Dermatology - Management

Question 1

What are emollients?

Answer 1

These are agents that rehydrate the skin and re-establish a surface lipid layer. They are useful for dry, scaling conditions and as soap substitutes.

E.g. aqueous cream, emulsifying ointment, liquid paraffin and white soft paraffin in equal parts (50:50).

Question 2

What are the side effects of emollients?

Answer 2

Reactions may be irritant or allergic (e.g. due to preservatives or perfumes in creams).

Question 3

Give some examples of topic corticosteroids?

Answer 3

These are classified as:

• mildly potent (e.g. hydrocortisone)
• moderately potent (e.g. clobetasone butyrate, EUMOVATE)
• potent (e.g. betamethasone valerate, BETNOVATE)
• very potent (e.g. clobetasol proprionate, DERMOVATE)

Question 4

What are the indications of topical corticosteroids?

Answer 4

Anti-inflammatory and anti-proliferative effects
Useful for allergic and immune reactions, inflammatory skin conditions, blistering disorders, connective tissue disease and vasculitis

Question 5

What are the side effects of topical corticosteroids?

Answer 5

Local side effects (from topical corticosteroids): skin atrophy (thinning) telangiectasia, striae, may mask, cause or exacerbate skin infections, acne or perioral dermatitis and allergic contact dermatitis.

Systemic side effects (from oral corticosteroids): Cushing’s syndrome, immunosuppression, hypertension, diabetes, osteoporosis, cataract and proximal myopathy.

Question 6

When is oral aciclovir indicated?

Answer 6

Aciclovir is used to treat viral infections caused by herpes simplex virus or herpes zoster virus.

Side effects include GI upset, raised liver enzymes, reversible neurological reactions and haematological disorders.

Question 7

Give some examples of oral anti-histamines and when they are indicated?

Answer 7

Oral anti-histamines are classified into non-sedative (e.g. cetirizine, loratadine) and sedative (e.g. chlorpheniramine, hydroxyzine).

They block histamine receptors and produce anti-pruritic effect. Useful for type 1 hypersensitivity reactions and eczema (especially sedative anti-histamines for children).

Question 8

What are the side effects of oral anti-histamines?

Answer 8

Sedative anti-histamines can cause sedation and anti-muscarinic effects (e.g. dry mouth, blurred vision, urinary retention and constipation).

Question 9

When are topical antiseptics used?

Answer 9

Topical antiseptics - e.g. chlorhexidine, cetrimide, povidone-iodine - are used to treat and prevent skin infection. They may cause local skin irritation or allergy.

Question 10

What are oral retinoids? What are there side effects?

Answer 10

These include isotretinoin, and acitretin. They are used to treat acne, psoriasis, and disorders or keratinisation.

Side effects:

• Mucocutaneous reactions such as dry skin, dry lips and dry eyes, disordered liver function, hypercholesterolaemia, hypertriglyceridaemia, myalgia, arthralgia and depression
• Teratogenicity: effective contraception must be practised one month before, during and at least one month after isotretinoin, but for two years after Acitretin (consult current BNF for further details)