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2021 Pre-registration > Chapter 13: Skin > Flashcards

Chapter 13: Skin Flashcards

1
Q

What are the different topical skin formulations?

A

Ointments: greasy, very hydrating, for chronic eczema

Creams: less greasy, dry quickly, more cosmetically acceptable

Lotions: suitable for large and hairy areas, cooling effect

Pastes: thick and used to form protective barrier for infected/excrutiated skin

Powders: help to reduce friction

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2
Q

What kind of application is suitable for those with dry skin?

A

Emollients. They should be applied frequently when required as they are short acting.

Use 30mins before steroids to open up pores
Use in the direction of hair growth
Use after wash/bath to increase hydration

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3
Q

MHRA warning with emollients?

A

MHRA: flammable and can cause severe and fatal burns so avoid clothing near naked flames/smoke

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4
Q

Emollient bath and shower preparations should be used how?

A

soak for 10-20 minutes

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5
Q

Two treatments for eczema?

A

1) Topical steroids

2) Emollients - minimum BD application

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6
Q

Discuss the factors that need to be considered before prescribing topical corticosteroids?

A

Severity
Site of application
helps to reduce inflammation
avoid use in rosacea/acne/infection as can flare up

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7
Q

For those with frequent flare ups within 2-3months what would you recommend in regards to steroid therapy?

A

Use twice a week as prophylaxis

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8
Q

What steroids are mildly potent?

A

Hydrocortisone <2.5%

Use on face and flexures

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9
Q

What steroids are moderately potent?

A

Betamethasone 0.025% and clobetasone (eumovate)

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10
Q

What steroids are potent?

A

Mometasone

Hydrocortisone butyrate

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11
Q

What steroids are very potent?

A

Clobetasol (dermovate)

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12
Q

Potent steroids are generally applied on?

A

trunk
limbs
scalp

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13
Q

Counselling for steroid application?

A

Apply thinly

Not for long term use as can worsen condition, discolour skin and cause skin thinning

Emollient 30mins before steroid to prevent dilution of steroid

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14
Q

If those with eczema get an infection, what are the common pathogens?

A

Staph aureus
Strep pyogenes

Can exacerbate eczema
Give topical/systemic abx for 1 week

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15
Q

Treatment options for severe refractory eczema?

A

Phototherapy

Alitretinoin (teratogenic, 7 day rx under PPP)

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16
Q

Treatment options for sebborhaeic dermatitis?

A

Yeast infection affects scalp eyebrows and nose

Treat with ketoconazole, steroids, coal tar

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17
Q

What is lichenification and how would you treat it?

A

Increased scratching. Treat with potent steroids, bandages, coal tar/zinc oxide paste

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18
Q

For itch and urticaria, what can you recommend OTC?

A

Antihistamines, sedating chlorphenamine (1yr+) if it interferes with sleep

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19
Q

Treatment options for weeping eczema?

A

potent steroids + potassium permanganate

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20
Q

What is psoriasis?

A

Thickening of outer layer of skin (epidermal) and scaling.

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21
Q

Describe psoriasis on a patient?

A

Well defined, silvery, scaley plaques that could also be red.

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22
Q

Commonly affected areas of psoriasis?

A

Scalp and extensor surfaces (front of knee, forearm, behind elbows)

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23
Q

what drugs can trigger psoriasis?

A 
ACEi
Beta blockers
NSAIDS
Lithium
Chloroquines 
(effect can occur after weeks/months of taking the drug)
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24
Q

1st line treatment for mild psoriasis and what should be used adjunctly in psoriasis?

A

Emollients

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25
Q

What treatment is suitable for chronic stable psoriasis/inflammatory PHASE of psoriasis?

A

Vitamin d analogues e.g. coal tar (potent smell)/dithranol/retinol tazarotene - unsuitable for more inflammatory forms as can cause irritation

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26
Q

what would you recommend for scalp psoriasis?

A

Plaques need to be softened with emollient lotion/oil/cream/oint and then use a tar-based shampoo

Use keratolytic e.g. salicylic acid if there is significan scaling to allow other treatments to work

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27
Q

How long should scalp preparations such as coal tar + salicylic acid be left for

A

1 hour / overnight

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28
Q

What can be used for face, flexure and genital psoriasis?

A

Mild (hydrocortisone<2.5%) /mod (eumovate clobetasone or betamethasone 0.0025%) or /potent (dermovate - clobetasol ) corticosteroids.
If ineffective then use vitamin d analogues like calcipotriol however it is irritating

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29
Q

What can be used for long-term plaque psoriasis?

A

Vitamin d analogues: more accepting to patients as do not smell or stain clothing. Tacalcitol and calcitriol are less likely to cause irritation

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30
Q

If topical treatment for psoriasis has failed what is the next option?

A

Phototherapy under specialist.
or
Systemic treatment: acitretin, ciclosporin, methotrexate

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31
Q

Acitretin (vitamin a derivative) can be used in psoriasis for specialist cases. When does optimal benefit occur and what duration do the manufacturers recommend?

A

2-4 weeks for therapeutic effect
Max benefit after 4 months
Not recommended for longer than 6 months
Teratogenic - 3yrs risk after stopping, contraception during and atleast 3 yrs after (Preg prevention programme)

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32
Q

What effect can vitamin d analogues have on electrolytes?

A

Hypercalcaemia

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33
Q

Treatment for steroids in children has to be limited to short term use. What should be the usual duration?

A

Try and use mild steroid e.g. HC - usually 5-7 days

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34
Q

Can topical corticosteroid treatment cause systemic SE?

A

Yes. Max BD - apply thinly and use the least potent formulation

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35
Q

The rule of thumb for topical corticosteroid treatment shows that a fingertip unit of steroid can cover how much area?

A

Twice that of the flat handprint

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36
Q

OTC steroids and age categories?

A 
Hydrocortisone 1%: over 10 yrs - max 1 week
Clobetasone butyrate (eumovate) 0.05%: over 12 yrs

Max 15g

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37
Q

Licensed indication for steroids OTC?

A

Atopic eczema
Contact dermatitis
insect bite reactions

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38
Q

Unlicensed indication for steroids OTC?

A

not for face, anogenitals, broken skin, - cold sores/acne/athletes foot

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39
Q

Coal tar can stain:

A

Skin, hair, fabric

40
Q

Tacrolimus counselling points:

A

Avoid UV light as photosensitivity

- alcohol intolerance (common)

41
Q

Retinoid based drugs such as alitretinon are contra-indicated in:

A

Hyperlipidaemia

42
Q

MHRA warning with retinoid based drugs?

A

Neuropsychiatric rx - suicidal behaviour

Teratogenic

Use SPF

43
Q

Give three treatment options for hyperhidrosis (excessive sweating)

A

1) Aluminium chloride
2) oxybutynin - unlicensed
3) Glycopyrronium bromide - dries out secretions (specialist)
4) Botox (specialist

44
Q

What is pruritus?

A

Excessive itch

45
Q

State some conditions that can cause pruritus?

A

jaundice/liver issues
eczema
Iron deficiency

46
Q

If pruritus is associated with dry skin, what preparation may be suitable?

A

Emollients

47
Q

What other topical treatments are suitable for pruritus?

A

Crotamiton (limited evidence - eurax)
Calamine (may be ineffective)
Levomenthol cream

48
Q

What oral medication can be used for pruritus?

A

Antihistamines e.g. sedating antihistamines (chlorphenamine) - is good for skin reactions

49
Q

Which topical prep used for pruritus in eczema can cause drowsiness and sensitisation?

A

Doxepin 5% cream

50
Q

What is acne?

A

An inflammatory skin condition that commonly affects face, chest and back.

Due to blockage of sebaceous glands, hair follicles and hair shafts. Can cause comedones (non inflammatory) or papules/pustules/nodules (inflammatory)

51
Q

How long does initial acne treatment take to work?

A

2 months

52
Q

Stepwise approach to treating acne:

A

1) topical treatment e.g. benzoyl peroxide - mild/mod
2) oral antibiotics - mod/sev
3) hormonal treatment co-cyprindiol for women only - anti androgen and risk of VTE
4) isotretinoin - dermatologist only - severe acne with psychological impact

53
Q

What kind of topical treatment would be suitable for mild/mod acne : comedones and inflamed lesions?

A

Benzoyl peroxide / retinoid

54
Q

What kind of topical treatment would be suitable for inflammatory acne?

A

Topical antibiotics e.g. erythromycin/clindamycin

55
Q

How long should benzoyl peroxide be trialled for acne?

A

minimum 2 months then switch if no response

56
Q

Initial SE with benzoyl peroxide?

A

Local irritation, redness, stains pillows and clothes, avoid sunlight and use SPF

57
Q

What would be an alternative treatment to benzoyl peroxide if a patient was suffering severe irritation?

A

Azelaic acid (less irritation than benzoyl peroxide)

58
Q

Topical retinoid preparation is ______

A

Adapalene - several months of treatment and continue until no new lesions develop

59
Q

Oral retinoid prescribed in mod-severe acne is called ______

A

Isotretinoin (vitamin a derivative)

60
Q

Give examples of antibiotics used in acne.

A

1) Oxytetracycline/tetracycline for 3/12, may be 2 years or longer
2) Doxycyline/Lymecycline (alternatives)
3) Minocycline (alternative and as effective as tetracyclines) but increased risk of lupus and irreversible pigmentation - OD/BD
4) Erythromycin BD (increased resistance) - only use if tetracycline contra indicated e.g. <12, pregnant
5) Trimethoprim - unlicensed

61
Q

When can you use the contraceptive co-cyprindiol for acne?

A

If topical treatment and antibiotics have failed.
Anti androgen so reduces sebum production.
Not to be used solely as a contraceptive
Women with hirsutism may also benefit

62
Q

Talk about isotretionoin.

A

Vitamin a derivative, works to reduce sebum production by drying out glands and disabling sebum production.

Must be on pregnancy prevention programme (scripts valid for 7 days)

Effective contraception (no progestorone only pills)

Minimum 4 months

SE: hepatotoxic, dry lips, nose bleeds, joint pain, rarely suicidal thoughts and depression (STOP drug)

Regular LFTS and FBCs

Max 30 day supply if not on PPP e.g. if lesbian

63
Q

What is rosacea and how does it differ from acne?

A

Later onset usually 40s. More burst capillaries on face, apples of cheek, nose, forehead (red) - sometimes accompanied with fluid filled spots - may happen in conjunction with acne

64
Q

Lifestyle advice for acne?

A

Prevent over exfoliating
Use non-comedogenic products
Increase water intake
Check hormone levels

65
Q

MHRA warning with isotretionoin?

A

Rare reports of erectile dysfunction and decreased libido

66
Q

Treatment options for rosacea?

A

1) Brimonidine
2) Topical azelaic acid/ ivermectin / metronidazole
Alt: PO tetracyclines (oxy/tetra) or macrolides (6-12 week courses)
3) doxycycline if tetracyclines contra ind e.g. renal impairment or MR doxy
4) isotretinoin

67
Q

Patient and carer advice with isotretinoin?

A

avoid laser hair removal, microdermabraasion, epilation during and 6 months after - risk of scarring

Avoid sun exposure - use SPF

68
Q

State two contra-indications for isotretinoin?

A

hyperlipidaemia
hypervitaminosis A
(>9mmol/l: risk of pancreatitis)

69
Q

Brimoinidine is used in rosacea (1g gel = 3.3mg brimonidine). What is the mHRA warning regarding this drug??

A

1) Serious cardiovascular effects - bradycardia, hypotension, dizzyness.
2) rosacea exacerbation

70
Q

Dandruff is a form of seborrhoeic dermatitis. what treatment options are available?

A

1) Shampoos with zinc/selenium
2) Coal tar shampoos - but smell and stain
3) Ketoconazole for more severe or persistent dermatitis (nizoral available OTC)
3) corticosteroid gels and lotions
4) creams/ointments with salicylic acid particulary useful in psoriasis

71
Q

How would you manage cradle cap in infants?

A

Coconut/olive oil to soften the plaques and then shampoo

72
Q

What is hirsutism and what drugs can cause this?

A

Excessive hair growth

Causes: corticosteroids, anabolic steroids, androgens, progestogens, phenytoin

73
Q

Lifestyle measure for hirsutism in obese women?

A

weight loss

74
Q

Treatment options for hirsutism?

A

Co-cyprindiol (anti androgen)
Metformin - PCOS (unlicensed)
Laser hair removal

75
Q

What can finasteride be used for?

A

Androgen alopecia in men - but must be used continously as hair loss can occur after stopping treatment

76
Q

What two drugs can be used in alopecia?

A

Finasteride and minoxidil (regaine available OTC): ensure hair and scalp are dry and wash hands after application

77
Q

What can potassium permanganate be used for?

A

Extreme eczematous areas

78
Q

MHRA warning with potassium permangante.

A

External use only as oral ingestion = risk of death or serious harm (treat like a CD)

79
Q

MHRA warning with chlorhexidine?

A

Use sparingly in premature infants as risk of severe burns

80
Q

What can be used for those with vitiligo and a high psychological impact?

A

Camoflauge creams e.g. dermacolor

81
Q

UV radiation can be harmful to skin. What drugs can cause photosensitivty?

A 
Amiodarone
Tetracyclines
Isotretinoin
Benzoyl peroxide
phenothiazine
demeclocycline (used in resistant hyponatraemia)
82
Q

What are the long term consequences of photo damage?

A

Skin cancer and aging

83
Q

How would you counsel a patient on applying sunscreen?

A

Thickly and frequently - every 2 hours

84
Q

What topical treatments can be used for photo damage (keratosis) - dry scaly dark patches?

A

Aloe vera gel
Diclofenac gel
Fluorouracil cream

85
Q

Warts are caused by which virus?

A

Human papillomavirus

86
Q

What areas of skin do warts commonly affect?

A

Hands, feet, anogenital (only need treatment if painful, unsightly, persistent or cause distress)

87
Q

What treatment options for warts are available OTC?

A

1) salicylic acid 1st line (keratolytic) soak for 5mins and then use daily for 3 months
2) freeze preparations - cryotherapy goes in 10 days
3) glutaraldehyde/formaldehyde
4) silver nitrate

88
Q

Salicylic acid for warts should be avoided in those with an allergy of

A

plasters

89
Q

Cryotherapy for warts can cause:

A

Pain, blisters and swelling and may be no more effective than topical salicylic acid

90
Q

What can be used of anogenital warts?

A

Podophyllotoxin

91
Q

Which preparation used in warts can stain fabric?

A

Silver nitrate

92
Q

Salicylic acid preparations are not licensed for those under the age of…

A

2 years

93
Q

Lifestyle advice for warts and calluses?

A

Rub gently with file/pumice stone weekly
can take upto 12 weeks to go
Prevent spread - avoid swimming (use flip flops/cover)

94
Q

What can be used for resistant verrucae?

A

Glutaraldehyde

95
Q

how to differentiate between warts and verrucae?

A

Warts - cauliflower like skin coloured - often on hands/fingers

Verrucae - sole of feet with black dots in the middle (disappears within 6months to 2 years

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