Derm Treatment Pathways

Question 1

Eczema management.

Answer 1

1. Emollients and soap substitutes.
2. Topical corticosteroids.
3. Topical calcineurin inhibitors (pimecrolimus/tacrolimus) if not controlled with steroids.
4. Systemic immunosuppression (azathioprine, ciclosporin, methotrexate) in severe disease.

Sedating antihistamines used intermittently at night can help prevent itch/scratch cycle.

Question 2

Psoriasis topical management

Answer 2

1. Emollients.
2. Topical corticosteroid and vitamin D analogue (potent corticosteroids not used for more than 8 weeks).
3. Coal tar in widespread disease.
4. Dithranol in treatment resistance.

Question 3

Skin candidiasis.

Answer 3

Clotrimazole cream and oral fluconazole (or nystatin).

Question 4

Acne.

Answer 4

Topical: 1. Retinoid

2. Benzoyl perozide
3. Topical antibiotics (e.g. clindamycin)

Systemic treatment: 1. Antibiotics.
2. Isotretinoin (oral retinoid).

Question 5

Rosacea.

Answer 5

1. Reduce aggravating factors (dietary triggers, sun exposure, topical steroids).
2. Topical treatments: metronidazole and ivermectin.
3. Oral therapy: tetracycline (only if moderate to severe and topical treatments haven’t worked) and isotretinoin (if severe).

Telangiectasia - vascular laser.
Rhinophyma - surgery/laser shaving.

Question 6

Lichen planus.

Answer 6

Topical steroids (potent/very potent). 
Oral steroids if severe.

Question 7

Bullous pemphigoid and pemphigus.

Answer 7

Systemic steroids and other immunosuppressive agents.
Tetracyclines in pephigoid.
Topical therapy: emollients, topical steroids, topical antisepsis/hygiene measures.

Question 8

Scabies.

Answer 8

Malathion lotion
Benzyl benzoate (avoid in children)

Question 9

Psoriasis systemic/non-topical management.

Answer 9

Phototherapy
Methotrexate (or other DMARDs)
Biologics (anti-TNF etc)

Question 10

Tinea capitis management

Answer 10

Oral antifungal (maybe griseofulvin)

Question 11

Body or groin tinea

Answer 11

Topical antifungal e.g. clotrimazole

Oral if severe

Question 12

Tinea pedis

Answer 12

Topical antifungal e.g. clotrimazole

Oral if severe

Question 13

Discoid lupus management

Answer 13

Potent topical steroids

Question 14

Seborrhoeic keratosis (basal cell papilloma) management

Answer 14

Do nothing as benign

If they want it gone:
Cryotherapy
Curettage