Dermatology Flashcards
What treatment can you give OTC for eczema?
- Emollients
- Topical steroids (hydrocortisone (mild), clobetasone (moderate, children over 12))
- Advice
- Sedating anti-histamines (chlorphenamine) - not in children
- Break the ‘itch-scratch’ cycle
When do you refer eczema?
- Children under 10 needing steroids
- Lesions on face unresponsive to emollients
- OTC treatment failure
- Suspect pompholyx
- Widespread and severe
- Secondary infection
- Pregnancy
How long should topical steroids be used OTC?
No longer than 7 days
What is the max amount of a topical steroid you should give OTC?
15g
What advice should you give to people with eczema?
- 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
What are the two types of seborrhoeic dermatitis?
Infantile and Adult
What are the symptoms for Infantile Seborrhoeic Dermatitis?
Large yellow, greasy scales and crusts on scalp
What are the symptoms of Adult Seborrhoeic Dermatitis?
- History of intermittent skin problems
- Red rash
- Greasy looking scales
- Mildly itchy
What treatment can you suggest for Infantile Seborrhoeic Dermatitis?
Simple treatments for infants
- Johnson’s baby oil and Baby shampoo
What treatment would you recommend for Adult Seborrhoeic dermatitis?
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
When should you refer psoriasis?
- Extensive lesions
- Moderate to severe itching
- Patients with no history or family history of psoriasis
- Pustular psoriasis (white heads/lesions)
What OTC treatment is available for psoriasis?
- 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
When do you refer acne?
- 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
What treatment is available OTC for acne?
Benzoyl peroxide Antibiotics Isotretinoin Nicotinamide 4% gel (freederm) Hormonal treatments in women
How does benzoyl peroxide work?
It is an oxidising agent
What strength can you get benzoyl peroxide in?
2.5-10% (always start off at the lowest strength)
What advice would you give to a patient with acne?
- 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
Which toes does athlete’s foot normally affect?
Between the 4th and 5th
What can you give OTC for Athlete’s foot?
Imidazoles (first line)
Allylamines (first line)
Tolnaftate
Undecenoates
What advice would you give to a patient with Athlete’s Foot?
- 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
What can you give OTC for the treatment of ringworm?
Treat with imidazole cream (or certain terbinafine products)
What can you give OTC for ‘Jock Itch’?
Imidazole or terbinafine
What are the differential diagnosis and referral points for fungal nail infections?
- 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
What can you give OTC for fungal nail infections?
- Amorolfine 5% nail lacquer
How does Amorolfine 5% work?
It is a topical anti-fungal that works by causing ergosterol depletion and accumulatioon of ignosterol - cell wall thickening
How long does treatment with amorolfine 5% take?
6-9 months as nails grow very slowly
What advice would give to a patient who has a fungal nail infection?
- 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
What can you give OTC for warts and verrucas?
- Salicylic acid 11-50% (destructive treatment)
How does salicylic acid work?
It is a keratolytic, which acts slowly by destroying the virus containing epidermis
What are the differential diagnosis and referral points for warts and verrucas?
- 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
How long is salicylic acid normally given for warts?
6-12 week treatment
What advice would you give to patients with warts and verrucas?
- 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
What can you use OTC for the treatment of cold sores?
Aciclovir or Penciclovir (every 4hrs for 5 days)
What can dark/black patches on the skin indicate?
Skin cancer
