Chapter 13: Skin Flashcards
How long should you use up diluted creams?
- within 2 weeks
- cream and ointment should not normally be diluted
What is Urea?
- hydrating agent, occasionally used with other topical agents such as CCS to enhance penetration e.g. Calmurid HC and Alphaderm contains hydrocortisone and urea which potency is moderate (stronger than hydrocortisone alone)
Nappy rash treatment?
1st line: change nappies frequently, then antifungal e.g. clotrimazole, mild corticosteroid such as HC 1% (limited to 1 week or less); zinc oxide cream/ointment (old fashioned)
What is Dimeticone?
(sprilon spray) - water repellent, can be used on the skin around stomas, bedsore etc
What is Crotamiton?
(Eurex) - sometimes used for the treatment of scabies mites and itchy skin.
How are insect bites treated?
- short course of CCS or antihistamine (cream/oral) but not with calamine (itchy residue)
How long can topical anaesthetics be used for?
- no more than 3 days; not generally suitable for young children
Topical anaethetics examples?
E.g. Burn-Eze, Wasp-Eze
spray (benzocaine + mepyramine (antihistamine) ointment
contains antihistamine only), Antihisan Plus (benzocaine +
mepyramine (antihistamine)), lidocaine
For eczema, dermatitis insect stings?
Corticosteroids can only
suppress inflammatory reaction during use; they are not curative
and it can cause rebound when discontinue
Perioral lesion treatment?
(skin disorder around the mouths area, cheek) - common in adult women
- Topical CCS: no more than twice daily; mixing should be
avoid; at least 30 mins gap for apply other topica (Not OTC - not allowed use on face and neck OTC)
OTC hydrocortisone?
- 10 years +
- not for pregnancy
- max 1 week use
- not on face
- sparingly 1-2 times a day
Hydrocortisone preparations and potency?
- hydrocortisone (mild)
- hydrocortisone + urea (moderate)
- hydrocortisone butyrate (locoid) (potent)
Clobetasone potency?
Moderate
- clobetasone (eumovate))
Clobetasol potency?
Very high (ultra potent) (dermovate)
Beclometasone dipropionate potency?
potent
Mometasone (elocon) potency?
potent
Betnovate RD potency?
Betnovate-RD is moderate which is weaker than Betnovate
potent) (Betnovate-RD is 1in 4 dilution of Betnovate in water-miscible basis
Which is the most common type of eczema?
- atopic eczema: usually involves dry skin as well as infection and Lichenification- caused
by scratching and rubbing (often in chronic eczema)
Eczema management?
- frequent and liberal use of emollients
- mild CCS can be used on the face and flexures; potent used on adult with discord or lichenified eczema or eczema on scalp, limb and trunk
- under specialist care: bandages with zinc oxide
- review treatment regularly
What is generally not recommended in eczema due to the high risk of developing skin reactions?
- aqueous cream
What is tacrolimus licensed for?
moderate to severe atopic eczema
What is topical pimecrolimus licensed for?
- treatmet of mild to moderate atopic eczema
What can be used if eczema is associated with infection?
- antibacterial e.g. fusidic acid can be used for 1 week
- if extensive/wide spread offer flucloxacillin or erythromycin if penicillin allergic
- treat simultaneously with topical ccs
How is exudative (wheeping) excema treated?
- potent ccs initially
- potassium permanganate can be used but it should be stopped when exudation stops
What is Seborrheoic dematitis ?
- associated with yeast, effects the scalp, paranasal areas and eyebrows - ketoconazole and coal tar shampoo + mild corticosteroids with antimicrobial
What can psoriasis be exacerbated by?
Lithium, chloroquine and and hydroxychloroquine, beta-blocker, NSAIDs and ACEi
What can be used for chronic stable plaque psoriasis?
- vitamin D analogues (help by reduce rate of cell division); coal tar, dithranol (not on the face or flexure) and tazarotene (since they can irritate the skin and they are not suitable for inflammatory phase of psoriasis)
What is effective for chronic stable psoriasis and guttate psoriasis?
Ultraviolet B
What can be used in most forms of psoriasis which have the side effects phototoxcitiy, skin aging, cancer and risk of cataracts?
Photochemotherapy combing long wave UVA with Psoralen (PUVA); Psoralen (topical or orally)
What is dovonex?
- indicated for the topical treatment of plaque psoriasis (psoriasis vulgaris) amenable to topical therapy.
- do not apply to the face, if used with UV treatment, apply at least 2 hours befpre hand
- 18yrs+
Dithranol?
POM if content more then 1%, otherwise can be sold to the public
Oral retinoids for psoriasis?
- acitretin
- avoid in pregnancy 1 month before and at least 2 years after treatment)
- avoid concomitant tetracycline/methotrexate or high dose vitamin A)
What is used in severe psoriasis or eczema?
- ciclosporin (avoid UVA/UVB)
- azathioprine or mycophenolate mofetil for severe refractory eczema
- methotrexate (avoid conception for 3 months after treatment)
- Efalizumab or Etanercept for moderate and severe chronic plaque psoriasis; Pilmecrolimus (Elidel cream) and Tacrolimus (Protopic ointment) are topical use for moderate atopic eczema (used when maximal topical corticosteroid tried)
When is Dianette used for acne?
- (Co-cyprindol- cyrpoterone acetate with ethinylestradiol)
- only for women when contain anti-androgen and decreased sebum secretion (also help for hirsutism (hairy)) 21 days + interval
What is used in severe acne?
For severe case, oral Isotretinoin (vit-A) (Roaccutane-oral; Isotrexgel) can be prescribed for specialist for a short course
(contraception 1 months before and 1 month after treatment, even topical and avoid sunlight)
What is used for mild to moderate acne?
Benzoyl peroxide (e.g. PanOxyl and Duac) is effective for mild to moderate acne. Both comedone and inflamed lesions respond well with it (start with a low strength 2.5% and increase the concentration 5% then 10% to avoid S/E redden and sore (avoid sunlight)
What is azelaic acid?
(Skinoren) has antimicrobial and anticomedonal properties
Topical antibiotics used in acne?
Erythromycin, Clindamycin and Tetracycline can be use for at least 6 months; they are more effective than Benzoyl peroxide or Tretinoin (Isotretinoin)
What is zineryt?
Erythromycin and Zinc acetate) discard 5 weeks after make-up; Benzamycin (Erythromycin and Benzoyl peroxide) discard after 3 months and need to keep in refrigerator
Oral antibiotics for acne?
Oxytetracyclinee or Tetracycline or
Doxycycline or Minocycline (>12), Eythromycin and Trimethoprim (not for pregnancy –> decrease folic acid and teratogenic)
Topical retinoids in acne?
Tretinoin (Retin-A) and its isomer Isotretinoin
(Isotrex) are useful in treating comedonal acne; Adapalene (Differin), a retinoid-like drug cause less irritant. Avoid: in sever acne involving large area, exposure to UV, contra-indicated in pregnancy (cos there are Vit-A)
Difference between UVB and UVA?
The medium wavelength- UVB cause sunburn (short term) and skin cancer/ageing (long term); the long wavelength UVA do not cause sunburn but are responsible for many photosensitivity reaction and photodermatoses. Both contribute to long term photodamage and skin cancer.
Dandruff treatment?
Dandruff is a mild form of seborrhoeic dermatitis, shampoo containing antimicrobial (Pyrithione zinc and Selenium sulphide), tar and Ketoconazole (severe) can be used
Cradle cap treatment?
Cradle cap in infants can be treated with olive oil or arachis oil (ground-nut oil, peanut oil) apply followed by shampooing
Male pattern baldness?
All preparation for Male pattern baldness are not prescribableFinasteride 1mg (Propecia) and Minoxidil (Regaine- extra strength
5% for men only)
What can be used to treat impetigo?
Fusidic acid and mupirocin can be used to treat impetigo (no longer than 10 days)
What can be used to treat an infected burn?
Silver sulfadiazine (Flamazine) is used in treatment of infected burn (discard 7 days after opened)
Ringworm treatment?
For scalp infection require systemic treatment, most other can be treat by topical e.g. all imidazole, terbinafine (expensive), amorolfine and griseofulvin
Betamethasone valerate and betacap potency?
potent
