Chapter 13: Skin Flashcards
1
Q
What is the MHRA advice regarding paraffin?
A
Fire risk - Severe and fatal burns
Possibility of residue build up on clothing and bedding so advised to wash these materials at a high temperature
Note- this risk cannot be excluded with paraffin-containing emollients
2
Q
What safety advice should you say to a patient if using a bath emollient?
A
Makes the skin and surface slippery so care is needed
If paraffin containing, also warn them of the fire risk
3
Q
Drugs marked with what letters are known as borderline substances?
A
ACBS
4
Q
What are borderline substances?
A
Regarded as drugs when prescribed in accordance with the advice of the Advisory Committee on Borderline Substances for the clinical conditions listed.
5
Q
The use of aqueous cream as a leave-on emollient may increase the risk of what?
A
Skin reactions - particularly in eczema
6
Q
Urea is used with other topical agents e.g. corticosteroids. What would be the reason for this?
A
To enhance penetration of the skin
7
Q
If a nappy rash is associated with candidal infection, what can be used?
A
Topical antifungal such as clotrimazole cream
8
Q
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?
A
Barrier cream to be applied after the hydrocortisone cream to prevent further damage
9
Q
Diluted creams should be used within how many weeks of preparation?
A
Within 2 weeks
10
Q
What is a suitable quantity of cream/ointment (non-steroidal) to prescribe for the face?
A
15-30g
11
Q
What is a suitable quantity of cream/ointment (non-steroidal) to prescribe for both hands?
A
25-50g
12
Q
What is a suitable quantity of cream/ointment (non-steroidal) to prescribe for the scalp?
A
50-100g
13
Q
What is a suitable quantity of cream/ointment (non-steroidal) to prescribe for both arms OR legs?
A
100-200g
14
Q
What is a suitable quantity of cream/ointment (non-steroidal) to prescribe for the trunk?
A
400g
15
Q
What is a suitable quantity of cream/ointment (non-steroidal) to prescribe for the groin/genitalia?
A
15-25g
16
Q
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?
A
Short-term application of fusidic acid
Flucloxacillin can be used (clarithromycin is penicillin allergic)
17
Q
Mupirocin ointment/ nasal ointment is used for what resistant bacterial strain?
A
MRSA
18
Q
Should topical antibacterials be used on leg ulcers?
A
No unless used in short courses for defined infections
19
Q
What topical antibiotic is used for rosacea?
A
Metronidazole
20
Q
To prevent relapse in local antifungal infections, how long after the disappearance of infection should topical antifungals be continued?
A
1-2 weeks after
21
Q
For fungal scalp infection, is systemic treatment required?
A
Yes, and the used of a topical antifungal during the early stages of treatment may reduce the risk of transmission
22
Q
What is tinea capitis?
A
Ringworm of the scalp
23
Q
What is tinea corporis?
A
Ringworm of the body
24
Q
What is tinea cruris?
A
Fungal infection of groin
25
What is tinea manuum?
Fungal infection of hands
26
What is tinea pedis?
Athlete's foot
27
What is tinea unguium?
Fungal nail
28
Is systemic or topical therapy more effective in fungal nail infections?
Systemic
29
In mild disease, what topical applications can be used for fungal nail infections?
Amorolfine or tioconazole
30
How can pityriasis (tinea) versicolor be treated?
What are alternatives?
Ketoconazole shampoo
Topical antifungals can be used but large quantities may be required
31
If topical treatment for Pityriasis (tinea) versicolor has not worked, what is the next step?
Systemic triazole antifungal
32
When would a combination cream of antifungal and steroid be used?
Fungal infection in the presence of inflammation
33
What is the common name for labial herpes simplex infection?
Cold sore
34
What is 1st line for scabies?
What is 2nd line?
Permethrin
Malathion
35
True or false:
It is recommended that scabies treatment is applied after a hot bath
No - this is not necessary
36
If a person with scabies lives with other people, what is recommended?
The whole household should be treated at the same time
37
Where should scabies treatment be applied?
The whole body, including scalp, face, neck and ears
Particular attention should be paid to the webs of fingers and toes, and lotion should be brushed under the end of nails
38
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 scabies
1 week apart
39
In the treatment of scabies, if after application the patient washes their hands, what is the advice?
Need to reapply treatment to hands
40
Dimeticone treatment for headlice should be repeated after how many days?
7 days
41
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
42
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
43
How much contact time with the scalp is recommended in head lice lotions and liquid?
8-12 hours or overnight
44
In general, what is the treatment regimen for headlice in terms of how many applications and when?
2 applications 7 days apart
45
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.
46
What are used to eliminate crab lice?
Permethrin and malathion are used to eliminate
47
What is Pthirus pubis?
Crab lice
48
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.
49
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)
50
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
51
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
52
In eczema, mild corticosteroids are usually recommended for what parts of the body?
Face and flexures
53
With how many eczema flare ups a month would you consider a corticosteroid to prevent further flares?
2-3 a month
54
In patients who require a corticosteroid to prevent flare ups, how often is application recommended?
To be applied on 2 consecutive days each week
55
True or false:
| Infection can exacerbate eczema
True
56
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
57
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
58
What drug classes can provoke psoriasis?
Lithium, chloroquine and hydroxychloroquine, beta-blockers, NSAIDs, and ACE inhibitors
Psoriasis may not be seen until the drug has been taken for weeks or months.
59
Are the use of preparations containing Vitamin D, coal tar, dithranol recommended in the inflammatory form of psoriasis?
No
Can irritate the skin
Their use should be suspended during an inflammatory phase of psoriasis
60
What is 1st line for scalp psoriasis?
Tar based shampoo
Salicylic acid can also be used if there is significant scaling
61
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
62
Widespread unstable psoriasis of erythrodermic or generalised pustular type requires what?
Urgent specialist assessment
63
Calcitriol is an active form of what vitamin?
D
64
What is first line for plaque psoriasis?
Vitamin D and its analogues
65
Of the Vitamin D analogues, what two are the least likely to irritate?
Calcitriol and tacalcitol
66
Is dithranol a Vitamin D analogue?
No
| Exact mechanism unknown
67
What are the disadvantages about the application of dithranol for psoriasis?
Irritation
Stains skin and clothing
Dithranol is not generally suitable for widespread small lesions and should not be used in the flexures or on the face
68
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 withdrawal
Can also lead to systemic side effects
69
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.
70
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
71
What are some examples of systemic drugs used in psoriasis?
Acitretin
Immunosuppressants e.g. methotrexate and ciclosporin
Systemic corticosteroids are rarely used due to risk of rebound deterioration
72
What type of drug is acitretin and what skin condition is it used in?
Vitamin A derivative retinoid used in psoriasis
73
The manufacturers of acitretin do not recommend continuous treatment for longer than how many months?
Longer than 6 months
74
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).
75
Phototherapy is via what type of UV light?
UVB
76
Photochemotherapy is via what type of UV light?
UVA (PUVA)
77
Topical corticosteroids should be applied no more than how many times a day?
No more than twice a day (often once a day is sufficient)
78
One fingertip unit (~500mg) is enough to cover how big of an area on the body?
Twice of that of an adult handprint (palms and fingers)
79
What information should be included on a topical corticosteroid dispensing label?
Potency
80
How do you treat the following:
Pruritus is common in biliary obstruction (primary biliary cirrhosis and drug-induced cholestasis)
Oral administration of colestyramine is the treatment of choice
81
Topical local anaesthetics should preferably not be used for more than how many days?
3 days
82
Are topical antihistamines recommended in eczema?
Topical antihistamines should be avoided in eczema and are not recommended for longer than 3 days. They are less suitable for prescribing.
83
Are topical corticosteroids recommended in acne?
No
84
Creams are more suitable for what type of lesions?
Moist or weeping lesions
85
Ointments are more suitable for what type of lesions?
Dry, lichenified, scaly lesions
86
True or false:
The inclusion of urea or salicylic acid preparations decrease the penetration of the corticosteroid.
False- they increase the penetration
87
What potency topical corticosteroids are associated with fewer side effects?
Mild and moderately potent
88
What is a suitable quantity of corticosteroid cream/ointment to dispense for 2 weeks treatment for the face and neck?
15- 30g
89
What is a suitable quantity of corticosteroid cream/ointment to dispense for 2 weeks treatment for both hands?
15-30g
90
What is a suitable quantity of corticosteroid cream/ointment to dispense for 2 weeks treatment for the scalp?
15-30g
91
What is a suitable quantity of corticosteroid cream/ointment to dispense for 2 weeks treatment for both arms?
30-60g
92
What is a suitable quantity of corticosteroid cream/ointment to dispense for 2 weeks treatment for both legs?
100g
93
What is a suitable quantity of corticosteroid cream/ointment to dispense for 2 weeks treatment for the trunk?
100g
94
What is a suitable quantity of corticosteroid cream/ointment to dispense for 2 weeks treatment for the groin and genitalia?
15-30g
95
Topical hydrocortisone (by itself) of all strengths is what potency?
What is the exception?
Hydrocortisone 0.1–2.5% is mild
Hydrocortisone butyrate is potent
96
Synalar 1 in 10 dilution is what potency?
Mild
97
Synalar 1 in 4 dilution is what potency?
Moderate
98
Synalar is what potency?
Potent
99
Canesten HC is what potency?
Mild
100
Daktacort is what potency?
Mild
101
Fucidin H is what potency?
Mild
102
Betnovate-RD is what potency?
Moderate
103
Eumovate contains what steroid?
Clobetasone butyrate
104
What potency is Eumovate?
Moderate
105
Alphaderm is what potency?
Moderate
| Hydrocortisone and urea
106
Alphaderm is a combination of what?
Hydrocortisone and urea
107
Beclometasone dipropionate 0.025% is what potency?
Potent
108
Betamethasone valerate 0.1% is what potency?
Potent
109
Betnovate is what potency?
Potent
110
Elocon is what potency?
Potent
111
Elocon contains what steroid?
Mometasone Furoate 0.1%
112
Hydrocortisone butyrate is what potency?
Potent
113
Mometasone furoate 0.1% is what potency?
Potent
114
Fucibet is what potency?
Potent
115
Fucibet contains what?
Betamethasone valerate 0.1%, and fusidic acid 2%
116
Lotriderm is what potency?
Potent
117
Lotriderm contains what?
Betamethasone and clotrimazole
118
Diprosalic is what potency?
Potent (also contains salicylic acid)
119
Dermovate is what potency?
Very potent
120
Dermovate contains what?
Clobetasol propionate 0.05%
121
What is the difference in storage requirements for Daktacort cream vs ointment?
Cream you store in a fridge, whereas with the ointment you don't
122
If mild-moderate acne does not respond to benzoyl peroxide, what should be considered?
Topical antibacterial e.g. erythromycin, clindamycin
123
What is azelaic acid used for?
Acne
124
What oral antibiotics are given for acne?
If there has been no improvement after 3 months, what should be tried?
Tetracycline, lymecycline, doxycycline
Try another oral antibacterial
125
Maximum improvement for acne with antibacterial treatment usually occurs after how much time?
4-6 months
126
For acne, is use of topical and oral corticosteroids at the same time recommended?
No due to increased risk of resistance
127
What is the minimum number of weeks isotretinoin is usually given for in acne?
16 weeks
128
What are the side effects of isotretinoin?
Severe dryness of the skin and mucous membranes, fragile skin, nose bleeds, joint and musclepains, chelitis (inflammation of lips). The drug is teratogenic and must not be given to women of child-bearing age unless they practice effective contraception
If psychiatric changes occur during treatment, isotretinoin should be stopped, the prescriber informed, and specialist psychiatric advice should be sought.
Photosensitivity- Avoid UV light and use high factor SPF
Risk of pancreatitis if triglycerides above 9 mmol/L
129
In child-bearing female patients on isotretinoin, contraception is needed. What kind of contraception medicine is not effective enough?
Progesterone only contraceptive is not considered effective
NB - Barrier methods should not be used alone
130
What is the topical treatment for rosacea?
Ivermectin
Metronidazole
Azelaic acid
131
What is the oral treatment for rosacea?
Oxytetracycline
Tetracycline
Erythromycin
Brimonidine tartrate
132
What is the MHRA warning with isotretinoin?
Rare reports of erectile dysfunction and decreased libido
Pregnancy prevention programme recommendation
133
What is the MHRA warnings with brimonidine gel?
Risk of systemic cardiovascular effects - avoid application to irritated or damaged skin, including after laser therapy
Risk of exacerbation of rosacea
134
What is the advice surrounding using isotretinoin in females of child bearing age in terms of excluding pregnancy, when they should use contraception?
Exclude pregnancy up to 3 days before treatment (start treatment on day 2 or 3 of menstrual cycle), every month during treatment (unless there are compelling reasons to indicate that there is no risk of pregnancy), and 5 weeks after stopping treatment
Women must practise effective contraception for at least 1 month before starting treatment, during treatment, and for at least 1 month after stopping treatment.
(POP is not effective contraception)
135
What is the limit of number of days supply for isotretinoin under PPP?
30 days
136
How long is an isotretinoin prescription valid for?
7 days
137
What type of UV rays cause sunburn?
UVB
138
What type of UV rays are responsible for photosensitivity reactions?
UVA
139
SPF is protection offered against what type of UV?
UVB
140
What does SPF 8 mean?
Should enable a person to remain 8 times longer in the sun without burning.
141
The star rating on sunscreen indicates protection against what type of UV?
UVA
142
For optimum protection, how often should suncream be applied?
Every 2 hours
143
What skin condition is formaldehyde used for?
Warts
144
Imiquimod is used for what skin conditions?
Genital and perianal warts
| Basal cell carcinoma Keratosis
145
Why should you apply an emollient in the direction of hair growth?
Reduces risk of folliculitis
146
Should you use corticosteroids in acne and rosacea?
No - can exacerbate these conditions
147
If a patient needs to apply a steroid cream and emollient, how is this done?
Apply emollient then apply steroid 30 minutes after
148
How much roughly is a finger tip unit of cream? (amount of cream from the tip of the finger to the first crease)
500mg
149
How many finger tip units of cream would you need to apply to the genitals?
0.5
150
How many finger tip units of cream would you need to apply to the hands/elbows/knees?
1
151
How many finger tip units of cream would you need to apply to the feet?
1.5
152
How many finger tip units of cream would you need to apply to the face and neck?
2.5
153
How many finger tip units of cream would you need to apply to the scalp?
3
154
How many finger tip units of cream would you need to apply to the hand and arm?
4
155
How many finger tip units of cream would you need to apply to the buttocks?
4
156
How many finger tip units of cream would you need to apply to the legs and chest?
8
157
How many finger tip units of cream would you need to apply to the legs and back?
8
158
Isotretinoin carries the risk of pancreatitis, especially in what case?
If triglycerides are above 9 mmol/L
