DERMATOLOGY

Question 1

What are the referral symptoms for those suffering with eczema?

Answer 1

Children under 10 needing steroids. 
Lesions on the face that are unresponsive to emollients. 
Suspected pompholyx
Widespread and severe 
Secondary infection
Pregnancy
Treatment failure

Question 2

How do we treat eczema?

Answer 2

Emollients
Topical steroids
Advice
Sedating anti-histamines

Question 3

What advice should we give to those with eczema?

Answer 3

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

Question 4

What are the symptoms of infantile seborrhoeic dermatitis?

Answer 4

Large yellow, greasy scales and crusts on the scalp.

Question 5

What are the symptoms of adult seborrhoeic dermatitis?

Answer 5

History of intermittent skin problems, red rash, greasy looking scales and mildly itchy.

Question 6

How should we treat seborrhoeic dermatitis?

Answer 6

coal tar shampoo or keratlytic tar combination: Capasal.

Ketoconazole shampoo or Selenium sulphide shampoo.

Question 7

When should we refer a patient with seborrhoeic dermatitis?

Answer 7

Treatment failure so the GP can prescribe corticosteroids.

If symptoms are extensive on face and body,.

Question 8

How does psoriasis present?

Answer 8

Well defined, thickened red plaques covered with silvery scales.

Question 9

When should we refer a patient with psoriasis?

Answer 9

Extensive lesions.
Lesions that cause moderate to severe itching.
Patients with no history or family history of psoriasis.
Pustular psoriasis.

Question 10

What type of plaque psoriasis can we treat?

Answer 10

Mild to moderate with emollients, tar preparations, cocois, exorex, polytar.
Dithranol. etc.

Question 11

When would a patient presenting with acne be referred? [5]

Answer 11

Moderate or severe acne. 
Risk of scarring. 
Occupational/drug-induced acne. 
OTC treatment failure - after two months of acne treatment OTC. 
Rosacea.

Question 12

What treatments are available for acne? [4]

Answer 12

Benzoyl peroxide.
Antibiotics.
Isotretinoin
Hormonal treatments in women.

Question 13

Well defined, thickened red plaques covered with silvery scales.

Answer 13

How does psoriasis present?

Question 14

How should freederm gel be used to treat acne?

Answer 14

Twice daily sparingly following skin cleansing.

Question 15

What advice should be given to those suffering from acne?

Answer 15

8-12 weeks for an improvement. 
Benzoyl peroxide can bleach hair, clothes, towels etc.
Wash area before application.
Apply sparingly. 
Apply to whole area not just lesions.
Sunlight can help
Avoid greasy, heavy make up.
Avoid squeezing spots.

Question 16

What advice should be given to someone suffering from athlete’s foot?

Answer 16

Wash 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

Question 17

How should ringworm be treated?

Answer 17

Treat with imidazole
cream (or certain
terbinafine products)

Question 18

History of intermittent skin problems, red rash, greasy looking scales and mildly itchy.

Answer 18

What are the symptoms of adult seborrhoeic dermatitis?

Question 19

How should jock itch be treated?

Answer 19

 Treat with imidazole or terbinafine cream

Question 20

When should patients presenting with fungal nail infections be referred?

Answer 20

Those with conditions which predispose
them to fungal infections
 Pregnant or breastfeeding women
 Under 18’s
 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

Question 21

How is fungal nail treated?

Answer 21

Amorolfine 5% nail lacquer
 Topical anti-fungal, works by causing ergosterol
depletion and accumulation of ignosterol – cell
wall thickening
 Because nail grows very slowly, treatment is long

Question 22

What advice should be given to those suffering from fungal nail?

Answer 22

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

Question 23

When should warts be referred to the GP?

Answer 23

Anogenital warts
 Diabetics
 Lesions on the face
Multiple and widespread warts
 Patients over 50 presenting with wart for
first time
Warts that itch or bleed without
provocation
Warts that have grown and changed in
colour

Question 24

How are warts treated?

Answer 24

 50% of all warts and verrucas will spontaneously
resolve after 2 years
 Salicylic acid – destructive treatment
 Is a keratolytic, which acts slowly by destroying
the virus containing epidermis
 OTC treatments contain between 11 & 50%
salicylic acid alone or in combination with lactic acid or podophyllum

Question 25

What advice should be given to those treating their warts/verrucas?

Answer 25

 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

Question 26

How are cold sores treated?

Answer 26

Treatment – aciclovir or penciclovir

 Pain relief

Question 27

How long should hydrocortisone be used for in the treatment of eczema?

Answer 27

7 days at most.

Question 28

What is cradle cap and what are the symptoms?

Answer 28

Infantile seborrhoeic dermatitis.

Large yellow scales and crusts on the scalp.

Question 29

What does psoriasis present like?

Answer 29

Well defined plaques covered with silvery scales.

Question 30

What is dithranol used to treat?

Answer 30

Dithrocream: psoriasis who had it on Rx before.

Question 31

What is rosacea?

Answer 31

Referral symptom

Facial butterfly.

Question 32

What is dimeticone?

Answer 32

Headlice treatment that is save to use in 6 months+ and in pregnancy.

Question 33

What is the max size of corticosteroid cream that can be sold OTC?

Answer 33

15 grams.