DERM Flashcards
Functions of skin (6)
- Barrier to infection
- Thermoregulation
- Protection against trauma
- Protection against UV
- Vitamin D synthesis
- Regulate H2O loss
Common causes of an itch WITH RASH:
- Urticaria (hives, weals, welts - raised itchy rash)
- Atopic eczema
- Psoriasis
- Scabies - burrows between fingers
Common causes of an itch with NO RASH:
- Renal failure
- Jaundice
- Iron deficiency
- Lymphoma - particularly Hodgkins
- Polycythaemia - bath itch
- Pregnancy alone
- Drugs
- Diabetes
- Cholestasis
- As skin ages it itches more
ACNE
Tx
- Mild:
• BENZYL PEROXIDE GEL/CREAM: - ^ skin turnover, Clears pores and reduces bacterial count
- Causes dryness due to keratolytic effect
• Topical antibiotics e.g. CLINDAMYCIN GEL or ERYTHROMYCIN GEL
• Topical retinoids e.g. TAZAROTENE GEL (irritating) - inhibit formation + reduce number of microcomedones
- Severe:
• In addition to topical therapy (above)
• Oral tetracyclines e.g. ORAL DOXYCYCLINE (first line) then ORAL MINOCYCLINE (second line) - 4 month minimum use
- Contraindicated in pregnancy and children
• Hormonal treatment: - when standard antibiotics treatments failed or
menstruation control required - Anti-androgen treatment suppress sebum production
- E.g. ORAL CO-CYPRINDIOL (contains acetate & ethinylestradiol)
ECZEMA/DERMATITIS
Tx:
Complete EMOLLIENT THERAPY e.g. E45 CREAM Topical therapies: • Topical corticosteroids - FIRST LINE TREATMENT - Classification: • Very potent - use ONLY on THICK SKIN - CLOBETASOL PROPIONATE • Potent: - FLUCINONIDE • Moderate: - CLOBETASOL BUTYRATE • Mild: - HYDROCORTISONE
Topical calcineurin inhibitors - SECOND LINE TREATMENT
- Slightly less effective but less SE and more useful
for sensitive areas where don’t want steroid SE
- e.g. PIMECROLIMUS (mild) or TACROLIMUS (moderate) OINTMENT:
Moderate-Severe/non responsive: - Oral immune-modulators: • CICLOSPORIN (calcineurin inhibitor) • AZOTHIOPRINE • Be aware of immuno-suppression effects i.e. infections!! - Oral steroids e.g. ORAL PREDNISOLONE - Antibiotics e.g. FLUCLOXACILLIN - Phototherapy with UV A - Antihistamines e.g. CHLORPHENAMINE:
Emollient therapy wrt ECZEMA/DERMATITIS
With emollients there is artificial restoration of the barrier in skin
with defective barriers:
• Occlusive emollients trap moisture in the skin and thus
transiently increase hydration
• An artificial permeability barrier is formed above the stratum
corneum and thus prevents water loss between corneocytes
• APPLICATION EVERY 4 HOURS/ 3-4 TIMES PER DAY (x2 a day at least)
• 250-500g per week for a child
• 500-750g per week for an adult
• Compliance is significantly correlated with clinical improvement
Topical calcineurin inhibitors do not cause … so good for on …
skin atrophy and are a good option for treating eczema in sensitive areas e.g. face & eyelids
PSORIASIS:
Tx:
- Emollients e.g. E45
- Topical vitamin D analogues:inhibit cell proliferation and stimulate keratinocyte differentiation
• E.g. CALCIPOTRIOL CREAM (irritating - not for face) or
CALCITRIOL OINTMENT (less irritating) - Topical corticosteroids e.g. HYDROCORTISONE CREAM
- Topical retinoids e.g. TAZAROTENE GEL (irritating)
- Ultraviolet B
- Coal tar
- Anti-mitotic e.g. DITHRANOL CREAM
• Use on LARGE PLAQUES ONLY - For extensive plaques:
• Phototherapy with UV A
• Disease modifying anti-rheumatic drug (DMARD): - Inhibits folic acid metabolism thus inhibits DNA replication
- Leads to anti-proliferative and anti-inflammatory effect
- MUST give FOLIC ACID SUPPLEMENTS 48HRS AFTER
TREATMENT - E.g. ORAL METHOTREXATE
• Immunosuppressant e.g. CICLOSPORIN
**- Anti-TNF biologics:
• ONLY USED ONCE SYSTEMIC THERAPY HAS FAILED!! - IV INFLIXIMAB, IV ETANERCEPT or IV ADALIMUMAB
Flexural psoriasis:
Tx:
- 1st line:
• Topical mild-moderate corticosteroids e.g. HYDROCORTISONE or CLOBETASOL BUTYRATE
• Short course to avoid atrophy! - 2nd line:
• Topical vitamin D analogue e.g. CALCIPOTRIOL CREAM (irritating - not for face)
Guttate (raindrop-like) psoriasis:
Tx:
Topical mild-moderate corticosteroids e.g. HYDROCORTISONE or CLOBETASOL BUTYRATE
- Ultraviolet B
- Coal tar
Palmoplantar psoriasis:
- Emollients e.g. greasy/ointments
- Keratolytic agents e.g. SALCYLIC ACID
- Potent topical corticosteroids e.g. FLUCINONIDE
- Phototherapy with UV A
- Oral retinoid e.g. ORAL ACITRETIN:
• Vitamin A derivative
• Anti-proliferative action
• TERATOGENIC
SKIN ULCERATION: - VENOUS ULCERS: -ARTERIAL ULCERS: -VASCULITIC ULCERS: DEF: Tx:
Defined as a loss of skin below the knee on the leg or foot that takes more than 2 weeks to heal
-Analgesia e.g. IBUPROFEN or even MORPHINE +High compression 4 layered bandage
Present as punched-out, painful ulcers higher up the leg or on the feet
-same +NEVER USE COMPRESSION BANDAGING
inflammatory disorder of blood vessels that causes endothelial damage
-DAPSONE (antibiotic) or PREDNISOLONE
BASAL CELL CARCINOMA (BCC) or ‘RODENT ULCER’:
is the …
• MOST COMMON MALIGNANT SKIN CANCER
MALIGNANT MELANOMA (MM): is the …
• MOST MALIGNANT FORM OF SKIN CANCER
MALIGNANT MELANOMA (MM): Clx:
ABCDE symptoms & criteria used for diagnosis:
• A - Asymmetrical shape
• B - Border irregularity
• C - Colour irregularity e.g. non-uniform
• D - Diameter > 6 mm
• E - Elevation/Evolution - change of lesion
