Dermatology Flashcards
Benzyl Benzoate
Topical antiparasitic (scabies, headlice and pubic lice)
D- apply to clean dry skin, leave for 24hours then wash off. Scabies apply from neck down repeat in 5 days if mites still present, lice repeat in 7 days. Dilute 1:1 for <12months and 1:3 <2months with water.
AE- skin irritation, burning
M- deinfestation, skin reactions
Avoid P/BF
Test on small patch of skin for 10min
Wash bedding, hats, pillows in very hot water
Benzyl Peroxide
Topical antiseptic
I- acne
D- aaa once or twice daily.
Combination with clindamycin- once daily nocte. Wash with soap and dry, Apply to whole area (not just spots)
AE- feeling of warmth, stinging, erythmia, skin dryness and peeling
M- acne resolution (assess after 6weeks), dryness and peeling (change to lower strength)
Bleaching of hair and fabric, avoid eyes and lips , soap substitute and moisturiser
Imiquimod
Drug for warts
Genital and anal warts, superficial basal cell carcinoma, actinic keratosis on face or scalp
Dose
Leave dose on for 6-10hours, apply at bed time, wash off in morning
warts aaa 3/7 until clear or max 16/52
BCC aaa 5/7 on consecutive days (ie 2 day break) for 6/52
AK- apply to contiguous area <25cm^2 3/7 for min 4/52, max 16/52
AE- erythema, itch, burning sensation, ulcers, blisters
M- skin condition resolution
Isotretinoin
Oral retinoid- modulates cell proliferation and differentiation. Reduces sebum excretion, propioibacterium acnes numbers, inflammation and cyst formation
I- severe cystic acne, keritinisation disorders (under specialist advice)
D- (>12yo)- 0.5-1mg/kg daily in 1 or 2 doses. Continue until cumulative dose is 120-150mg/kg, usually 4-6months treatment
AE- acne flare (1-2 weeks), raised CK, dry skin lips eyes
M- LFT (can cause derangement, CI in severe impairment), lipids (cholesterol, HDL, LDL, triglycerides- hyperlipidaemia usually resolves with cessation), psychological symptoms, contraception, acne resolution, blood glucose (oral retinoids can change glucose tolerance), occular changes (mostly due to dryness- increased infections, blurred vision, photophobia, impaired night vision),
C- take with food, swallow whole, tell dr asap of nausea headaches or visual changes, will cause dryness- use moisturiser lubricant eye drops lip balm, importance of contraception (inc 1 month after), don’t donate blood during treatment and for 8 weeks after stopping, avoid other acne treatment including topical (inc tetracyclines- benign intracranial hypertension), CAL 8- sun sensitivity importance of sun protection and avoiding sunlaps/tanning beds, may cause acne flare in first few weeks- this should resolve with continued treatment, can change you mood- make sure you and your family is aware of how the medication is affecting your mood, avoid vitamin A supplements, avoid waxing and exfoliation during and for 6 months post treatment, do not share medicine with others
CALs- 8, 21, A, B
Other oral retinoids- acitretinin
Maldison
Antiparasitic
I- headlice, pubic lice
D- apply to dry hair, repeat application after 7 days
AE- stinging, irritation
M- deinfestation, skin reaction
Avoid P, safe BF
Permethrin
Antiparasitic
I- scabies (treatment of choice), headlice
Dose
Scabies- apply chin down and leave for 8-14 days then wash off. Repeat after 7 days
Headlice- apply to damp clean hair, leave for 10min then rinse. Repeat after 7 days
AE- itch, redness
M- treatment failure (resistance), skin reactions
Safe- >2months, P/BF
Topical steroids
I- inflammatory skin conditions
Potency and use
Mild- facial and flexural dermatitis and psoriasis, nappy dermatitis
Hydrocortisone 0.5-1%- once or twice daily
Moderate- mild to moderate atopic dermatitis, adjunctive treatment in extensive psorasis
Betamethasone valerate 0.02-0.05%- once or twice daily
Clobetasone 0.05%- once or twice daily
Desonide 0.05%- once or twice daily
Triamcinolone 0.02%- once or twice daily
Potent- short term in severe inflammatory dermatoses
Betamethasone dipropionate 0.05%- once or twice daily
Betamethasone valerate 0.1%- once or twice daily
Mometasone 0.1%- once daily
Methylprednisolone 0.1%- once daily
Very potent- severe eczema and psoriasis, often refractory
Betamethasone diprpionate OV 0.05%
Clobetasol 0.05%- once daily for up to 4 weeks
M- resolution of skin condition, BGLs if large area is used in patient with diabetes, systemic AE, AE- skin thinning, acne eruption, depigmentation, folliculitis,
C- Fingertip units, apply after bathing, regular moisturiser (unclear which to apply first- but allow time inbetween for absorption), use until resolution not as preventative- use for the shortest duration,
Ointments tend to be better absorbed due to occlusive nature. Occlusive dressings may be required on palms, soles and areas of lichenifcation
CALs- for external use only
Topical retinoids
Topical retinoids- modulate cell proliferation and differentiation and decrease inflammation; in acne, formation of new comedones and inflammatory lesions is reduced
I-acne vulgaris
D
Adapalene- apply once daily at bedtime (inc combo with benzoyl peroxide)
Tazarotene- apply once daily at bedtime (also used for plaque psoriasis)
Tretinoin- apply once daily at bedtime (also used for mottled hyperpigmentation, roughness and fine wrinkling due to photoaging)
M- ezcema/dermatitis/rosacea (increased irritation), contraception (avoid in women planning to conceive or with inadequate contraception), efficacy (some improvement after 2-3 weeks, full benefit after months), topical AE- redness/dryness/burning/stinging,
C
Application steps: 1.wash with mild soap and warm water, rinse and pat dry.2.Apply to whole area (not just pimples)- do not apply to eyes lips irrirated skin sun burn broken skin or nostrils. Wash hands after application.
Causes irritation- esp during first weeks. to reduce irritation trial: waiting 20-30min after washing until skin is totally dry to apply, use a thin layer (a pea size amount should cover the whole face), avoid other acne medictions unless cleared by dr, use a non-comodogenic moisturiser in the morning, avoid waxing, dr may advise to take every 2nd night to build tolerance, if irritation is troublesome- apply less often or have a break for a few days- if it is unbearable see the doctor, CAL 8- use suncream/cover up/ avoid tanning/sunlaps etc, dont pick spots, get healthy balanced diet, wash after exercising
CAL- 8,21
