Chapter 13: Skin Flashcards
What is the MHRA advice regarding paraffin?
Fire riskSevere and fatal burns Possibility of residue build up on clothing and bedding so advised to wash these materials at a high temperatureNote- this risk cannot be excluded with paraffin-containing emollients
What safety advice should you say to a patient if using a bath emollient?
Makes the skin and surface slippery so care is neededIf paraffin containing, also warn them of the fire risk
Drugs marked with what letters are known as borderline substances?
ACBS
What are borderline substances?
Regarded as drugs when prescribed in accordance with the advice of the Advisory Committee on Borderline Substances for the clinical conditions listed.
The use of aqueous cream as a leave-on emollient may increase the risk of what?
Skin reactions - particularly in eczema
Urea is used with other topical agents e.g. corticosteroids. What would be the reason for this?
To enhance penetration of the skin
If a nappy rash is associated with candidal infection, what can be used?
Topical antifungal such as clotrimazole cream
If hydrocortisone cream is needed for a nappy rash (if inflammation is present and causing discomfort), should a barrier cream be applied before or after?
Barrier cream to be applied after the hydrocortisone cream to prevent further damage
Diluted creams should be used within how many weeks of preparation?
Within 2 weeks
What is a suitable quantity of cream/ointment (non-steroidal) to prescribe for the face?
15-30g
What is a suitable quantity of cream/ointment (non-steroidal) to prescribe for both hands?
25-50g
What is a suitable quantity of cream/ointment (non-steroidal) to prescribe for the scalp?
50-100g
What is a suitable quantity of cream/ointment (non-steroidal) to prescribe for both arms OR legs?
100-200g
What is a suitable quantity of cream/ointment (non-steroidal) to prescribe for the trunk?
400g
What is a suitable quantity of cream/ointment (non-steroidal) to prescribe for the groin/genitalia?
15-25g
Acute impetigo on small areas of the skin is treated with what?If the impetigo is extensive/cream has not worked, what can be used?
Short-term application of fusidic acid Flucloxacillin can be used (clarithromycin is penicillin allergic)
Mupirocin ointment/ nasal ointment is used for what resistant bacterial strain?
MRSA
Should topical antibacterials be used on leg ulcers?
No unless used in short courses for defined infections
What topical antibiotic is used for rosacea?
Metronidazole
To prevent relapse in local antifungal infections, how long after the disappearance of infection should topical antifungals be continued?
1-2 weeks after
For fungal scalp infection, is systemic treatment required?
Yes, and the used of a topical antifungal during the early stages of treatment may reduce the risk of transmission
What is tinea capitis?
Ringworm of the scalp
What is tinea corporis?
Ringworm of the body
What is tinea cruris?
Fungal infection of groin
What is tinea manuum?
Fungal infection of hands
What is tinea pedis?
Athlete’s foot
What is tinea unguium?
Fungal nail
Is systemic or topical therapy more effective in fungal nail infections?
Systemic
In mild disease, what topical applications can be used for fungal nail infections?
Amorolfine or tioconazole
How can pityriasis (tinea) versicolor be treated?What are alternatives?
Ketoconazole shampoo Topical antifungals can be used but large quantities may be required
If topical treatment for Pityriasis (tinea) versicolor has not worked, what is the next step?
Systemic triazole antifungal
When would a combination cream of antifungal and steroid be used?
Fungal infection in the presence of inflammation
What is the common name for labial herpes simplex infection?
Cold sore
What is 1st line for scabies?What is 2nd line?
PermethrinMalathion
True or false:It is recommended that scabies treatment is applied after a hot bath
No - this is not necessary
If a person with scabies lives with other people, what is recommended?
The whole household should be treated at the same time
Where should scabies treatment be applied?
The whole body, including scalp, face, neck and earsParticular attention should be paid to the webs of fingers and toes, and lotion should be brushed under the end of nails
How often is it recommended that the permethrin and malathion is applied and how many times for scabies?
Applied twice to the whole body for the treatment of scabies1 week apart
In the treatment of scabies, if after application the patient washes their hands, what is the advice?
Need to reapply treatment to hands
Dimeticone treatment for headlice should be repeated after how many days?
7 days
Are the scabies lotions licensed for head lice? What are the disadvantages of these?
Permethrin yes but methods of application make them unsuitable for head lice treatment Malathion yes but resistance has been reported
What is the MHRA warning regarding head lice products?
Risk of serious burns if treated hair is exposed to open flames or other sources of ignition
How much contact time with the scalp is recommended in head lice lotions and liquid?
8-12 hours or overnight
In general, what is the treatment regimen for headlice in terms of how many applications and when?
2 applications 7 days apart
What is the wet combing regimen for head lice treatment?
Using a plastic detection comb (probably for at least 30 minutes each time) over the whole scalp at 4-day intervals for a minimum of 2 weeks, and continued until no lice are found on 3 consecutive sessions; hair conditioner or vegetable oil can be used to facilitate the process.
What are used to eliminate crab lice?
Permethrin and malathion are used to eliminate
What is Pthirus pubis?
Crab lice
What is the treatment regimen with crab lice using permethrin or malathion?
An aqueous preparation should be applied, allowed to dry naturally and washed off after 12 hours; a second treatment is needed after 7 days to kill lice emerging from surviving eggs.
What areas of the body are treated if a patient has crab lice?
All surfaces of the body should be treated, including the scalp, neck, and face (paying particular attention to the eyebrows and other facial hair)
For the treatment of scabies with malathion lotion, after application, how long should it be left until washing off?
24 hours- when hands are washed within this time, this needs to be repeated
For the treatment of scabies with permethrin cream, after application, how long should it be left until washing off?
8-12 hours - when hands are washed within this time, this needs to be repeated
In eczema, mild corticosteroids are usually recommended for what parts of the body?
Face and flexures
With how many eczema flare ups a month would you consider a corticosteroid to prevent further flares?
2-3 a month
In patients who require a corticosteroid to prevent flare ups, how often is application recommended?
To be applied on 2 consecutive days each week
True or false:Infection can exacerbate eczema
TRUE
What is lichenification?
Skin condition that occurs in response to excessive itching or rubbing of the skin and results in thick, leathery patches of skin
How do you treat Seborrhoeic dermatitis?
Shampoos active against the yeast (including those containing ketoconazole or coal tar) and combinations of mild corticosteroids with suitable antimicrobials are used
What drug classes can provoke psoriasis?
Lithium, chloroquine and hydroxychloroquine, beta-blockers, NSAIDs, and ACE inhibitorsPsoriasis may not be seen until the drug has been taken for weeks or months.
Are the use of preparations containing Vitamin D, coal tar, dithranol recommended in the inflammatory form of psoriasis?
No Can irritate the skinTheir use should be suspended during an inflammatory phase of psoriasis
What is 1st line for scalp psoriasis?
Tar based shampooSalicylic acid can also be used if there is significant scaling
What is the short term management of facial, flexural and genital psoriasis?What about in the long term?
Short-term use of a mild or moderate potency topical corticosteroid (a mild potency topical corticosteroid is preferred for the initial treatment of facial psoriasis). For long term use- calcitrol or tacalcitol, low strength tar preparations
Widespread unstable psoriasis of erythrodermic or generalised pustular type requires what?
Urgent specialist assessment
Calcitriol is an active form of what vitamin?
D
What is first line for plaque psoriasis?
Vitamin D and its analogues
Of the Vitamin D analogues, what two are the least likely to irritate?
Calcitriol and tacalcitol
Is dithranol a Vitamin D analogue?
No Exact mechanism unknown
What are the disadvantages about the application of dithranol for psoriasis?
IrritationStains skin and clothingDithranol is not generally suitable for widespread small lesions and should not be used in the flexures or on the face
Is a topical corticosteroid recommended for the long-term use of extensive chronic plaque psoriasis?
No There is a risk of the condition deteriorating or of precipitating an unstable form of psoriasis (e.g. erythrodermic psoriasis or generalised pustular psoriasis) on withdrawalCan also lead to systemic side effects
Photochemotherapy via PUVA for psoriasis comes with what risks (short term and long term)?
Early adverse effects = phototoxicity and pruritus. Higher cumulative doses = skin ageing, increased risk of dysplastic and neoplastic skin lesions, especially squamous cancer, risk of cataracts.
When would consider initiating systemic treatment for psoriasis?
Severe, resistant, unstable or complicated forms of psoriasis, and it should be initiated only under specialist supervision
What are some examples of systemic drugs used in psoriasis?
AcitretinImmunosuppressants e.g. methotrexate and ciclosporinSystemic corticosteroids are rarely used due to risk of rebound deterioration
What type of drug is acitretin and what skin condition is it used in?
Vitamin A derivative retinoid used in psoriasis
The manufacturers of acitretin do not recommend continuous treatment for longer than how many months?
Longer than 6 months
What is the advice regarding contraception and pregnancy during and after acitretin treatment?What kind of contraceptive pill should not be used?
The possibility of pregnancy must be excluded before treatment and effective contraception must be used during treatment and for at least 3 years afterwards (oral progestogen-only contraceptives not considered effective).