Dermatology

Question 1

How can you treat acne? Mild/moderate

Answer 1

• Benzoyl peroxide (ACNECIDE)
• inflammatory and non inflammatory acne
• applied to the entire affected area
• apply day and night
• can stain clothes, bed linen, towels
• can cause dryness so moisturise area 30-60 mins after applying treatment
• can take 6-8 weeks to see improvement
• Azelaic acid
• can be used as an alternative to benzoyl peroxide as it is less likely to cause irritation
• Topical retinoids (ADAPALENE or TRETINOIN)
• non inflammatory acne
• good in early stages of acne to stop new comedones forming
• can take weeks-4M to work
• need to wear suncream because it can increase sunburn risk
• NOT for pregnant women

Question 2

How can you treat acne? Moderate/severe

Answer 2

• Oral antibiotics OR topical antibiotics
  *12 weeks maximum duration of treatment
  *combine with topical retinoid for better effectiveness
• Oral isotretinoin
  *teratogenic so cannot be given to women of child bearing age unless practising effective contraception
  *ideally they should take pregnancy test before starting treatment, during and after 5week treatment
  *dispensed within 7 days of Rx being written
  *drug can be present in semen so wear condoms
  *toxic drug so only given under consultant supervision
  *photosensitive effects - may be sensitive to light
  *return any unused to pharmacy for safe disposal
• Hormonal treatment
  *for women not responding to other treatments
  Co-pyrindiol is effective for TWO reasons:
  effective contraceptive AND anti androgenic because ingredients compete with DHT for androgen receptors to reduce testosterone
  21 days on when period starts then 7 day pill break

Question 3

What non pharmacological advise can you give?

Answer 3

Do not pick and scratch acne
Stop smoking to reduce sebum secretions
Wash affected areas no more than twice a day
Moisturise with water based moisturiser after treatments
Use non comedogenic make up
Remove make up before bed
Try to keep hair off face

Question 4

What treatments are given for rosacea?

Answer 4

Antibiotics for 6-16 weeks
*oxytetracycline
Topical creams and gels
*acelaic acid

Question 5

What advice can you give for rosacea?

Answer 5

Wear high SPF suncream when going out
Avoid heat, sunlight and humidity where you can
Cover face in cold weather
Gentle skincare routine
Manage stress
Work out your triggers with a diary and avoid

Question 6

What are the treatments for eczema?

Answer 6

• Emollients (DERMOL)
  *should be use regularly to avoid flare ups
  *form an oily barrier to stop irritants contacting the skin
• Topical corticosteroids
  *for flare ups
  Hydrocortisone
  *7 day maximum from pharmacy
  *do not use on face unless GP advised
  *over 10 years old
  *one FTU for application
  *spread in direction of hair growth
  Eumovate
  *stronger cream
  *7-14 day use on Rx
  *apply 2x a day and try to leave 8h before each application
  *one FTU for application
  *avoid broken skin
• Calcineurin inhibitors (TACROLIMUS)
  *avoid overexposure to sun
  *apply thin layer 2x a day for 7 days
  *may burn or sting but should settle
  *after 7 days reduce to 1x a day
• Bandage treatments
• Phototherapy
  *can take 2m to see improvement
• Systemic therapy

Question 7

What advice can you give for eczema?

Answer 7

Un-perfumed and non biological washing powders
Avoid fabric conditioners
Avoid soaps and bubble baths as these can dry skin out
Try not to scratch
Use emollient regularly
Use a humidifier as central heating can cause a dry environment
Avoid fan heaters as these stir up dust
Maintain a cool home temperature
Know your triggers and avoid
Vacuum and damp dust regularly

Question 8

How can you treat psoriasis?

Answer 8

• Topical steroids
  *applied 1-2x daily using FTU as guidance for up to 4 weeks
  *use circular motion to cover the plaque
  *can experience stinging/burning sensation
• Vitamin D analogues
  *suppress pro inflammatory cytokines and inhibit keratinocyte proliferation
  *apply thin layer 102x a day for up to 8 weeks
  *skin irritation can occur
• Calcineurin inhibitors
  *immunosuppressants
  *avoid UV exposure where possible and wear suncream
• Dithranol
  *apply small amount to plaque until fully absorbed
  *strength can be increased over four weeks if tolerated well
  *apply for 30-60 mins then wash off
  *can leave on overnight
• Coal tar
• Tazarotene
• Combination therapy
  Vitamin D analogue (calcipotriol) plus betamethasone
  *apply one in the morning and one in the evening to ensure they both get good contact time
  *Calcipotriol - apply liberal amount, wash hands before and after applying, can get skin irritation , can cause sensitivity to light, max. 100g use per week as it can affect calcium levels

Question 9

How can you treat scalp psoriasis?

Answer 9

- Betnovate scalp application
olive oil 
take it section by section and apply 
1h application time
comb through the scale
repeat as many times as needed

Question 10

How can you counsel for psoriasis?

Answer 10

• Find an emollient you like and use it daily
• Moisturise entire body daily, using long strokes, in direction of hair growth
• Carry a small moisturiser to apply to plaques
• Avoid scratching
• Leave 20-30 mins between emollient and treatments
• Persevere for at least 1M as it can take this long to see improvement
• Scale will disappear and skin will be red which is normal
• De scale scalp before applying any scalp treatments
• Once skin is flat you can stop treatments but keep up emollient use
• Some evidence for omega 3 fish oils