Derm - OSCE Flashcards
What is the triple therapy treatment for eczema?
- Soap Replacement (Dermol 500, E45 Lotion)
- Emollient
- Steroid
Name a mild, moderate, potent, and very potent steroid
- Mild: Hydrocortisone 1%, Canestan (Antifungal)
- “Hydro” – watered down
- Moderate: Eumovate, Trimovate (Antimicrobial)
- “Eumovolaemic” in the middle
- Potent: Betnovate, Fucibet (Antimicrobial)
- “BETter than…”
- Very Potent: Dermovate
- “Dermovate Destroys”
Name a light, cream, greasy and very greasy emollient
Light: E45 Lotion
Cream: Diprobase
Greasy: Doublebase Cream
Very Greasy: Hydromol Ointment
What are the severities of acne?
- Mild - no scarring, some small comedones
- Moderate - no scarring, big comedones = papules
- Moderate-severe - some scarring, papules and pustules
- Severe - lots of scarring, nodulocystic acne
What are the treatments for MILD acne? (1st line)
Topical treatments
- Benzoyl peroxide face wash 1-2 times a day
- Azelaic acid 1-2 times a week, increasing to once daily
- Topical retinoid (for example adapalene), alone or in combination with benzoyl peroxide. Retinoids are contraindicated in pregnancy and breastfeeding.
What are the treatments for MODERATE acne? (2nd line)?
Topical antibacterials e.g. clindamycin 1%. Use with benzoyl peroxide to reduce resistance
What are the treatments for MOD-SEVERE acne? 3rd line?
If response to topical preparations alone is inadequate consider adding an oral antibiotic such as tetracycline or lymecycline or doxycycline (for a maximum of 3 months)
- Use with benzoyl peroxide or topical retinoid should be prescribed with the abx to prevent resistance
Can add COCP in women
What is the treatment for SEVERE acne? not that you would give it as a non-consultant dermatologist…
Isotretinoin
= teratogenic, given for 16 weeks, very powerful, some side effects from ↓sebum e.g. nose bleeds, dry skin / mucous membranes, joint pain
How do you counsel for treatment with tetracycline abx? e.g. doxycycline
- SEs
- contraindications
- interactions
- All abx SEs: nausea, vomiting, diarrhoea, c.diff infection
- Specific SEs:
- photosensitivity
- stains childrens teeth <12yrs
- oesophageal irritation / reflux
- binds to fetal bones / teeth
- Contraindications
- <12
- breastfeeding
- pregnancy
- renal impairment
- Interactions
- Iron, calcium, PPIs - as it binds to cations!
How do you counsel for treatment of acne with benzoyl peroxide?
- applied 20 minutes after washing to all of the parts of your face affected
- used sparingly, as too much can irritate skin.
- more sensitive to sunlight; avoid too much sun and sources of ultraviolet (UV) light (such as sunbeds), or wear sun cream.
- bleaching effect, so avoid getting it on your hair or clothes.
- SEs:
- dry and tense skin
- a burning, itching or stinging sensation
- some redness and peeling of the skin
- Most people need to continue for 6 weeks
How does benzoyl peroxide help acne?
Benzoyl peroxide works as an antiseptic to reduce the number of bacteria on the surface of the skin.
It also helps to reduce the number of whiteheads and blackheads, and has an anti-inflammatory effect.
How do topical retinoids work?
Topical retinoids work by removing dead skin cells from the surface of the skin (exfoliating), which helps prevent them building up within hair follicles.
Name 2 topical retinoids
Tretinoin and adapalene
How do you counsel for use of topical retinoids?
- Apply to all the parts of your face affected by acne 20 minutes after washing your face.
- It’s important to apply topical retinoids sparingly and avoid excessive exposure to sunlight and UV.
- Topical retinoids are not suitable for use during pregnancy, as there’s a risk they might cause birth defects.
- The most common side effects of topical retinoids are
- mild irritation and
- stinging of the skin.
- A 6-week course is usually required, but you may be advised to continue using the medicine less frequently after this.
What is the alternative to benzoyl peroxide or topical retinoids if side effects are too severe?
Azelaic acid
