Dermatology Flashcards

1
Q

Eczema: Treatment Options:

What are the **general **measures used in the management of eczema? What are the treatment options for **mild, moderate **and severe eczema?

A
  1. General:
    1. Identify and exclude triggers; irritants (soaps and detergents), contact, food or inhaled allergens, and skin infections
  2. ​Mild: dry skin, infrequent itch
    1. Emollient, mild topical corticosteroid
  3. Moderate: frequent itching, redness ± excoriations, local skin thickening:
    1. Body: emollient, moderate topical corticosteroid, tacrolimus, bandages
    2. Face: emollient, mild or moderate corticosteroids (3-5 days only), tacrolimus
  4. Severe: incessant itching, widespread, thickening, bleeding / oozing, pigment alteration
    1. Emollient, potent topical steroids (maximum moderate on face), tacrolimus, phototherapy, consider systemic therapy
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2
Q

Emollients and Soap Substitutes:

What are the indications, examples and adverse effects of emollients and soap substitutes.

A
  1. Indications: dry skin, eczema, psoriasis - short lived effects therefore apply liberally and frequently and prescribe in large tubs.
  2. **Examples: **(Note: choice is patients favourite; offer a selection)
    1. Light creams: aqueous cream, diprobase, double bass
    2. Lotion:** **dermol 500
  3. Adverse effects (uncommon)
    1. Contact dermatitis; more common in creams (preservatives) than ointments
    2. Fire hazard
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3
Q

Topical Corticosteroids

What is application advice for topical corticosteroids? What are examples of mild, moderate, potent and very potent topical corticosteroids and what are adverse effects?

A
  1. General advice: no more frequently than BD, OD usually sufficient. Spread thinly, only on active areas, about 30mins after emollinet
  2. Steroid ladder:
    1. Mild: hydrocortisone (+ antimicrobials; daktacort, fucidin H)
    2. Moderate: eumovate
    3. **Potent: **betanovate, elocon
    4. **Very potent: **dermovate
  3. **Adverse effects: **for potent / very potent
    1. Worsening and spread of fungal infections
    2. Thinning of skin
    3. Irreversible striae atrophicae and telangectasia
    4. Acne, or worsening of acne or rosecea
    5. Delayed diagnosis of more serious problems (e.g. malignancy
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4
Q

Calcineurin Inhibitors

What is the mechanism of calcineurin inhibitors, what are the examples, and what are the dermatological indications?

A
  1. Mechanism: prevent IL-2 production in T-cells
  2. Examples: tacrolimus, pimecrolimus
  3. Indications: moderate / severe atopic eczema, facial psoriasis

Not considered first line, unless there is a specific reason to avoid / reduce topical corticosteroid. Should avoid sun and UV exposure due to increased risk of skin cancer.

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5
Q

Acne: Treatment Options

What are the definitions and treatment options for mild, moderate and severe acne?

A
  1. Mild: predominantly open / closed comodones ± papules and pustules. Poor psychological effect is indication for ↑ treatment
    1. Benzoyl peroxide, topical retinoid (tretinoin, isotretinoin, adapalene)
  2. Moderate: predominantly inflammatory papules / pustules. May be widespread, risk of scarring.
    1. If unlikely to scar: as mild
    2. If risk of scarring: add in topical antibiotic
    3. If on back: add oral antibiotic
  3. Severe: made up of **nodules **and cysts, with papules and pustles. High risk of scarring.
    1. Refer to specialist → oral isotretinoin
    2. Contraceptive in women requiring contraception.
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6
Q

Mild Acne: Treatment

What are treatment options for mild acne, and what are the side effects of treatments used?

A
  1. **Benzoyl Peroxide **(2.5%, 5%, 10%): effective in acne with comedones. Begin at low concentration and gradually increase → maximal effect takes 2 - 3 months. Adverse effects: skin irritation, bleaching of clothes / towels
  2. **Adapalene: **topical retinoid, effective for comedonal acne. Adverse effects: burning, erythema, stinging
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7
Q

**Moderate Acne: Treatment **

What are treatment options for moderate acne (papules and pustules), and what are the side effects of treatments used?

A
  1. Continue with treatment for mild acne (benzoyl peroxide, topical retinoid)
  2. Topical antibiotic: erythromycin or clindamycin for 4-6 months are effective in mild inflammatory acne; used with benzoyl peroxide to ↓risk resitance
  3. Oral antibiotics: tetracycline, lymecycline, erythromycin. Maximal improvement at 4-6 months; controls rather than cures, and often recurs after cessation. Side effects → deposition of **tetracycline **in growing bone and teeth causing staining and dental hypoplasia; avoid below age 12 or in pregnancy.
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8
Q

Severe Acne: Treatment

What are the treatment options for severe acne (pustules and cysts), and what are the adverse effects.

A
  1. Continue with treatment, but refer to specialist
  2. COCdianette for women with acne refractory to prolonged oral antibiotics. Avoid if history of venous / arterial thrombosis, arterial disease risk or migraine.
  3. **Oral retinoids (isotretinoin): **given for 16w. Adverse effects:
    1. Dry skin + mucous membranes, joint pains, nose bleeds.
    2. Highly teratogenic → written consent before starting; must practice contraception
    3. Depression and suicide: unproven link, but needs to be discussed with patient
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9
Q

Psoriasis: Treatment Options

What are first, second and third line options for psoriasis?

Note: with a severe presentation, first line topical traetments can be combined with second / third line options)

A
  1. First Line: topical treatments
    1. Potent Corticosteroid (use mild / moderate on face, flexures, genitalia)
    2. Vitamin D analogues: calcipotriol
    3. Coal tar preparation (exorex lotion, crude coal tar)
  2. **Second line: phototherapy **(specialist)
  3. Third line: **systemic therapy **(specialist)
    1. Methotrexate
    2. Ciclosporin
    3. Acetretin
  4. Fourth line: biologics - adalimumab, etanercept, infliximab
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10
Q

Psoriasis: First Line Treatment options

First line topical therapies for psoriasis include:

  1. Corticosteroids
  2. Topical Vitamin D analogues
  3. Coal tar preparations

What is relevant information for each?

A
  1. Corticosteroids:
    1. potent (betanovate) for trunk and limbs,
    2. mild (hydrocortisone) or moderate (eumovate) for face, genitalia and flexures
  2. Vitamin D Analogues: calcipotriol
    1. Adverse effects - itching, erythema, burning, paraesthesia, dermatitis. Reduced through combination with corticosteroid.
  3. **Coal tar preparations: **used in chronic plaque psoriasis:
    1. Exorex lotion used most frequently for outpatients; no harm of contact with normal skin so appropriate for widespread, small lesions.
    2. Cocois scalp ointment (coal tar and salicylic acid in coconut oil): useful for scaly scalps of psoriasis, eczema or seborrheic dermatitis.
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11
Q

Dermatophytoses: Treatment Options

What are the treatment options for tinea infections? Note - tinea may affect:

  • Body (corporis)
  • Groin (cruris)
  • Hand (manuum)
  • Foot (pedis - athlete’s foot)
  • Scalp (capitis) or nail (unguium) - require more aggressive treatment
A
  1. Topical imidazole antifungals: clotrimazole, miconazole
  2. Terbinafine cream - more effective, but more expensive
  3. Systemic therapy required for tinea capitis or unguium. Options include:
    1. Terbinafine (fungicidal, most effective)
    2. Griseofulvin (fungistatic)
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12
Q

Scabies: Treatment

What is the recommended treatment for scabies, and who requires treatment?

A
  1. Adult: 5% permethrin cream over whole body - wash off after 8 - 12 hours
  2. Children, elderly, immunosuppressed: apply to whole bodyincluding face, neck, scalp, ears.
  3. All members of household, sexual contacts, other close contacts should be treated simultaneously. Itch takes several weeks to settle; treat with sedating antihistamine, emollient, corticosteroid.
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