Chapter 13- Skin Flashcards
What do emollients do and when are they indicated
Soothe, smooth and hydrate the skin
Indicated for all dry or scaling disorders
When are barrier preparations indicated
They contain water repellent substances used on: The skin around a stoma Bedsores Pressure areas Nappy rash
What’s the MHRA alert for emollients
Risk of severe and fatal burns
How long should local antifungal infection treatment be carried on for after signs are gone
1-2 weeks
What antibacterials are mainly used for skin infections
Neomycin Metronidazole Polymyxins Silver sulfadiazine Mapirocin
Which antifungals are mainly used for skin infections
Imidazole: Clotrimazole Econazole Ketoconazole Miconazole Tioconazole
Other:
Amorolfine
Griseofulvin
Terbinafine
What’s used for viral skin infection
Aciclovir
Why might some emollients contain urea
To relieve itching and hydrate the skin
What steroid is available OTC and from what age
Hydrocortisone 1%
Aged 10 +
What is scabies caused by
Parasites
How long can local topical anaesthetics be used for
3 days
What skin condition should corticosteroids not be used in
Acne
Rosacea
What drugs can exacerbate psoriasis
Lithium Chloroquine Hydroxychloroquine Beta blocker Nsaid ACEI
What’s important to caution with the use of oral retinoids (can be used in psoriasis)
Avoid pregnancy 1 month before and Atleast 2 years after treatment
Counselling point with benzyl peroxide (used for acne)
Avoid sunlight
Can stain clothes
Which topical antibiotics can be used for acne
Tetracycline
Erythromycin
Clindamycin
For 6 months
Side effect of retinoids
Risk of benign intracranial hypertension Headache Nausea Vomiting Visual disturbances
What preparation is mild to moderate acne usually treated with
Topical preparations
Benzyl peroxide, topical retinoids or topical antibiotic
When is systemic treatment for acne used
Moderate to severe acne
Topical not tolerated
Hard to reach the site
Long term risk associated with acireitin (retinoid)
Skeletal hypertosis
Uses of co-cyprindol
Contraception
Acne (in women)
Drug in roaccutane and drug class
Isotretinoin (vit a)
Retinoid
Counselling for roaccutane
Seek help of psychiatric disorders develop
Avoid wax and laser During treatment and 6 months after
Avoid exposure to UV light
Use emollients form the start (lips too)
Possible nose bleeds and joint pain
What are warts caused by and how are they treated
HPV- treated by destroying the affected skin
First line: salicylic acid (OTC)
Cryotherapy equally effective but may cause pain and blistering
What do the different UV cause
UVA- tanning and long term skin damage
UVB- sunburn
How’s hydrogen peroxide used for skin cleaning
Disinfectant and deodorant for wounds
How can potassium permanganate be used for skin cleaning
Used for weeping eczema lesions (may stain the skin)
What’s used for many preparations of anti perspirant
Aluminium
What’s ointments
Greasy preparations form a more occlusive barrier over the skin
The most hydrating for chronic dry skin
What are creams
More cosmetically acceptable
Less greasy in comparison to ointments
Dries quicker than ointment so applied more frequently
What’s gels
Contains high water content, suitable for scalp and face application
What’s lotions
Have a cooling effect, preferred for applying over a large or hairy area
Can sting promenade skin
What’s a mild topical corticosteroid used
Hydrocortisone <2.5%
What’s a moderate topical corticosteroid used
Clobetasone (Eumovate)
Betamethasone 0.025% (Betnovate)
What’s a potent topical corticosteroid used
Betamethasone 0.1% (betnovate)
Hydrocortisone
Momentasone
What’s a very potent topical corticosteroid used
Clobetasol (Dermovate)
Counselling on how to apply steroids
Apply thinly to the affected area no more than twice a day
Avoid prolonged use especially to the face
Apply emollient first then the steroid cream 30 minutes after for maximum absorption
How is rosacea- facial redness treated
Brimonidine
What’s does the pregnancy prevention programme include for roaccutane
Exclude pregnancy with Atleast 2 negative tests
Rx valid for only 7 days with a max 30 day supply
Emergency supply can be given with w negative pregnancy test
When should roaccutane treatment be started
On the 2nd or 3rd day of me natural cycle
What contraception is not suitable when on roaccutane
Progesterone only contraceptives
Should antihistamines be given in eczema?
No as eczema is not histamine related
First line otc acne medication
Benzoyl peroxide
How can you identify psoriasis
Usually raised red patches of dry skin covered with silvery while scales or plaques
Occurs on the elbows knees and scalp
What meds can worsen psoriasis
Lithium
BB
ACEi
Anti malarial drugs
OTC treatment for dandruff
Ketoconazole 2% (nizoral)
What are warts caused by and Treatment of choice for warts
Virus
Salicylic acid
Treatment otc for ring worm
Imadazole (miconazole, ketoconazole, clotrimazole)
Terbineafine (over 16)
When should fungal nail infections be referred
2 or more nails affected Under 18 Pregnant/ diabetes Damage to the nail Bottom of the nail affected
Treatment of choice otc for fungal nail infection and how long can it take to work
Amolorfine 5%
Can take 6 months
How do you treat a boil otc
Magnesium sulphate can draw out the inside
Abx may be needed
Refer to gp
What Comorbidity should you usually refer with skin problems
Diabetes due to poor would healing
What’s the key treatment in managing eczema
Emollient
If soap is an irritant substitute for an emollient wash
What age can topical steroids be sold to the public from
10 and above hydrocortisone
12 and above clobetasone
What should not be used in acne and why
Topical steroids
They can increase local hormone effect making the problem worse
How can you avoid damaging healthy skin when removing warts and varrucas with salicylic acid
Apply vaseline on the healthy skin
Scabies treatment
Permethrin (> 2 months)
or
malathion (>6 months)
One treatment for whole family then repeated after 7 days
What’s the only product licensed to treat hair loss
Minoxidil
2% men and women
5% men only
What otc treatment should you not used for psoriasis that can be used in eczema
Steroid
What’s the duration of treatment for amorolfine
6 months fingernails
9-12 months toenails
What antihistamine has a license for pruritis
Hydroxyzine
What condition presents as a rash, can have blisters is the rash and and has a tingly sensation like pins and needles
Shingles
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
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
Diluted creams should be used within how many weeks of preparation?
Within 2 weeks
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
What topical antibiotic is used for rosacea?
Metronidazole
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
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?
Permethrin
Malathion
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 ears
Particular 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 scabies
1 week apart
Dimeticone treatment for headlice should be repeated after how many days?
7 days
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
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
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
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.
What is 1st line for scalp psoriasis?
Tar based shampoo
Salicylic acid can also be used if there is significant scaling
What is first line for plaque psoriasis?
Vitamin D and its analogues
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
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)
What information should be included on a topical corticosteroid dispensing label?
Potency
Lotriderm contains what?
Betamethasone and clotrimazole
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
What is azelaic acid used for?
Acne
Maximum improvement for acne with antibacterial treatment usually occurs after how much time?
4-6 months
What is the minimum number of weeks isotretinoin is usually given for in acne?
16 weeks
What is the limit of number of days supply for isotretinoin under PPP?
30 days
What does SPF 8 mean?
Should enable a person to remain 8 times longer in the sun without burning.
For optimum protection, how often should suncream be applied?
Every 2 hours
What skin condition is formaldehyde used for?
Warts
Should you use corticosteroids in acne and rosacea?
No - can exacerbate these conditions
If a patient needs to apply a steroid cream and emollient, how is this done?
Apply emollient then apply steroid 30 minutes after
How much roughly is a finger tip unit of cream? (amount of cream from the tip of the finger to the first crease)
500mg
What does 1 finger tip unit cover
2 palms
Isotretinoin carries the risk of pancreatitis, especially in what case?
If triglycerides are above 9 mmol/L
How should Oral thrush be treated?
1) Daktarin (Miconazole) oral gel
2) Nystatin solution
3) Oral fluconazole
Urea is often present in many topical agents. What is its action?
Hydrating agent
How is Nappy Rash managed?
1) Change Nappy more frequently2) Irritant case: Barrier cream e.g. Sudocreme, Drapolene, Zinc oxide3) Fungal cases: Clotrimazole cream BD- do not use barrier cream till infection settled
How are insect bites and stings usually managed?
Antihistamine cream or short course of steroid cream if inflamed. DO NOT use calamine lotion- leaves itchy residues
Topical local anaesthetics may be used for burns, wasp stings etc. These should be avoided in young children, and used for max __ days?
max 3 days Creams containing Benzocaine
Hydrocortisone is a ___ steroidHydrocortisone + urea is a ____ steroidHydrocortisone Butyrate is a _____ steroid
Mild
Moderate
Potent
First line treatment for seborrhoeic dermatitis?
Ketoconazole 2% shampoo
What drugs, used for psoriasis and acne, are teratogenic?
Oral Retinoids: IsotretinoinAcitretin Alitretinoin These are similar to VITAMIN A/ RETINOL and this is also contra-indicated in pregnancy!
Acetretin is especially teratogenic. When should pregnancy be avoided?
3 days before, every month whilst on it and at least 3 years after
When should contraception be used with Isotretinoin?
1 month before and 1 month after (even with topical). Exclude pregnany 3 days before every month during treatment and 5 weeks after
Which drugs used for acne may cause Benign Intercranial Hypertension?
Oral Retinoids: IsotretinoinAcitretin Alitretinoin Discontinue if severe headache, nausea, vomiting or visual disturbance occur
How should cradle cap in infants be treated?
Olive oil or Arachic oil (nut oil) or coconut oil
Preparations for Male pattern baldness include Finasteride and Minoxidil. Can these be prescribed on NHS Rx’s?
NO- all preps for male baldness not available on prescription
What age can terbinafine- lamisil and lamisil once be sold otc
Lamisil 16+
Lamisil once 18+
When should you return to work with impetigo
48 hours after abx started
How long after can you return to work with scarlet fever
24hrs after abx started
1-2 weeks if no abx commenced
When can people with scabies return to work
After the first treatment
What cases of impetigo do you refer
All bullous impetigo
