All treatments Flashcards
does flucloxacillin cover beta haemolytic strep
yes
what for skin does doxycycline cover
staph aureus inc MRSA
beta haemolytic strep
what does co-trimoxazole cover
staph aureus inc MRSA
65% of coliforms inc e coli
what treatment for cellulitis
Flucloxacillin, or Doxycycline if Penicillin allergic.
Refer to infectious diseases if: systemically unwell, or not responding to treatment.
May be suitable for outpatient IV therapy (OHPAT).
If recurrent boils, or abscesses, consider swabbing for PVL
what are the causative organisms of cellulitis
Staph aureus.
group A and other Beta haemolytic Strep.
Tx for athletes foot
topical 1% terbinafine
Tx for dermatophyte infection
Small area infected: clotrimazole cream (canestan), topical nail paint (amorolfine)
Scalp: terbinafine orally, itracinazole orally
Tx for candida impetigo
clotrimoxazole cream, oral fluconazole
Tx for scalies
Malathion lotion (overnight) Benzyle Benzoate
tx for lice
Malathion
Tx for diabetic foot infection
Mild: Flucloxacillin (1st line) or Doxycycline (2nd line) 7 days
Moderate: Flucloxacillin + metronidazole (or doxycycline + metronidazole)
causative organisms for diabetic foot infection
acute= s aureus
acute on chronic= s aureus, coliforms, anaerobes
tx for impetigo
Localised lesions: topical Fusidic acid.
Not localised: (both 7 days)
1st Line – oral Flucloxacillin.
2nd Line – oral Clarithromycin.
tx for syphillis
penicillin
tx for lyme disease
doxycyline or amoxicillin
tx for chicken pox
Prescribe antiviral if patient presents <24hours of onset of rash: Aciclovir (oral)
tx for shingles
Must present within 72hr of onset of rash: Aciclovir or Valaciclovir
tx for bites
1st line: Co-amoxiclav.
2nd line: Metronidazole + doxycycline
tx for rosacea
Reduce aggravating factors (diet, sun, AVOID topical steroids)
1st line: topical metronidazole, ivermectin (to reduce demodex mite)
2nd line: oral therapy: oral tetracycline long term, low dose isotretinoin
Telangiectasia: vascular laser
Rhinophyma: surgery/ laser shaving
tx for psorias
- Emollients
- Vit D analogues (calcipotriol, calcitriol)
- Vit D analogue + potent corticosteroid (beware of rebound flare)
(If on face, genitalia or flexures= mild steroid ) - Refer:
- phototherapy UVB (if don’t want to be admitted)
-coal tar/ dithranol
- systemic therapy 1st : methotrexate (ciclosporin if family planning)
2nd: biologics (-umabs)
what are the severities of acne
Mild- scattered papules and pustules, comedones
Moderate - numerous papules, pustules &
mild atrophic scarring
Severe - cysts, nodules and significant scarring
hat advice for acne vulgaris
avoid over cleaning (not caused by poor hygiene), 2x daily cleaning w/ gentle soap, use make up/ moisturisers that don’t clog up pores, avoid picking/ squeezing= scarring, healthy diet
what is the topical treatment for acne
- Topical retinoid (Vit A) (has drying effect, contraindicated in pregnancy/ breast feeding)
- & benzoly peroxide (keratolytic, antibacterial)
- Topical antibiotics (anti inflammation and antibacterial)- clindamycin (ALWAYS in combo with topical retinoid/ benzoyl peroxide to prevent resistance)
- Azelic acid
what treatment for acne not responding to topical treatment
- Oral antibiotic (lymecycline/ doxycycline) (need to take for 6 months, always co prescribe topical retinoid benzoyl peroxide for resistance prevention)
- Combined oral contraceptive pill
- Oral isotretinoin (oral retinoid) (affects sebaceous gland activity)
tx for lichen planus
Treat symptomatically – topical steroids
last 12-18 months, self limiting
ix for bullous disorders
skin biopsy with immunofluorescence
Indirect immunofluorescence
tx for bullous disorders
systemic steroids
- Pemphigoid: tetracycline antibiotics
- Other immunosuppressive agents
- Topicals: emollients, topical steroids, topical antisepsis/ hygiene measure
tx for eczema
- Emollients
- Avoid irritants (shower gel soaps)
- Topical steroids
- Tx infections
- Phototherapy UVB
- Systemic immunosuppression
- Biologics (cyclosporin, methotrexate, azathioprine)
- If itch/ urticaria= sedative antihistamines
ux for photodermporphyrias
Porphyria cutanea tarda
Ix- woods lamp
Erythropoietic protoporphyria
Ix- check for anaemia, biliary tract USS (for stones), RBC porphyrins, fluorocytes, transaminases
tx for porphyria cutanea tarda
treat underling cause (alcohol, viral hepatitis, oestrogens, haemochromatosis)
- Relieve skin disease
tx for erythopoietic protoporphyria
6 monthly LFTs and RBC porphyrins
- Visible light photoprotection measures (protective clothing, visible light suncream, behavior)
- Anti oxidants
- Only cure bone marrow transplant, may have liver failure so might need transplant for that too
tx for pruritis
- sedative antihistamine
- emollients
- anti depressants
- anti epileptics
- phototherapy
- opiate agonists, ondansetron
tx for non melanoma skin cancer
Surgery
5% imiquimod cream
tx for pre cancers
Cryotherapy Solaraze 5 FU PDT Imiquimod Resurfacing
tx for melanoma
Surgery
Chemo/ radiotherapy may be needed
types of surgery for skin cancer
electrosurgery, snip excision, curettage, shave excision, punch biopsy, elliptical excision
Ix for leg ulcers
Ix- ABPI (to establish if there is arterial disease)
Wound swap ONLY if signs of infection
what are the ABPI parameters
- 1= normal
- 0.8-1.3= compress
- <0.8 = vascular disease
- > 1.5 = calcification
tx for venous ulcers
- Pain control
- Clean with warm tap water and soap substitute (not sterile wound)
- Non adherent dressing
- De-sloughing (hydrogel, honey, biological, sharp debridement, surgical)
- 4 layer compression bandaging (cone shaped leg) (last 6 months)
- Leg elevation
- Once healed emollients and compression stockings
