A

Can cause the skin to start stinging, burn, red peeling. Can tell patient to reduce strength to reduce the side effects.

Must wash skin with mild soap to remove excess oil. Apply to whole area affected, not just lesions. Best applied at night as it can cause skin to become sun sensitive. Takes up to 8 weeks to work

Wash hands after use as it can bleach clothes

25
Q

Cold sore treatment

A

Acyclovir cream (Zovirax)

Apply 5 times per day for at least 4 days

Alternatively: Fenistil cream

26
Q

Cold sore counselling

A

Very contagious!
Avoid close contact with other persons

27
Q

Corns and calluses

A

Plasters/padding/shielding

e.g corn plasters

28
Q

Corns and calluses

A

Wear appropriate well-fitting shoes

Dry feet thoroughly after washing

Use a pumice stone to gently remove hard skin

29
Q

What is eczema

A

A type of dermatitis called atopic dermatitis

30
Q

Eczema symptoms

A

Sore and inflamed rash

Flaky skin

Irritated and itchy skin

31
Q

Contact dermatitis

A

Types:
- Irritant (substance which directly damages the outer layer of the skin)

  • Allergic (substance which causes an immune response)
32
Q

Atopic and contact dermatitis referral

A

Infected skin
Broken skin
Anogenital areas
Face
Symptoms > 2 weeks
OTC failure > 7 days
If eczema is suspected but has not been previously diagnosed

Only mild-moderate eczema can be treated over the counter

33
Q

Eczema treatment (1st line)

A

Emollients help to sooth and hydrate skin

  • Lotion e.g Dermon 500
  • Cream e.g Aveeno, Cetraben, E45
  • Ointment e.g Epaderm ointment - (ointments have most lipid content and most hydrating, more suited to patients with excessive dryness)

-Soap substitute
- Bath additives
(some are perfumed which may worsen dermatitis)

34
Q

Eczema treatment - flare ups

A

Steroids:
Hydrocortisone 10+ - mild potency
Clobetasone 12+ - moderate potency

Max 15g pack size, with max use of 7 days
Not to be used for broken or infected skin

Cannot be used in
acne, rosacea, skin infections, impetigo, ringworm
(as steroids cause immunosuppression and may worsen the infection)

35
Q

Eczema itching

A

The cause of itching in eczema is not histamine related so will not be effective.
Can recommend sedating antihistamines.

Calamine/crotamiton will be most effective

36
Q

Eczema counselling

A

Apply emollient first, then wait 30 minutes to apply steroid

Use soap substitutes, as normal soap may dehydrate the skin

Avoid cold, harsh weathers, perfumed cosmetics, dairy, red meat

37
Q

Psoriasis cause

A

Caused by increased skin turnover

38
Q

Psoriasis symptoms

A

Red plaques
Silvery scales
Well-defined edges

Commonly appear on the elbow, knees. but can also occur on the scalp

39
Q

Psoriasis

A

If undiagnosed
Moderate to severe

40
Q

Psoriasis treatment

A

OTC
- Emollients
- Coal tar solution (Exorex, T/Gel shampoo politer)
Can stain clothes, has an unpleasant smell and is photosensitive

POM
- Vitamin D (Calcipitrol), Steroids, Dithranol

41
Q

Tinea pedis - Athlete’s foot

A

White, itchy, flaky macerated skin in-between toes

42
Q

Tinea corproris - Body ringworm

A

Flat, slightly, raised circular rings with a distinctive red scaly border

43
Q

Tinea capatis - Scalp ringworm

A

Distinctive ring-shaped rash with associated hair loss

44
Q

Tinea cruris - Jock itch

A

Fungal groin infection

Red-brown rash with well-defined edge on inner thighs and buttocks

45
Q

Tinea fungal Referral

A

Facial or scalp involvement

Toenails also affected in athlete’s

Large area affected

Broken skin

Secondary bacterial infection

Diabetic/immunocompromised

OTC Failure after 2 weeks

46
Q

Topical imidazoles

A

Clotrimazole - All ages (Canestan)
Ketoconazole (Daktarin GOLD, Intensiv)
Miconazole (Daktarin, Daktacort - 15g)

Terbinafine (Lamisil 16+, Lamisil Once 18+)

Powders (Mycota, Mycil)
Can be used prophylactically for athlete’s foot

47
Q

Fungal nail infection symptoms

A

Dull, yellow colour starting at the side of the nail or beneath the top

The nail thickens and becomes distorted

48
Q

Fungal nail referral

A

Nail breaking away
Immunocompromised
Diabetes
Peripheral circulatory disease

49
Q

Fungal nail infection

A

5% amorolfine
18+ years
Contraindicated in pregnancy and breastfeeding

Apply once weekly to affected nails.The nails must be filed down, cleaned before use.
Must continue using the product until nail tissue grows out.
One pack provides 3 months supply

50
Q

Warts vs verrucae

A

Warts - flesh-colour raised cauliflower surface

Verrucae - flat with black dots in the middle (due to blackened capillaries)

51
Q

Warts and verrucae referral

A

Facial warts
Multiple warts
Anogenital warts - may be an STI
Diabetics
Immunocompromised
Itching/bleeding warts

52
Q

Warts and verrucae treatment

A
  • SALICYLIC ACID (Bazooka, Salactol)
    Softens and destroys the skin

Before applying salicylic acid, soak area in warm water to soften the skin. Protect healthy skin with petroleum jelly. Remove dead skin every week.

Can take up to 12 week to work

  • CRYOTHERAPY (Wartner)

Chapter 13 - Skin (1 decks)

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