Derm treatments Flashcards
Bullous pemphigoid
oral corticosteroids
pemphigus vulgaris
- localised
- systemic
localised/1st line - topical steroids
systemic - high dose steroids + immunosuppression +/- rituximab
Dermatitis herpetiformis
gluten free diet +/- Dapsone
Guttate psoriasis
self-limiting, resolves in 6 weeks
Psoriasis 1st line
potent corticosteroid alongside vitamin D analogue
e.g. betamethasone + calciprotriol
psoriasis 2nd line
if no improvement after 8 weeks offer increase dose of vitamin D analogue to twice daily
psoriasis 3rd line
if no improvement after 8-12 weeks then either increase corticosteroid dose or coal tar preparation
psoriasis severe/non-responsive
oral methotrexate
when is methotrexate particularly useful in psoriasis
psoriatic arthritis
Scalp psoriasis
potent topical corticosteroid once daily 4 weeks - if no improvement use a different formulation e.g. shampoo to remove scale before application of the steroid
face/flexural/genital psoriasis
mild or moderate potency corticosteroid once or twice daily for max of 2 weeks
how much of a gap should be left between courses of corticosteroids
4 weeks
eczema herpeticum
admission for IV aciclovir
atopic eczema standard for everyone even when asymptomatic
avoid irritants
emollients
how should one be advised to use a steroid and emollient together
emollient first wait 30 mins then topical steroid
itch in atopic eczema
anti-histamine
flare in atopic eczema
topical steroids
mild eczema
emollient + mild topical steroid
example of mild topical steroid
hydrocortisone
moderate atopic eczema
emollient + moderate topical steroid +/- tacrolimus
example of a moderate topical steroid
eumovate
severe atopic eczema
potent topical steroid +/- UV light therapy +/- immunosuppresion e.g. ciclosporin - specialist advice
example of a potent topical steroid
betnovate
fluticasone
what kind of drug is tacrolimus
topical calcinurin inhibitor
example of a very potent topical corticosteroid
dermovate
seborrhoeic dermatitis - infantile
baby shampoo and baby oil
emollients +/- topical steroids
seborrhoeic dermatitis - adult scalp disease
neutrogena and head+shoulders
seborrhoeic dermatitis - adult 1st line, non-scalp
topical ketoconazole
+ emollients +topical steroids
pompholyx
cool compresses, emollients, topical steroids
azteototic eczema
emollients
venous eczema
compression bandage
contact dermatitis - allergic and irritant
antigen avoidance
regular emollients
potent topical steroids during flares
mild acne
topical therapy only - benzoyl peroxide
salicylic acid
topical retinoid
moderate acne
topical retinoid + topical benzoyl peroxide + topical antibiotic
what antibiotics are used in acne
tetracyclines
moderate/severe acne
oral antibiotic instead of topical
should oral antibiotic be given as a monotherapy in acne
no always co-prescribe with topical therapy
severe acne
topical therapies + oral isotretinoin
can GP prescribe isotretinoin
no - specialist advice needed so refer to dermatology
what is needed in women of CBA on isotretanoin
double contraception and pregnancy test before each monthly prescription
acne fulminans
hospital admission + oral steroids
Rosacea 1st line
topical metronidazole
what is good in rosacea with flushing and limited telangiectasia
topical brimonidine gel
severe rosacea
systemic antibiotics - tetracyclines
what tetracyclines are ok for use in pregnancy and breastfeeding
erythromycin
telangiectasia is rosacea
laser
last line in rosacea
isotretinoin
pityriasis rosea
self limiting over 6-12 weeks, emollients and anti-histamines if needed
lichen planus
potent topical steroid
oral lichen planus
benzydamine mouth wash
port wine stain
cosmetic camouflage or laser therapy
infantile haemangioma
leave alone
erythema multiforme
supportive care and treat underlying cause
investigation to do with erythema nodosum of unknown cause
xray to exclude sarcoidosis and TB
necrobiosis lipoidica
improve glycaemic control
topical or intralesional steroid
pyoderma gangrenosum
very potent topical steroid
immunosuppressant e.g. infliximab if resistant and treat underlying cause
seborrhoeic keratoses
leave alone, cryotherapy, curettage
BCC
leave alone and monitor
or
surgical (MOHS for awkward site)
topical imiquimod or 5-FU
bowens/actinic keratoses
5-FU twice daily for 4 weeks
cryotherapy, curettage, excision
SCC
biopsy then surgical excision with 4mm margins if < 20mm or 6mm margins if > 20mm
topical 5-FU
melanoma
surgical excision with 2mm margins, check breslow thickness then wide local excision
acute intermittent porphyria
avoid triggers
acute attack - IV haematin/haem arginate or IV glucose if former not available
prophyria cutanea tarda
venesection or chloroquine
herpes zoster opthalmicus
oral antiviral for 7-10 days
Ramsay hunt
oral aciclovir and corticosteroids
shingles
paracetamol and NSAIDs
when can oral antivirals be used in shingles
within 72 hours of ash unless under 50
antivirals aim to do what in the treatment of shingles
reduce post herpetic neuralgia
urticaria
antihistamines - more effective if taken regularly
UVB phototherapy
herpes simplex: gingivostomatitis
oral aciclovir
chlorhexidine mouthwash
herpes simplex cold sore
topical aciclovir
herpes simplex genital herpes
oral aciclovir
herpes simplex in pregnancy if primary attack occurs after 28 weeks
elective c section at term
herpes simplex in pregnancy recurrent (not first episode)
suppressive therapy and advise that transmission to baby is low
solitary keratinised genital wart
cryotherapy
multiple non keratinised genital warts
topical podophyllum
2nd line genital wards
imiquimod
common warts
salicyclic acid
cryotherapy
imiquimod
molloscum in kids
resolve in 18 months encourage not to itch can prescribe emollient if that is an issue
orf
resolve after 4-6 weeks
hand foot and mouth
self limiting
tinea capitis
topical ketoconazole shampoo
localised tinea
topical antifungals - clotrimazole, miconazole continuing for 10 days post lesion healing
widespread tinea or nails
oral antifungals
finger nail tinea
terbinafine 250mg 6-12 weeks
toe nail tinea
terbinafine 250mg 3-6 months
alternative to oral terbinafine
oral itraconazole
what monitoring does terbinafine need
LFTs
tx genital candida 1st line
oral fluconazole 150mg single dose
2nd line tx genital candida if oral contraindicated e.g. pregnant
topical clotrimazole - cream or pessary
oral candida
nystatin
skin candida
topical clotrimazole or oral fluconazole
pityriasis versicolor
topical antifungal
2nd line pityriasis versicolor
oral itraconazole
impetigo
1st - hydrogen peroxide 1% cream
2nd line - topical fusidic acid 7 days
extensive or severe impetigo
oral flucloxacillin
erythromycin if pen al
(if group A strep phenoxymethylpenicillin)
folliculitis
topical benzylperoxide and loose clothes
boil / furuncle
10 days oral flucloxicillin
cellulitis
flucloxicillin
if PA - clarithromycin, erythromyin or doxycycline
cellulitis in pregnancy
erythromycin
severe cellulitis
co-amoxiclav, cefuroxime, clindamycin or ceftriaxone
erysipelas
IV flucloxicillin
necrotising fasciitis
urgent surgical debridement and IV antibiotics
scabes 1st line
permethrin 5%
scabies 2nd line
malathion 0.5%
how many cycles of treatment does scabies require
2, 7 days apart
do house hold contacts need to be treated in scabies?
yes, all household and close physical contacts treated as if they have it - 2 cycles 7 days apart
lice - head/body/pubic
malathion
if resistant - dimeticone
lyme disease
doxycycline
disseminated disease - ceftriaxone
lyme disease in pregnancy
amoxicillin
venous ulcer
compression banding
pentoxifylline - improves healing
vitiligo
sun cream
topical steroids
kawasaki
high dose aspirin and IV immunoglobulin
