dermatology otc Flashcards
what is eczema?
re often used synonymously to
describe a polymorphic pattern of inflammation, which in the
acute phase is characterised by erythema, vesiculation and in
chronic phase by dryness, lichenification and fissuring
what kind of a condition is eczema?
Non-infective, inflammatory condition
what are some of the clinical variants of eczema?
atopic, irritant contact, allergic contact, sebborrhoeic,
gravitational (varicose), asteatotic, pompholyx, discoid,
chronic hand
what are the common features of eczema?
dry, red, itchy skin
what is atopy?
a state of hypersensitivity to common
environmental allergens that may be inherited.
how does atopic ezcema occur?
Barrier lipids in lower part of the stratum corneum not formed
normally
•Results in dysfunctional skin barrier and immune system
dysregulation causing:
–Increased water loss from the stratum corneum – dryness and
itching
•Resulting in dry skin that does not retain water effectively
–Skin susceptible to allergens and often hyperreactive
–Predisposed to infection by stap.aureus
–Soap removes more lipid and reduces barrier function further
what are the signs of atopic eczema?
•Presence of itch
•Onset of signs and symptoms under the age of 2
years
–Visible flexural dermatitis
–History of other atopic disease e.g. asthma,
hayfever
•In adults:
•Generalised dryness and itching, particularly with
exposure to irritants.
what could be a potential complication of atopic eczema?
Bacterial Infection
–Scratching and excoriation of the skin causing
secondary infection, usually with Staphylococcus
aureus
–Signs: crusting, weeping, fever, malaise
what would be common allergens of allergic contact dermatitis?
- Nickel
- Topical antibiotics
- Preservative chemicals
- Fragrances
- Rubber accelerators
what would be common irritants of irritant contact dermatitis?
- Water
- Urine (nappy rash)
- Strong acid or alkali
- Bleach
- Detergents
- Abrasives e.g. sand
what are the typical features of irritant contact dermatitis?
Burning, stinging and soreness are predominant
Usual onset within 48 hours; may be immediate
Rash only in areas of skin exposed to the irritant
Resolution occurs quickly after removal of the
irritant - typically, within four days
Commonly associated with atopic eczema, which
increases the risk
xposure to friction, soap, detergents, solvents, or
wet work make diagnosis likely
what are the typical features of allergic contact dermatitis?
Redness, itch and scaling are predominant
Delayed onset
Rash may be in areas which have not been in
contact with and allergen. However, the
distribution of the rash is still helpful in
ascertaining the likely allergen
Resolution may take longer than irritant contact
dermatitis, with or without treatment
Less strong association with atopic eczema
how do you manage irritant contact dermatitis?
•Avoid irritant - Occupational considerations
•Protection
–Commonly involves hands- gloves mainstay of protection with a
cotton liner or worn over cotton gloves. Take gloves off on
regular basis as sweating may aggravate existing dermatitis
•Substitution
–substitute non-irritating agents e.g. soap substitute, bath
additives
•Improve barrier function of skin with heavy emollients
•Topical corticosteroids, soap substitutes and emollients are widely
accepted as treatment of established contact dermatitis
what is complete emollient therapy?
Frequent applications of creams or ointments
–Bath oil when bathing/showering
–Routine use of emollient soap substitute
–Avoidance of regular soaps/detergents/bubble baths
when is creams more appropiate than oitments?
if skin is infected/oozing
how should you apply emollients?
•Apply at least 30-60mins before any topical steroids to avoid
dilution
•Apply in direction of hair growth to reduce risk of folliculitis
•Emollient use should generally outweigh steroid use by 10:1 in
terms of quantities used.
•Recommended quantities for use in generalised eczema are:-
–500g/week adult
–250g/week child
why is aq cream unsuitable as a leave on emollient?
as contains sodium lauryl
sulphate…fine as soap substitute
how do topical corticosteroids work?
Inhibit the production and action of inflammatory mediators, reducing
inflammation and itch
The least potent corticosteroid to produce the required effect should be
prescribed
what age is hydrocortisone and clobetasone licensed for?
– Hydrocortisone (Aged 10)
- Clobetasone (Aged 12)
where should steroid creams not be used?
Not for use on the face/genitals
how should you council on hydrocortisone 1% cream?
•Apply up to bd for no more than 7 days
•Do not apply to broken/infected skin
•Do not apply on face or neck except earlobes
•Not for children under 10 years of age
•Do not use if pregnant
•Do not use in ano-genital area
1 FTU will treat an area twice the size of the flat of
an adult’s hand with the fingers together
what is acne?
Chronic inflammatory disorder of sebaceous unit
what can cause acne?
oral contraceptives, phenytoin, lithium
when would you refer for acne?
drug induced, severe acne, failed treatment, extreme
distress
what would you use to treat acne?
Benzoyl peroxide
how would you council on benzyl peroxide?
•Available as - lotions, creams, gels, pads, washes
•Topical oxidising agent that is bactericidal for P.acnes and has
some anti-comedogenic activity
(Acnecide, Quinoderm)
•Strengths from 5% to 10%
•Causes dryness, irritation, peeling
•Sunlight is beneficial for acne but avoid strong sun when using
this product
•Unlikely to see immediate response, usually takes up to 4
weeks to work - If no response within 8 weeks— refer
•Counsel on application!!!!
what are the symptoms of a coldsore?
•Painful crops of small blisters usually around the mouth/nose area (can be anywhere on face or body)
when should you refer a cold sore?
Lesions inside the mouth or involving the eye -refer
what are common triggers of coldsores?
•Sunlight, trauma, emotional upset,
menstruation, illness
what are stages of cold sores?
- Prodromal phase - Tingling sensation
- Eruption of vesicles within 24 hours
- Rupture of vesicles —> painful, weeping erosions
- Crusting / scab formation
- Takes 10 to 14 days to heal
how would you treat cold sores?
Aciclovir cream 5% (Zovirax,
Soothelip)
how would you council with zovirax?
Best used at the tingling stage for maximum effect Can decrease length of time of attack Apply to face only Application is five times daily Apply UV sunblock to lips to prevent recurrence Reduce spread of infection as before Especially avoid kissing newborn and infants
how would you treat coldsores after vessicles have errupted?
Local anaesthetics
Antiseptics
Patch (Compeed Cold Sore
patch)…physical shield/barrier
when would you refer coldsore?
- Affecting the eye
- Frequent severe attacks
- Pregnant
- Genital lesions
- Lesions in mouth
- Patient on immunosuppressive therapy
- Young infants
- Painless lesion – cancer??
how do you treat impetigo?
Treatment OTC is with hydrogen
peroxide 1% cream (apply two or
three times daily for 5 days)
what does impetigo look like?
•Often develops on the face as small
red lesions which subsequently weep
and form a yellow crust
what is the incubation/infectious period for chicken pox?
incubation ranges from 11-21 days and is infectious 1-2 days before and around 6 days after the first crop of vesicles appear.
what happens in the prodromal phase for chicken pox?
A prodromal phase does present for up to 3 days of fever, headache and sore throat.
how do you treat chicken pox?
•Oral treatment is rarely indicated.
•Supportive treatment:
–Fluids
–Analgesia: paracetamol 1st line – Avoid NSAIDs
–Antihistamines – sedative best!
–Frequent cool washes, inclusion of sodium bicarbonate is a tradition measure alleged to help.
–Topical application of calamine lotion or cream
•Oral aciclovir (POM) may be used in adults or immunocompromised patients.
•Antibiotics (POM) may be indicated in secondary infections
why do you not give NSAIDs for chicken pox?
scarring
what are the symptoms of shingles?
•Pain before a rash appears •Unilateral rash of red papules •Change to vesicles and then to scabs •Pain can persist
what is the treatment for shingles?
- Painkillers can be offered (but are not always effective)
- Rest
- Emollients
- Calamine lotion….limited effect
- If POM treatment is required (oral aciclovir), it should be started promptly
- Try not to scratch lesions (apply antipruritic)
- Highly contagious especially in period before rash
- Antiviral treatment
when would you refer shingles?
eye involvement
how does atheletes foot present?
–Fungus likes soft moist conditions –First presents as red and itchy between toes –Then becomes white, soggy and sore –May spread over rest of foot •Sides and soles of feet •Small vesicles on instep
how do you treat atheletes foot?
imidazole anti-fungals
daktarin - miconazole
how would you counsel someone with athletes foot?
•Hygiene important
•Wash feet twice daily and dry thoroughly
•Apply cream widely to include infected area and about 2
inches all round to treat any spores.
•Don’t share towels
•Avoid wearing same pair of shoes every day
•Wash socks/tights at high temperature!
•If the area is “hot” and/or red, could be bacterial infection —
refer
•If nail is affected — treat with Amorolfine if appropriate
