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Responding to Symptoms > Dermatology > Flashcards

Dermatology Flashcards

0
Q

What treatment can you give OTC for eczema?

A
  • Emollients
  • Topical steroids (hydrocortisone (mild), clobetasone (moderate, children over 12))
  • Advice
  • Sedating anti-histamines (chlorphenamine) - not in children
  • Break the ‘itch-scratch’ cycle
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1
Q

When do you refer eczema?

A
  • Children under 10 needing steroids
  • Lesions on face unresponsive to emollients
  • OTC treatment failure
  • Suspect pompholyx
  • Widespread and severe
  • Secondary infection
  • Pregnancy
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2
Q

How long should topical steroids be used OTC?

A

No longer than 7 days

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3
Q

What is the max amount of a topical steroid you should give OTC?

A

15g

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4
Q

What advice should you give to people with eczema?

A
  • Decrease level of house dust mite
  • Avoid drying soaps
  • Avoid perfumed toiletries
  • Avoid abrasive clothing
  • Stress management
  • Wet-wrap technique
  • Sunshine
  • No evidence that dietary manipulation has an effect
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5
Q

What are the two types of seborrhoeic dermatitis?

A

Infantile and Adult

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6
Q

What are the symptoms for Infantile Seborrhoeic Dermatitis?

A

Large yellow, greasy scales and crusts on scalp

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7
Q

What are the symptoms of Adult Seborrhoeic Dermatitis?

A
  • History of intermittent skin problems
  • Red rash
  • Greasy looking scales
  • Mildly itchy
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8
Q

What treatment can you suggest for Infantile Seborrhoeic Dermatitis?

A

Simple treatments for infants

- Johnson’s baby oil and Baby shampoo

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9
Q

What treatment would you recommend for Adult Seborrhoeic dermatitis?

A

Simple options to start

  • Consider use of a coal tar shampoo, or keratolyic-tar combination (e.g Capasal)
  • Ketaconazole shampoo or Selenium sulphide shampoo may be given as an alternative
  • Referral to GP if this fails (for corticosteroid treatment)
  • Refer if symptoms are extensive on face and body
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10
Q

When should you refer psoriasis?

A
  • Extensive lesions
  • Moderate to severe itching
  • Patients with no history or family history of psoriasis
  • Pustular psoriasis (white heads/lesions)
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11
Q

What OTC treatment is available for psoriasis?

A
  • Can only treat mild to moderate plaque psoriasis and scalp psoriasis
  • Emollients
  • Tar preparations (Cocois, Exorex, Polytar)
  • Dirthranol (Dithrocream)
  • Treatment limited OTC but extensive treatment available from GPs, specialists
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12
Q

When do you refer acne?

A
  • Moderate or severe acne, especially where there is a risk of scarring
  • Occupational/drug-induced acne
  • OTC treatment failure - after 2 months of acne treatment OTC
  • Rosacea
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13
Q

What treatment is available OTC for acne?

A 
Benzoyl peroxide
Antibiotics 
Isotretinoin
Nicotinamide 4% gel (freederm) 
Hormonal treatments in women
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14
Q

How does benzoyl peroxide work?

A

It is an oxidising agent

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15
Q

What strength can you get benzoyl peroxide in?

A

2.5-10% (always start off at the lowest strength)

16
Q

What advice would you give to a patient with acne?

A
  • Can take 8 to 12 weeks to see an improvement in symptoms
  • Benzoyl peroxide can bleach hair, clothes, towels etc
  • Wash area carefully before application
  • Apply sparingly - a small pea-sized amount is enough for the face
  • Apply to the whole area not just the lesions
  • No evidence that food causes acne
  • Stress does not cause acne, but can make it worse
  • Sunlight can help
  • Avoid greasy, heavy make up, moisturisers etc
  • Avoid squeezing spots
17
Q

Which toes does athlete’s foot normally affect?

A

Between the 4th and 5th

18
Q

What can you give OTC for Athlete’s foot?

A

Imidazoles (first line)
Allylamines (first line)
Tolnaftate
Undecenoates

19
Q

What advice would you give to a patient with Athlete’s Foot?

A
  • Wash the affected area daily and dry carefully
  • Do not share towels
  • Avoid scratching the area since this might spread the infection further
  • Wear non-occlusive footwear to minimise foot perspiration and alternate footwear every 2 to 3 days
  • Wear cotton socks
  • Use flip-flops in communal areas
  • Consider anti-fungal sprays and talcs in shoes to eliminate spores
  • No need for children to miss school
20
Q

What can you give OTC for the treatment of ringworm?

A

Treat with imidazole cream (or certain terbinafine products)

21
Q

What can you give OTC for ‘Jock Itch’?

A

Imidazole or terbinafine

22
Q

What are the differential diagnosis and referral points for fungal nail infections?

A
  • Those with conditions which predispose them to fungal infections
  • Pregnant or breastfeeding women
  • Under 18s
  • Those with fungal nail infections other than DLSO
  • Those with more than TWO infected nails
  • Nail dystrophy or a destroyed nail
  • Failed treatment or no improvement within 3 months
  • Diabetics
23
Q

What can you give OTC for fungal nail infections?

A
  • Amorolfine 5% nail lacquer
24
Q

How does Amorolfine 5% work?

A

It is a topical anti-fungal that works by causing ergosterol depletion and accumulatioon of ignosterol - cell wall thickening

25
Q

How long does treatment with amorolfine 5% take?

A

6-9 months as nails grow very slowly

26
Q

What advice would give to a patient who has a fungal nail infection?

A
  • Wash and dry feet thoroughly everyday
  • Try to prevent infection spreading to other toes
  • Avoid tight fitting or occlusive shoes
  • Alternate use of shoes
  • Exercise good nail care
  • Use anti-fungal sprays in shoes
  • Visit podiatrist regularly
  • Avoid going bare foot in communal areas
  • Avoid nail varnish and artificial nails
27
Q

What can you give OTC for warts and verrucas?

A
  • Salicylic acid 11-50% (destructive treatment)
28
Q

How does salicylic acid work?

A

It is a keratolytic, which acts slowly by destroying the virus containing epidermis

29
Q

What are the differential diagnosis and referral points for warts and verrucas?

A
  • Anogenital warts
  • Diabetics
  • Lesions of the face
  • Multiple and widespread warts
  • Patients over 50 presenting with wart for the first time
  • Wart that itch or bleed without provocation
  • Warts that have grown and changed in colour
30
Q

How long is salicylic acid normally given for warts?

A

6-12 week treatment

31
Q

What advice would you give to patients with warts and verrucas?

A
  • Soak affected area prior to treatment
  • The affected skin should then be lightly rubbed with pumice or emery board
  • Application of product should only be made to the affected skin
  • Allow product to dry - many products now form an occlusive layer to stop spread of HPV
32
Q

What can you use OTC for the treatment of cold sores?

A

Aciclovir or Penciclovir (every 4hrs for 5 days)

33
Q

What can dark/black patches on the skin indicate?

A

Skin cancer

Responding to Symptoms (7 decks)

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