1. Skin Flashcards
Differences between skin formulations
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.
Skin excipients and sensitisation
- 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
Emollients counselling
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
Skin conditions topical corticosteroids ARE used in
Eczema, dermatitis
Skin conditions topical corticosteroids ARE NOT used in
Acne, rosacea, skin infections as corticosteroids may exacerbate it
Mild topical corticosteroids
Hydrocortisone <2.5%
Moderate topical corticosteroids
- Clobetasone (Eumovate)
- Betamethasone 0.025% (Betnovate RD)
Potent topical corticosteroids
- Betamethasone 0.1% (Betnovate)
- Hydrocortisone Butyrate
- Mometasone
Very potent
Clobetasol (Dermovate)
Topical steroid applications counselling
- Apply thinly to affected areas no more than twice daily
- Avoid prolonged use - can cause skin thinning, hypo or hyper-pigmentation
- Apply emoliient first, 30 minutes then apply steroid for maximum absorption, prevents the emolient from diluting the steroid
- Keep away from eyes
Fingertip units
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
Rosacea
Common skin condition that causes flushing or long-term redness on the face. May also cause enlarged blood vessels and small, pus-filled bumps.
Rosacea Treatment
- facial erythema
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.
Rosacea Treatment
- pustules and papules
Topical preparations: metronidazole, azelaic acid, ivermecitin
OR
Oral preparations: oxytetracycline, tetracycline, erythromycin
Oral isotretinoin
Prescribed underspecialist supervision, as all retinoids or vitamin A derivatives are teratogenic.
Isotretinoin and contraception
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
Isotretinoin and pregnancy tests
- 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
Pregnancy prevention programme
- At least two negative pregnancy tests to exclude pregnancy
- Prescription is only valid for 7 days
3.** Max 30 day supply**
4.Repeat prescriptions/fax should not be accepted - Emergency supply can only be given on specialist request with negative pregnancy test
Isotretinoin side effects
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
Isotretinoin patient counselling
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
Acne OTC products
Only limited to use on the face
Acne referral
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
Acne 1st line treatment OTC
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)
Acne advice
Avoid oil-based cosmetics. Stick to water-based cosmetics
Avoid over-scrubbing.
Do not squeeze spots as this can cause scarring.
