Drugs & Doses: Dermatology

Question 1

Acne

Answer 1

1. Benzoyl Peroxide 5% + Clindamycin 1% (if inflammatory) OR benzoyl peroxide + adapalene 0.1% (if comedomal) topically, once daily for 6 weeks
   OR
2. Topical Tretinoin 0.025% daily for 6 weeks
   OR if more severe
3. Oral doxycycline 50-100mg daily for 6 weeks
   OR if pregnant
4. Erythromycin 250-500mg BD for 6 weeks
   +/-
5. Spironolactone 50-100mg daily / OCP / refer for isotretinoin

Question 2

Psoriasis + Eczema

Answer 2

1. Mild - Hydrocortisone 1% for kids / faces
2. Moderately potent – Betamethasone Valerate 0.02% - (betnovate or celestone)
3. Potent – Methylprednisolone Aceponate 0.1% (Advantan Fatty Ointment)
4. Ultra Potent – Betamethasone Diproprionate 0.05% in Optimised Vehicle (Diprosone OV)
5. Psoriasis - coal tar 1% as maintenance

Question 3

Perioral dermatitis + Rosacea

Answer 3

1. 0.75% metronidazole gel BD OR

2. Doxycycline 50-100mg daily for minimum 6 weeks

Question 4

SCC + BCC (unless superficial)

Answer 4

Excision with 3-4mm margin

Question 5

Bowens disease on biopsy (SCC in situ) + Superficial BCC

Answer 5

Topical Imiquimod or 5% Fluorouracil

Bowens must be excised if involves hair follicles due to risk of development into SCC

Question 6

Melanoma

Answer 6

1. Excisional biopsy with 2mm margin

2. IF positive refer for WIDE excision + Sentinel Node Biopsy if depth >1cm

Question 7

Seborrhoeic dermatitis

Answer 7

1. Hydrozole (hydrocort 1% + clotrimazole 1%) cream BD topically for up to 14 days
2. For scalp, use steroid lotion nocte for 7/7 (ie. betamethasone 0.05%)

Question 8

Tinea (not scalp or nails)

Answer 8

Terbinafine 1% cream/gel topically, 1-2 times day for 7 to 14 days

Question 9

Tinea capitis

Answer 9

Terbinafine 250mg oral, daily for 4 weeks (child <20kg: 62.5mg, child 20-40kg: 125mg)

Question 10

Onychomycosis

Answer 10

Terbinafine 250mg daily for 12 weeks if toes, 6 weeks if fingers

Question 11

Pityriasis Versicolor

Answer 11

1. Econazole 1% solution topically to wet skin, leave overnight, for 3 days
2. OR Ketoconazole 2% shampoo, once daily for 5 mins then wash off, for 5 days
3. OR if not resolving
4. Fluconazole oral 400mg, single dose

Question 12

Impetigo

Answer 12

1. Mupirocin 2% TDS for 5/7 for localised lesions
2. Flucloxacillin 500mg or cephalexin 500mg (both 12.5mg/kg) Q6H for 7/7
3. Trimethoprim + sulfamethoxazole 4+20mg/kg Q12H for 3/7

Question 13

Scabies

Answer 13

Permethrin 5% from neck down, leave minimum 8hrs. Repeat in 7/7

Question 14

Seborrhoiec dermatitis

Answer 14

1. Hydrocort + clotrimazole 1+1% BD for 2/52

2. Antiyeast shampoo if scalp involvment

Question 15

Actinic keratoses

Answer 15

1. Cryo
2. Topical Imiquimod 3x/week for 3-4 weeks
3. 5% Fluorouracil 1-2x/day for 2-6 weeks

Question 16

Posterior blepharitis/ocular rosacea

Answer 16

Doxy 100mg daily for 8/52

Question 17

Erythrasma

Answer 17

Fusidate sodium 2% top BD for 14/7

Question 18

Keloids

Answer 18

Intralesional triamcinolone