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Full Pre Registration Exam Notes > Chapter 13: Skin > Flashcards

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

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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

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3
Q

Drugs marked with what letters are known as borderline substances?

A

ACBS

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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.

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5
Q

The use of aqueous cream as a leave-on emollient may increase the risk of what?

A

Skin reactions - particularly in eczema

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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

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7
Q

If a nappy rash is associated with candidal infection, what can be used?

A

Topical antifungal such as clotrimazole cream

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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

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9
Q

Diluted creams should be used within how many weeks of preparation?

A

Within 2 weeks

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10
Q

What is a suitable quantity of cream/ointment (non-steroidal) to prescribe for the face?

A

15-30g

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11
Q

What is a suitable quantity of cream/ointment (non-steroidal) to prescribe for both hands?

A

25-50g

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12
Q

What is a suitable quantity of cream/ointment (non-steroidal) to prescribe for the scalp?

A

50-100g

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13
Q

What is a suitable quantity of cream/ointment (non-steroidal) to prescribe for both arms OR legs?

A

100-200g

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14
Q

What is a suitable quantity of cream/ointment (non-steroidal) to prescribe for the trunk?

A

400g

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15
Q

What is a suitable quantity of cream/ointment (non-steroidal) to prescribe for the groin/genitalia?

A

15-25g

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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)

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17
Q

Mupirocin ointment/ nasal ointment is used for what resistant bacterial strain?

A

MRSA

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18
Q

Should topical antibacterials be used on leg ulcers?

A

No unless used in short courses for defined infections

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19
Q

What topical antibiotic is used for rosacea?

A

Metronidazole

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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

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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

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22
Q

What is tinea capitis?

A

Ringworm of the scalp

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23
Q

What is tinea corporis?

A

Ringworm of the body

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24
Q

What is tinea cruris?

A

Fungal infection of groin

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25
Q

What is tinea manuum?

A

Fungal infection of hands

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26
Q

What is tinea pedis?

A

Athlete’s foot

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27
Q

What is tinea unguium?

A

Fungal nail

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28
Q

Is systemic or topical therapy more effective in fungal nail infections?

A

Systemic

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29
Q

In mild disease, what topical applications can be used for fungal nail infections?

A

Amorolfine or tioconazole

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30
Q

How can pityriasis (tinea) versicolor be treated?

What are alternatives?

A

Ketoconazole shampoo

Topical antifungals can be used but large quantities may be required

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31
Q

If topical treatment for Pityriasis (tinea) versicolor has not worked, what is the next step?

A

Systemic triazole antifungal

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32
Q

When would a combination cream of antifungal and steroid be used?

A

Fungal infection in the presence of inflammation

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33
Q

What is the common name for labial herpes simplex infection?

A

Cold sore

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34
Q

What is 1st line for scabies?

What is 2nd line?

A

Permethrin

Malathion

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35
Q

True or false:

It is recommended that scabies treatment is applied after a hot bath

A

No - this is not necessary

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36
Q

If a person with scabies lives with other people, what is recommended?

A

The whole household should be treated at the same time

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37
Q

Where should scabies treatment be applied?

A

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

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38
Q

How often is it recommended that the permethrin and malathion is applied and how many times for scabies?

A

Applied twice to the whole body for the treatment of scabies

1 week apart

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39
Q

In the treatment of scabies, if after application the patient washes their hands, what is the advice?

A

Need to reapply treatment to hands

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40
Q

Dimeticone treatment for headlice should be repeated after how many days?

A

7 days

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41
Q

Are the scabies lotions licensed for head lice? What are the disadvantages of these?

A

Permethrin yes but methods of application make them unsuitable for head lice treatment

Malathion yes but resistance has been reported

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42
Q

What is the MHRA warning regarding head lice products?

A

Risk of serious burns if treated hair is exposed to open flames or other sources of ignition

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43
Q

How much contact time with the scalp is recommended in head lice lotions and liquid?

A

8-12 hours or overnight

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44
Q

In general, what is the treatment regimen for headlice in terms of how many applications and when?

A

2 applications 7 days apart

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45
Q

What is the wet combing regimen for head lice treatment?

A

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.

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46
Q

What are used to eliminate crab lice?

A

Permethrin and malathion are used to eliminate

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47
Q

What is Pthirus pubis?

A

Crab lice

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48
Q

What is the treatment regimen with crab lice using permethrin or malathion?

A

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.

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49
Q

What areas of the body are treated if a patient has crab lice?

A

All surfaces of the body should be treated, including the scalp, neck, and face (paying particular attention to the eyebrows and other facial hair)

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50
Q

For the treatment of scabies with malathion lotion, after application, how long should it be left until washing off?

A

24 hours- when hands are washed within this time, this needs to be repeated

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51
Q

For the treatment of scabies with permethrin cream, after application, how long should it be left until washing off?

A

8-12 hours - when hands are washed within this time, this needs to be repeated

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52
Q

In eczema, mild corticosteroids are usually recommended for what parts of the body?

A

Face and flexures

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53
Q

With how many eczema flare ups a month would you consider a corticosteroid to prevent further flares?

A

2-3 a month

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54
Q

In patients who require a corticosteroid to prevent flare ups, how often is application recommended?

A

To be applied on 2 consecutive days each week

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55
Q

True or false:

Infection can exacerbate eczema

A

True

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56
Q

What is lichenification?

A

Skin condition that occurs in response to excessive itching or rubbing of the skin and results in thick, leathery patches of skin

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57
Q

How do you treat Seborrhoeic dermatitis?

A

Shampoos active against the yeast (including those containing ketoconazole or coal tar) and combinations of mild corticosteroids with suitable antimicrobials are used

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58
Q

What drug classes can provoke psoriasis?

A

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.

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59
Q

Are the use of preparations containing Vitamin D, coal tar, dithranol recommended in the inflammatory form of psoriasis?

A

No
Can irritate the skin
Their use should be suspended during an inflammatory phase of psoriasis

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60
Q

What is 1st line for scalp psoriasis?

A

Tar based shampoo

Salicylic acid can also be used if there is significant scaling

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61
Q

What is the short term management of facial, flexural and genital psoriasis?

What about in the long term?

A

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

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62
Q

Widespread unstable psoriasis of erythrodermic or generalised pustular type requires what?

A

Urgent specialist assessment

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63
Q

Calcitriol is an active form of what vitamin?

A

D

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64
Q

What is first line for plaque psoriasis?

A

Vitamin D and its analogues

65
Q

Of the Vitamin D analogues, what two are the least likely to irritate?

A

Calcitriol and tacalcitol

66
Q

Is dithranol a Vitamin D analogue?

A

No

Exact mechanism unknown

67
Q

What are the disadvantages about the application of dithranol for psoriasis?

A

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
Q

Is a topical corticosteroid recommended for the long-term use of extensive chronic plaque psoriasis?

A

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
Q

Photochemotherapy via PUVA for psoriasis comes with what risks
(short term and long term)?

A

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
Q

When would consider initiating systemic treatment for psoriasis?

A

Severe, resistant, unstable or complicated forms of psoriasis, and it should be initiated only under specialist supervision

71
Q

What are some examples of systemic drugs used in psoriasis?

A

Acitretin
Immunosuppressants e.g. methotrexate and ciclosporin

Systemic corticosteroids are rarely used due to risk of rebound deterioration

72
Q

What type of drug is acitretin and what skin condition is it used in?

A

Vitamin A derivative retinoid used in psoriasis

73
Q

The manufacturers of acitretin do not recommend continuous treatment for longer than how many months?

A

Longer than 6 months

74
Q

What is the advice regarding contraception and pregnancy during and after acitretin treatment?

What kind of contraceptive pill should not be used?

A

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
Q

Phototherapy is via what type of UV light?

A

UVB

76
Q

Photochemotherapy is via what type of UV light?

A

UVA (PUVA)

77
Q

Topical corticosteroids should be applied no more than how many times a day?

A

No more than twice a day (often once a day is sufficient)

78
Q

One fingertip unit (~500mg) is enough to cover how big of an area on the body?

A

Twice of that of an adult handprint (palms and fingers)

79
Q

What information should be included on a topical corticosteroid dispensing label?

A

Potency

80
Q

How do you treat the following:

Pruritus is common in biliary obstruction (primary biliary cirrhosis and drug-induced cholestasis)

A

Oral administration of colestyramine is the treatment of choice

81
Q

Topical local anaesthetics should preferably not be used for more than how many days?

A

3 days

82
Q

Are topical antihistamines recommended in eczema?

A

Topical antihistamines should be avoided in eczema and are not recommended for longer than 3 days. They are less suitable for prescribing.

83
Q

Are topical corticosteroids recommended in acne?

A

No

84
Q

Creams are more suitable for what type of lesions?

A

Moist or weeping lesions

85
Q

Ointments are more suitable for what type of lesions?

A

Dry, lichenified, scaly lesions

86
Q

True or false:

The inclusion of urea or salicylic acid preparations decrease the penetration of the corticosteroid.

A

False- they increase the penetration

87
Q

What potency topical corticosteroids are associated with fewer side effects?

A

Mild and moderately potent

88
Q

What is a suitable quantity of corticosteroid cream/ointment to dispense for 2 weeks treatment for the face and neck?

A

15- 30g

89
Q

What is a suitable quantity of corticosteroid cream/ointment to dispense for 2 weeks treatment for both hands?

A

15-30g

90
Q

What is a suitable quantity of corticosteroid cream/ointment to dispense for 2 weeks treatment for the scalp?

A

15-30g

91
Q

What is a suitable quantity of corticosteroid cream/ointment to dispense for 2 weeks treatment for both arms?

A

30-60g

92
Q

What is a suitable quantity of corticosteroid cream/ointment to dispense for 2 weeks treatment for both legs?

A

100g

93
Q

What is a suitable quantity of corticosteroid cream/ointment to dispense for 2 weeks treatment for the trunk?

A

100g

94
Q

What is a suitable quantity of corticosteroid cream/ointment to dispense for 2 weeks treatment for the groin and genitalia?

A

15-30g

95
Q

Topical hydrocortisone (by itself) of all strengths is what potency?

What is the exception?

A

Hydrocortisone 0.1–2.5% is mild

Hydrocortisone butyrate is potent

96
Q

Synalar 1 in 10 dilution is what potency?

A

Mild

97
Q

Synalar 1 in 4 dilution is what potency?

A

Moderate

98
Q

Synalar is what potency?

A

Potent

99
Q

Canesten HC is what potency?

A

Mild

100
Q

Daktacort is what potency?

A

Mild

101
Q

Fucidin H is what potency?

A

Mild

102
Q

Betnovate-RD is what potency?

A

Moderate

103
Q

Eumovate contains what steroid?

A

Clobetasone butyrate

104
Q

What potency is Eumovate?

A

Moderate

105
Q

Alphaderm is what potency?

A

Moderate

Hydrocortisone and urea

106
Q

Alphaderm is a combination of what?

A

Hydrocortisone and urea

107
Q

Beclometasone dipropionate 0.025% is what potency?

A

Potent

108
Q

Betamethasone valerate 0.1% is what potency?

A

Potent

109
Q

Betnovate is what potency?

A

Potent

110
Q

Elocon is what potency?

A

Potent

111
Q

Elocon contains what steroid?

A

Mometasone Furoate 0.1%

112
Q

Hydrocortisone butyrate is what potency?

A

Potent

113
Q

Mometasone furoate 0.1% is what potency?

A

Potent

114
Q

Fucibet is what potency?

A

Potent

115
Q

Fucibet contains what?

A

Betamethasone valerate 0.1%, and fusidic acid 2%

116
Q

Lotriderm is what potency?

A

Potent

117
Q

Lotriderm contains what?

A

Betamethasone and clotrimazole

118
Q

Diprosalic is what potency?

A

Potent (also contains salicylic acid)

119
Q

Dermovate is what potency?

A

Very potent

120
Q

Dermovate contains what?

A

Clobetasol propionate 0.05%

121
Q

What is the difference in storage requirements for Daktacort cream vs ointment?

A

Cream you store in a fridge, whereas with the ointment you don’t

122
Q

If mild-moderate acne does not respond to benzoyl peroxide, what should be considered?

A

Topical antibacterial e.g. erythromycin, clindamycin

123
Q

What is azelaic acid used for?

A

Acne

124
Q

What oral antibiotics are given for acne?

If there has been no improvement after 3 months, what should be tried?

A

Tetracycline, lymecycline, doxycycline

Try another oral antibacterial

125
Q

Maximum improvement for acne with antibacterial treatment usually occurs after how much time?

A

4-6 months

126
Q

For acne, is use of topical and oral corticosteroids at the same time recommended?

A

No due to increased risk of resistance

127
Q

What is the minimum number of weeks isotretinoin is usually given for in acne?

A

16 weeks

128
Q

What are the side effects of isotretinoin?

A

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
Q

In child-bearing female patients on isotretinoin, contraception is needed. What kind of contraception medicine is not effective enough?

A

Progesterone only contraceptive is not considered effective

NB - Barrier methods should not be used alone

130
Q

What is the topical treatment for rosacea?

A

Ivermectin
Metronidazole
Azelaic acid

131
Q

What is the oral treatment for rosacea?

A

Oxytetracycline
Tetracycline
Erythromycin
Brimonidine tartrate

132
Q

What is the MHRA warning with isotretinoin?

A

Rare reports of erectile dysfunction and decreased libido

Pregnancy prevention programme recommendation

133
Q

What is the MHRA warnings with brimonidine gel?

A

Risk of systemic cardiovascular effects - avoid application to irritated or damaged skin, including after laser therapy

Risk of exacerbation of rosacea

134
Q

What is the advice surrounding using isotretinoin in females of child bearing age in terms of excluding pregnancy, when they should use contraception?

A

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
Q

What is the limit of number of days supply for isotretinoin under PPP?

A

30 days

136
Q

How long is an isotretinoin prescription valid for?

A

7 days

137
Q

What type of UV rays cause sunburn?

A

UVB

138
Q

What type of UV rays are responsible for photosensitivity reactions?

A

UVA

139
Q

SPF is protection offered against what type of UV?

A

UVB

140
Q

What does SPF 8 mean?

A

Should enable a person to remain 8 times longer in the sun without burning.

141
Q

The star rating on sunscreen indicates protection against what type of UV?

A

UVA

142
Q

For optimum protection, how often should suncream be applied?

A

Every 2 hours

143
Q

What skin condition is formaldehyde used for?

A

Warts

144
Q

Imiquimod is used for what skin conditions?

A

Genital and perianal warts

Basal cell carcinoma Keratosis

145
Q

Why should you apply an emollient in the direction of hair growth?

A

Reduces risk of folliculitis

146
Q

Should you use corticosteroids in acne and rosacea?

A

No - can exacerbate these conditions

147
Q

If a patient needs to apply a steroid cream and emollient, how is this done?

A

Apply emollient then apply steroid 30 minutes after

148
Q

How much roughly is a finger tip unit of cream? (amount of cream from the tip of the finger to the first crease)

A

500mg

149
Q

How many finger tip units of cream would you need to apply to the genitals?

A

0.5

150
Q

How many finger tip units of cream would you need to apply to the hands/elbows/knees?

A

1

151
Q

How many finger tip units of cream would you need to apply to the feet?

A

1.5

152
Q

How many finger tip units of cream would you need to apply to the face and neck?

A

2.5

153
Q

How many finger tip units of cream would you need to apply to the scalp?

A

3

154
Q

How many finger tip units of cream would you need to apply to the hand and arm?

A

4

155
Q

How many finger tip units of cream would you need to apply to the buttocks?

A

4

156
Q

How many finger tip units of cream would you need to apply to the legs and chest?

A

8

157
Q

How many finger tip units of cream would you need to apply to the legs and back?

A

8

158
Q

Isotretinoin carries the risk of pancreatitis, especially in what case?

A

If triglycerides are above 9 mmol/L

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