Dry and scaling skin orders

Question 1

Emollients soothe, smooth and hydrate the skin. What is the MHRA advice for them?

Answer 1

Emollients - risk of severe and fatal burns with paraffin containing and paraffin free emollients

Build up residue in bedding and clothing

Avoid smoking, naked flames etc

Washing at high temps may remove some build up but not totally remove it

Question 2

First line treatment for nappy rash ?

Further advice?

Answer 2

Nappies changed frequently and avoid tight fitting water proof pants

Rash may clear when left exposed to air and a barrier preparation applied after each nappy change

Question 3

2nd line treatment for nappy rash?

What if it is fungal?

Answer 3

Mild corticosteroid e.g. 0.5% or 1% hydrocortisone to be used no more than a week

Anti -fungal - clotrimazole

Question 4

Aminoglycosides (gentamicin) can still have risk of ototoxicity when used topically…especially when used…. in certain patients…

Answer 4

Large area of skin being treated

Children
Elderly
Renal impairment

Question 5

What is used for infected burns?

Answer 5

Silver sulfadiazine

Question 6

Metronidazole is used for what kind of skin conditions (3)

Answer 6

Topically for
Rosacea
Reduce odour associated with anaerobic infections

Orally
Wounds infected with anaerobic bacteria

Question 7

To prevent relapse after anti fungal treatment - how long should treatment continue for?

Answer 7

1- 2 weeks after disappearance of all signs of infection

Question 8

What antifungals can be used to treat ringworm / tinea e.g. athletes foot infection ?

Answer 8

1. Imidazoles:

Clotrimazole, Ketoconazole, Miconazole, Econazole

2. Terbinafine (more expensive)
3. Griseofulvin

Question 9

What is Pityriasis versicolor and treatment options?

Answer 9

Pityriasis versicolor is a harmless fungal infection (yeast overgrowth) that causes patches of discoloured skin.

Antifungal shampoos e.g. ketoconazole or selenium sulfide

Question 10

Treatment options for candidiasis/thrush?

Answer 10

Imidazole group
Miconazole, ketoconazole, clotrimazole etc

Refractory requires systemic treatment with a triazole such as fluconazole

Question 11

Aciclovir is used for ? (2)

Answer 11

Herpes simplex infections - buccal or vaginal 
Herpes Zoster (shingles)

Question 12

Treatment for scabies? (2)

Answer 12

1. Permethrin
2. Malathion

Should be applied twice - one week apart

Question 13

Itch and eczema of scabies can last for weeks after treatment - what can be used to help? (3)

Answer 13

1. Crotamiton
2. Topical corticosteroid
3. Oral antihistamine at night (sedating)

Question 14

What is involved in the management of eczema?

Answer 14

1. Emollients applied regularly (BD daily) to help with dryness and irritation
2. Topical corticosteroids
3. Antihistamine

Question 15

Eczema can commonly be infected with …and sometimes with?

Answer 15

Staphylococcus aureus

Occasionally streptococcus pyogenes

Question 16

Which drugs can provoke or exacerbate psoriasis ? (6)

Answer 16

1. Lithium
2. NSAIDs
3. Beta-blockers
4. Chloroquine
5. Hydroxy chloroquine
6. ACE inhibitors

May be seen weeks or months of treatment

Question 17

When should corticosteroid CREAM or OINTMENTS be used?

Answer 17

creams most suitable for moist or weeping lesions

ointments for dry, lichenified or scaly lesions or where a more occlusive effect is required

Question 18

MHRA warning on corticosteroids? whether it be topical/systemic etc

Answer 18

Rare risk of chorioretinopathy (retinal disorder)

pt advised to look out for changes in vision/blurred

refer to opthalmologist

Question 19

Treatment options for hyperhidrosis? (2)

Answer 19

Aluminium chloride hexahydrate antiperspirant

more severe glycopyrronium bromide

Question 20

Hormone treatment co-cyprindiol can be used for the treatment of …..in women only.

Answer 20

acne and moderate hirsutism

Question 21

Treatment options for mild to moderate acne? (3)

Answer 21

1. Topical Benzoyl peroxide / Azelaic acid

if acne doesn’t respond after 2 months tryantibacterial

2. Topical retinoid (tretinoin)
3. Topical antibacterial e.g. erythromycin, clindamycin for inflammatory acne

Question 22

Treatment options for moderate to severe acne?

Answer 22

Oral antibacterials e.g. oxytetracylcine or tetracycline

If no improvement first 3 months another oral antibac to be used for example

1. Doxycycline
2. Lymecycline

Question 23

How does Isotretinoin work? used for what type of acne?

how long is the course?

Answer 23

reduces sebum secretion

treat cystic acne, scarring, severe acne, acne not responding to other treatments

16 weeks

Question 24

Isotretinoin should only be prescribed for… because it is….?

Answer 24

for women who will practice effective contraception (oral progestogen only contraceptives not considered effective) and registered with pregnancy prevention programme

teratogenic!