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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
What treatment is suitable for chronic stable psoriasis/inflammatory PHASE of psoriasis?
Vitamin d analogues e.g. coal tar (potent smell)/dithranol/retinol tazarotene - unsuitable for more inflammatory forms as can cause irritation
26
what would you recommend for scalp psoriasis?
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
27
How long should scalp preparations such as coal tar + salicylic acid be left for
1 hour / overnight
28
What can be used for face, flexure and genital psoriasis?
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
29
What can be used for long-term plaque psoriasis?
Vitamin d analogues: more accepting to patients as do not smell or stain clothing. Tacalcitol and calcitriol are less likely to cause irritation
30
If topical treatment for psoriasis has failed what is the next option?
Phototherapy under specialist. or Systemic treatment: acitretin, ciclosporin, methotrexate
31
Acitretin (vitamin a derivative) can be used in psoriasis for specialist cases. When does optimal benefit occur and what duration do the manufacturers recommend?
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)
32
What effect can vitamin d analogues have on electrolytes?
Hypercalcaemia
33
Treatment for steroids in children has to be limited to short term use. What should be the usual duration?
Try and use mild steroid e.g. HC - usually 5-7 days
34
Can topical corticosteroid treatment cause systemic SE?
Yes. Max BD - apply thinly and use the least potent formulation
35
The rule of thumb for topical corticosteroid treatment shows that a fingertip unit of steroid can cover how much area?
Twice that of the flat handprint
36
OTC steroids and age categories?
``` Hydrocortisone 1%: over 10 yrs - max 1 week Clobetasone butyrate (eumovate) 0.05%: over 12 yrs ``` Max 15g
37
Licensed indication for steroids OTC?
Atopic eczema Contact dermatitis insect bite reactions
38
Unlicensed indication for steroids OTC?
not for face, anogenitals, broken skin, - cold sores/acne/athletes foot
39
Coal tar can stain:
Skin, hair, fabric
40
Tacrolimus counselling points:
Avoid UV light as photosensitivity | - alcohol intolerance (common)
41
Retinoid based drugs such as alitretinon are contra-indicated in:
Hyperlipidaemia
42
MHRA warning with retinoid based drugs?
Neuropsychiatric rx - suicidal behaviour Teratogenic Use SPF
43
Give three treatment options for hyperhidrosis (excessive sweating)
1) Aluminium chloride 2) oxybutynin - unlicensed 3) Glycopyrronium bromide - dries out secretions (specialist) 4) Botox (specialist
44
What is pruritus?
Excessive itch
45
State some conditions that can cause pruritus?
jaundice/liver issues eczema Iron deficiency
46
If pruritus is associated with dry skin, what preparation may be suitable?
Emollients
47
What other topical treatments are suitable for pruritus?
Crotamiton (limited evidence - eurax) Calamine (may be ineffective) Levomenthol cream
48
What oral medication can be used for pruritus?
Antihistamines e.g. sedating antihistamines (chlorphenamine) - is good for skin reactions
49
Which topical prep used for pruritus in eczema can cause drowsiness and sensitisation?
Doxepin 5% cream
50
What is acne?
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
How long does initial acne treatment take to work?
2 months
52
Stepwise approach to treating acne:
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
What kind of topical treatment would be suitable for mild/mod acne : comedones and inflamed lesions?
Benzoyl peroxide / retinoid
54
What kind of topical treatment would be suitable for inflammatory acne?
Topical antibiotics e.g. erythromycin/clindamycin
55
How long should benzoyl peroxide be trialled for acne?
minimum 2 months then switch if no response
56
Initial SE with benzoyl peroxide?
Local irritation, redness, stains pillows and clothes, avoid sunlight and use SPF
57
What would be an alternative treatment to benzoyl peroxide if a patient was suffering severe irritation?
Azelaic acid (less irritation than benzoyl peroxide)
58
Topical retinoid preparation is ______
Adapalene - several months of treatment and continue until no new lesions develop
59
Oral retinoid prescribed in mod-severe acne is called ______
Isotretinoin (vitamin a derivative)
60
Give examples of antibiotics used in acne.
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
When can you use the contraceptive co-cyprindiol for acne?
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
Talk about isotretionoin.
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
What is rosacea and how does it differ from acne?
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
Lifestyle advice for acne?
Prevent over exfoliating Use non-comedogenic products Increase water intake Check hormone levels
65
MHRA warning with isotretionoin?
Rare reports of erectile dysfunction and decreased libido
66
Treatment options for rosacea?
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
Patient and carer advice with isotretinoin?
avoid laser hair removal, microdermabraasion, epilation during and 6 months after - risk of scarring Avoid sun exposure - use SPF
68
State two contra-indications for isotretinoin?
hyperlipidaemia hypervitaminosis A (>9mmol/l: risk of pancreatitis)
69
Brimoinidine is used in rosacea (1g gel = 3.3mg brimonidine). What is the mHRA warning regarding this drug??
1) Serious cardiovascular effects - bradycardia, hypotension, dizzyness. 2) rosacea exacerbation
70
Dandruff is a form of seborrhoeic dermatitis. what treatment options are available?
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
How would you manage cradle cap in infants?
Coconut/olive oil to soften the plaques and then shampoo
72
What is hirsutism and what drugs can cause this?
Excessive hair growth | Causes: corticosteroids, anabolic steroids, androgens, progestogens, phenytoin
73
Lifestyle measure for hirsutism in obese women?
weight loss
74
Treatment options for hirsutism?
Co-cyprindiol (anti androgen) Metformin - PCOS (unlicensed) Laser hair removal
75
What can finasteride be used for?
Androgen alopecia in men - but must be used continously as hair loss can occur after stopping treatment
76
What two drugs can be used in alopecia?
Finasteride and minoxidil (regaine available OTC): ensure hair and scalp are dry and wash hands after application
77
What can potassium permanganate be used for?
Extreme eczematous areas
78
MHRA warning with potassium permangante.
External use only as oral ingestion = risk of death or serious harm (treat like a CD)
79
MHRA warning with chlorhexidine?
Use sparingly in premature infants as risk of severe burns
80
What can be used for those with vitiligo and a high psychological impact?
Camoflauge creams e.g. dermacolor
81
UV radiation can be harmful to skin. What drugs can cause photosensitivty?
``` Amiodarone Tetracyclines Isotretinoin Benzoyl peroxide phenothiazine demeclocycline (used in resistant hyponatraemia) ```
82
What are the long term consequences of photo damage?
Skin cancer and aging
83
How would you counsel a patient on applying sunscreen?
Thickly and frequently - every 2 hours
84
What topical treatments can be used for photo damage (keratosis) - dry scaly dark patches?
Aloe vera gel Diclofenac gel Fluorouracil cream
85
Warts are caused by which virus?
Human papillomavirus
86
What areas of skin do warts commonly affect?
Hands, feet, anogenital (only need treatment if painful, unsightly, persistent or cause distress)
87
What treatment options for warts are available OTC?
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
Salicylic acid for warts should be avoided in those with an allergy of
plasters
89
Cryotherapy for warts can cause:
Pain, blisters and swelling and may be no more effective than topical salicylic acid
90
What can be used of anogenital warts?
Podophyllotoxin
91
Which preparation used in warts can stain fabric?
Silver nitrate
92
Salicylic acid preparations are not licensed for those under the age of...
2 years
93
Lifestyle advice for warts and calluses?
Rub gently with file/pumice stone weekly can take upto 12 weeks to go Prevent spread - avoid swimming (use flip flops/cover)
94
What can be used for resistant verrucae?
Glutaraldehyde
95
how to differentiate between warts and verrucae?
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

2021 Pre-registration (15 decks)

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