Dermatology Flashcards
Nappy rash advice
High absorbency nappy well fitted
Leave nappy off as much as possible to help skin drying
Clean skin and change nappy every 3-4hrs or as soon as wetting/soiling
Use water or fragrance+alcohol free baby wipes
gently dry after cleaning
bath daily NOT using soap, bubblebath, lotions or talc
NHS choices leaflet
Nappy rash w/mild erythema or child asymptomatic
Barrier preparation (OTC) Apply thinly after nappy change (Zn or castor oil ointment, white soft paraffin)
Nappy rash that is inflamed or causing discomfort
If >1m hydrocortisone 1% cream OD max 7d
If nappy rash persists and candidal infection suspected/detected
Advise against barrier
prescribe topical imidazole (eg clotrimazol, econazole, miconazole)
Preparation determines frequency
If nappy rash persists or bacterial infection suspected/confirmed
PO fluclox 7d (clari if allergy)
arrange r/v
Summary of nappy rash
Disposable nappies better than towel
Expose area to air where possible
Barrier eg subocrem
Mild steroid 1% hydrocort. in severe cases
Candida: imidazole and cease barrier until candida settled
Seborrhoeic dermatitis in children
NOT serious
will resolve in wks/months (usually by 8m)
If scalp affected:
-Regular washing + brushing
- soften w/baby oil and then wash with baby shampoo
- soak crusts overnight in white petroleum jelly or slightly warmed oil and shampoo in morning
If conservative ineffective: topical imidazole cream 2-3 times/day
Specialist if lasting 4wks
If non scalp advise bathing and using emollient and soap substitute
if severe 1% hydrocort
Atopic eczema skin/physical severity
Clear: normal skin
Mild: areas of dry skin, infreq. itch
mod: mild+redness
Sev: widespread areas odf dry skin, incessant itch, redness, skin thickening
Atopic eczema impact on life and psychosocial wellbeing
none: no impact
mild: little impact
mod:mod impact+disturbed sleep
Sev: severe limitation and nigthtly loss of sleep
Atopic eczema Ix
Identify triggers
Consider diagnosis of food allergy
Atopic eczema mild Mx
emollients
mild potency topical CS
Atopic eczema moderate Mx
emollients
moderate potency topical CS
topical calcineurin inhibitors
bandages
Severe eczema Mx
Emollient potent topical CS topical calcineurin inhibitors bandages Phototherapy systemic therapy
how long to treat flares in eczema
treat as soon as identified and until 48 hrs after
Emollients in Atopic eczema
Large amounts and often
E45, cetraben, diprobase, aveeno
should be applied on whole body
use as soap substitute
Topical CS in Atopic eczema
use O/BD
only apply to active eczema
dont use potent CS <12m w/o specialist advise
In areas prone to flares use for 2 consecutive days/wk r/v at 3-6mo
If TCS ineffective use different steroid of same potency before increasing potency
Potency of steroid in eczema
Mild: hydrocortisone 1%
mod: betamethasone valerate 0.025% or clobetasone butyrate 0.05%
Potent: betamethasone valerate 0.1%, mometasone
If very severe and extensive consider PO steroids
Topical calcineurin inhibitors Atopic eczema
topical tacrolimus 2L in mod-sev eczema (alt. pimecrolimus)
Apply only to active eczema
NOT under occlusive bandages
Bandages in Atopic eczema
Can be used w/emollients for areas of lichenified skin
short term flares 7-14d
whole body occlusive may be used by specialists
Antihistamines in atopic eczema
1 month trial of nonsedating antihistamone (fexofenadine, certirizine) if sev. itching or urticaria r/v every 3mo
Consider 7-14d of sedating antihistamine (promethazine, chlorphenamine) if causing sleep disturbance
Infected eczema
Swab area
Advise maintaining good hygiene (use spatula, dont leave it open)
First line: flucloxacillin (PO if extensive topical if local)
penicillin allergy: erythro/clarithromycin use Abx for no longer than 2w
Eczema herpeticum
Oral aciclovir
If widespread start aciclovir immediately and refer for same day derm
if around eyes: opthalmology r/v
Educate parents of signs: rapidly worsening/painful, clustered blisters
Alternative treatments in eczema
phototherapy
homeopathy, herbal medicine, food supplements
Indication for specialist referral in eczema
Eczema herpeticum (immediate)
Urgent if severe atopic has not responded to optimum therapy within 1wk or treating bacterial eczema has failed
If diagnosis uncertain, atopic on face is not responding, ?contact allergic dermatitis, causing significant impact on life, severe of recurrent infections
PACES counselling of Atopic eczema
Dx: dry itchy skin very common many will grow out Encourage regular liberal emollients and use as soap substitutes Steroids if necessary A/w atopy avoid triggers: clothes, detergents, soaps, antivirals Avoid scratching if possible (nails short/mittens) Safety net: oozing, red, fever Info+support: itchywheezysneeze.co.uk BAD national eczema society
Viral warts
daily administration of proprietary salicylic acid or lactic acid paint or glutaraldehyde
cryotherapy w/liquid nitrogen
Molluscum contagiosum
NOT Rx if immmunocompetent
Resolution within 18m
Advise agaisnt squeezing mollusca to avoid spreading and superinfections
Avoid towel/clothing/bath sharing
If eczema or infection develops give emollients/steroids
chemical or physical destruction can be done by a specialist
Ringworm
Mild: topical antifungal (terbinafine cream, clotrimazole)
If marked inflammation consdier 1% hydrocortisone
Severe: systemic Afx
1L: terbinafine, 2L itraconazole
Tinea capitis:
- systemic Afc (griseofulvin or terbinafide) 2L:itra/fluconazole
topical Af shampoo in some patients (ketoconazole)
Tinea Faciei, Tinea Corporis, Tinea Cruris or Tinea Pedis
topical Afx (terbinafine, naftifine, butenafine) topical aluminium acetate
Tinea infections
Loose fitting cotton cothing wash affected areas of skin daily dry thoroughly after washing Avoid scratching Do not share towels Wash clothes and bed linen frequently No need for school exclusion
Scabies
Topical permethrin 5% - whole body from chin and ears down - particularly between fingers - apply to cool/dry skin and let dry before dressing - wash off after 8-12h - second application 1wk after first 2L: malathion 0.5% Babies: face and scalp included Alternative: benzylbenzoate solution applied below neck but smells bad and had irritant reaction
Scabies advise
members of household traced and treated
bedding, clothing, towels of patient and any potential contacts should be decontaminated by washing at a high temp and drying in a hot dryer
Patients whose Sx persist beyond 1m after Rx should be retreated
Treat post-scabietic itch w/crotimiton 10% cream or topical hydroc.)
Night time sedative antihistamine
Seek specialist help: crusted scabies, <2m old
Pediculosis (head lice)
wet combing with fine tooth every 3-4d for 2 wees
Dimeticone 4% or aqueous 0.5% malathion rubbed into sclap and left overnight
shampoo next morning
Repeat Rx after 1wk
Guttate psoriasis
Coal tar preps useful in plaque psoriasis >6yr
Dithranol: resistant plaque psoriasis
Calcipotriol: plaque psoriasis >6
occasionally may develp into psoriatic arthritis
Psoriasis association
Acne vulgaris Advice
Avoid over cleaning (twice daily w/gentle soap adequate)
Non-comedogenic products w/pH close to skin
Avoid picking/squeezing
Rx can take up to 8wks
Healthy diet
NHS choices
BAD
Mild-moderate acne
Topical: benzoyl peroxide benzoyl peroxide + clindamycin Adapalene (topical retinoid CI in preg/bf) Azelaic acid 20% - creams/lotions preferable of dry skin
Moderate acne not responding to topical Rx
consider PO Abx:
Lymecycline/Doxycycline
for MAX 3mo
NB. Topical retinoid or benzoyl peroxide should be co-prescribed w/PO abx to reduce risk of Abx resistance
Change to alternative after 3m if no improvement
If no response to 2 cycles or if scarring send to derm ?isotretinoin
COCP in combination w/ topicals in girls (avoid POP)
Refer to specialist: Acne
severe variant severe with (risk of) scarring multiple failed treatments psychological distress diagnostic uncertainty
Follow up of moderate/severe acne
R/v each step at 8-12wks
if adequate continue Rx for 3m
if acne nearly cleared consider maintenance w/topical retinoids or azelaic acid
if NO response: consider adherence/moving up ladder
Hand foot and mouth disease
Sx Mx only
no link to Dx in cattle
do NOT need exclusion
Insect bites and stings
If stinger visible remove by scraping sideways with a finger nail or credit card Clean area Specifics: - bedbugs: pest control - fleas: a/w pets - Lice: check head lice - Scabies
Transient localised reaction to Insect bites and stings
simple analgesia
oral anti-histamine or topical steroids (1%Hydrocort)
OTC: crotamiton, topical antihistamines, topical anaesthetics
secondary bacterial infection can be treated as cellulitis
Animal and human bite
Check risk if tetanus
Co-amox 7d
(metro/doxy 7d if allergic)
Safety net for signs of infection
Neck masses
Branchial cyst: anterior to SCM near angle of mandible, anechoic
Dermoid cyst: midline, suprahyoid, heterogenous on USS
Cystic hygroma: posterior to SCM, painless fluid filled, hyperechoic on USS
