Josh's Complete OTC Handbook Flashcards
1
Q
A
2
Q
A
3
Q
Is there a PSA self-care card for acne?
A
Yes
4
Q
What are 2 over-the-counter treatment options for acne?
A
- Azelaic acid
- Benzoyl peroxide
5
Q
What is a product containing azelaic acid?
A
Azclear lotion
6
Q
How should Azclear lotion be used?
A
Apply to the affected area(s) TWICE daily
7
Q
What are 2 products containing benzoyl peroxide?
A
- Benzac Gel
- Benzac AC Wash
8
Q
What 3 strengths is Benzac Gel available in?
A
- 2.5%
- 5%
- 10%
9
Q
How should Benzac Gel be used?
A
Apply to the affected area(s) once or twice daily, beginning with a lower strength and increasing up to 10% after 3 to 4 weeks if tolerated and acne is still not well controlled.
10
Q
How should Benzac AC Wash be used?
A
Wet the treated area then wash the face with Benzac wash solution and leave to soak for 30 seconds before washing off. Do this once or twice daily.
11
Q
Describe the use of azelaic acid in pregnancy
A
The safety of azelaic acid in pregnancy is unknown
12
Q
Describe the use of azelaic acid in breastfeeding
A
Azelaic acid is safe to use in breastfeeding
13
Q
Describe the use of azelaic acid in children
A
Azelaic acid is safe to use in children over 2 years old
14
Q
Describe the use of benzoyl peroxide in pregnancy
A
Benzoyl peroxide is safe to use in pregnancy
15
Q
Describe the use of benzoyl peroxide in breastfeeding
A
Benzoyl peroxide is safe to use in breastfeeding
16
Q
Describe the use of benzoyl peroxide in children
A
Benzoyl peroxide is safe to use in children over 2 years old
17
Q
What are 10 pieces of non-pharmacological advice to provide with acne?
A
- Acne usually gets worse before it gets better
- Gradual improvmenet should be seen over time with treatment, usually within 8 to 12 weeks of therapy
- Ensure a good face wash/skin care routine
- Use a moisturiser to minimise dryness
- Avoid using toner
- Avoid squeezing or picking lesions
- Avoid waxing treating areas
- Avoid wearing heavy oil-based makeup and clean makeup off thoroughly each night
- It is important to wear sunscreen
- Exercise regularly and eat a healthy diet with many fresh food and water
18
Q
List 4 practice points to remember with azelaic acid
A
- Azelaic acid can bleach dark skin complexions
- Azelaic acid products contain propylene glycol
- Gel is a good formulation for greasy skin
- Lotions are easier to apply on hairy areas
19
Q
List 3 practice points to remember with benzoyl peroxide
A
- Can bleach clothing and linen
- Gel contains propylene glycol
- 5% Benzac gel appears as effective as the 10% but is but less irritating
20
Q
What are the directions of Differin 0.1% gel (Adapalene)?
A
Adult, children >12 years: Apply to clean, dry skin every second night at bedtime for 2 weeks and apply every night thereafter. Wash the product off in the morning to reduce the risk of photosensitivity. If irritation occurs, reduce the frequency of treatment, or stop treatment for a few days before restarting.
21
Q
Describe the use of Differin 0.1% gel (Adapalene) in pregnancy.
A
Differin 0.1% gel (Adapalene) is in Pregnancy Category D: Avoid use
22
Q
Describe the use of Differin 0.1% gel (Adapalene) in breastfeeding.
A
Differin 0.1% gel (Adapalene) is safe in breastfeeding.
23
Q
What are 2 practice points to remember with Differin 0.1% gel (Adapalene)?
A
- Improvement should be noticeable after 6 weeks. Continue for 6 weeks before assessing effectiveness.
- Skin redness, dryness, irritation and peeling generally resolves with continued use of the product.
24
Q
What are 4 symptoms of head lice?
A
- Itchy scalp
- Visible moving lice
- Small, pale eggs stuck to the bases of hair strands
- Skin sores on the scalp, caused by scratching
25
What are 3 red flags for referral with head lice?
1. Unclear diagnosis
2. Signs of secondary infection
3. Topical treatment has failed which was not due to incorrect application or re-infestation
26
Is there a PSA Self-Care Card for head lice?
Yes (Head Lice)
27
What are 5 over-the-counter treatment options for head lice?
1. KP-24 lotion (Maldison)
2. KP-24 shampoo (Maldison)
3. Banlice Mousse (Pyrethrins and Piperonyl Butoxide)
4. Banlice Aerosol Spray (Pyrethrins and piperonyl butoxide)
5. Hedrin 15 (Dimeticone 4%)
28
What are the directions for KP-24 Lotion (Maldison)?
Adult and Children over 1: Apply to dry hair. Wash hair after 8 to 12 hours and use a fine-tooth comb to remove eggs and dead lice. Repeat after 7 days
29
What are the directions for KP24 Shampoo (Maldison)?
Adult and Children over 1: Apply to dry hair (use a little water if required). Rinse out after 30 minutes and use a fine-tooth comb to remove eggs and dead lice. Repeat after 7 days
30
What are the directions for Banlice Mousse (Pyrethrins and Piperonyl Butoxide)?
Adult and children over 2: Apply to dry hair and massage in until wet. Leave for 10 minutes, then wash out with shampoo. Use a fine-tooth comb to remove eggs and dead lice. Repeat after 7 days
31
What are the directions for Banlice Aerosol Spray (Pyrethrins and Piperonyl Butoxide)?
Adult and children over 2: Apply on dry hair. Moisten whole scalp by spraying in short bursts (2 to 3 seconds); leave for 30 minutes (do not cover head), then rinse out with warm water. Use a fine-tooth comb to remove eggs and dead lice. Repeat after 7 days. Use in a well-ventilated area
32
What are the directions for Hedrin 15 (Dimethicone 4%)?
Adult and Children over 6 months: Apply to dry hair, ensuring it is completely covered from scalp to tip. Leave on for 15 minutes, then use a fine- tooth comb to remove eggs and dead lice. After combing, rinse out with water. Repeat after 7 days.
33
Describe the use of maldison in pregnancy.
Maldison is in Pregnancy Category B2 (Avoid use)
34
Describe the use of Pyrethrins and Piperonyl butoxide in pregnancy.
Pyrethrins and Piperonyl butoxide is in Pregnancy Category B3 (Avoid use)
35
Describe the use of topical dimeticone in pregnancy
Topical dimeticone is Safe in pregnancy
36
Describe the use of maldison in breastfeeding
Maldison is safe in pregnancy
37
Describe the use of Banlice® (Pyrethrins and Piperonyl Butoxide) in pregnancy
Banlice® (Pyrethrins and Piperonyl Butoxide) is safe in pregnancy
38
Describe the use of Differin 0.1% gel (Adapalene) in pregnancy
Differin 0.1% gel (Adapalene) is safe in pregnancy
39
What are 10 pieces of non-pharmacological advice for
headlice?
1. Check other family members for head lice. Treat only if live lice are found
2. Use gloves when handling the products or wash hands thoroughly afterwards
3. Apply insecticide to hair without conditioner or hair products in it
4. Ensure to repeat the application after 7 days
5. Do not use hair dryer to dry hair after insecticide treatment because the heat can inactivate the drug
6. This is a treatment not a prevention. Overuse can lead to irritation and resistant lice
7. Soak combs and hairbrushes in hot water (>60°C) for 30 seconds and wash pillowcases in hot water or put in a clothes dryer for 15 minutes.
8. Items that cannot be washed should be placed in airtight bags for 3-4 days.
9. Avoid sharing hats or combs or towels
10. Children can be sent back to school after the first successful treatment.
40
What are 6 practice points relating to headlice?
1. Moving lice must be found to confirm infestation (wet combing is better than visual inspection for doing this). Itching or the presence of eggs (nits) does not necessarily indicate active infestation
2. Eggs >1 cm from scalp are empty casings or dead. Viable eggs are close to scalp(~6mm) and pop when squashed between fingers
3. Lice can range from nearly colourless (when they hatch) to reddish brown (after feeding), and are about 1 to 4mm long
4. Maldison lotion is generally preferred to shampoo as the contact time is longer and shampoo may be diluted during use, reducing efficacy. However, shampoo may be preferred in asthmatic patients and small children to avoid ethanol vapour from the lotion
5. Resistance is common for neurotoxic insecticides but unlikely for physical insecticides
6. Treatment failure can be due to resistance, incorrect application, or re-infestation
41
What are 4 symptoms of scabies?
1. Intense itching, especially at night or after a hot shower
2. Visible burrows on the skin, typically finger webs, armpits, genitals (i.e., skin creases)
3. A bump or pimple-like rash that is difficult to see
4. Small, clear, fluid-filled spots or lesions
42
What are 5 red flags for referral with scabies?
1. Children under 2 years.
2. Immunosuppressed patients.
3. Signs of secondary infection for example, yellow discharge, crust on skin.
4. Treatment failure.
5. Unclear diagnosis.
43
Is there a PSA Self-Care card for scabies?
Yes (Scabies)
44
What are 2 over over-the-counter treatment options for scabies?
1. Lyclear® Cream (Permethrin 5%)
2. Benzoyl benzoate
45
What is the first line over-the-counter treatment option for scabies (including in pregnancy)?
Lyclear® Cream (Permethrin 5%)
46
What are the directions for Lyclear® Cream (Permethrin 5%)?
Adults and children over 2 months: Apply from the chin down particularly between fingers, toes and genitalia and wash off with warm, soapy water 8 to 14 hours later. Best applied before bedtime and washed off in the morning. Rinse thoroughly. Repeat after 7 days
47
What are the directions for benzyl benzoate in adults and children over 12 years?
Adult, children over 12 years: Apply undiluted from chin down and wash off 24 hours later. Repeat after 5 days
48
What are the directions for benzoyl benzoate in children aged 2 to 11 years?
Dilute with an equal quantity of water and apply from chin down and wash off 24 hours later. Repeat after 5 days
49
What are the directions for benzoyl benzoate for infants aged 1 month to 2 years?
Dilute with 3 parts of water and apply from chin down and wash off 24 hours later. Repeat after 5 days
50
What is a practice point for benzoyl benzoate relating to use in children?
For children and infants, use an alternative agent because efficacy is reduced by further dilution
51
Describe the use of Lyclear® Cream (Permethrin 5%) in pregnancy.
Lyclear® Cream (Permethrin 5%) is safe in pregnancy
52
Describe the use of Lyclear® Cream (Permethrin 5%) in breastfeeding
Lyclear® Cream (Permethrin 5%) is safe in breastfeeding
53
How should Lyclear® Cream (Permethrin 5%) be used in breastfeeding?
Wash from nipples before breastfeeding then re-apply
54
What age range is Lyclear® Cream (Permethrin 5%) appropriate for?
Infants over 2 months
55
Describe the use of Benzyl benzoate in pregnancy
Permethrin is preferred in pregnancy
56
Describe the use of Benzyl benzoate in breastfeeding
Permethrin is preferred in breastfeeding
57
What is the age range for use of benzoyl benzoate?
Infants over 1 month
58
What are 8 pieces of non-pharmacological advice for scabies?
1. Check other family members for scabies. Treat them regardless
2. Use gloves when handling the products or wash hands thoroughly afterwards
3. Ensure to repeat the treatment after 7 days
4. Any clothing, bedding or towels that were in contact with the person in the past 2-3 days should be washed on a hot cycle or dry-cleaned
5. Items that cannot be washed should be stored in tightly sealed plastic bags for at least 3 days
6. Avoid prolonged physical contact with others to reduce transmission
7. Exclude from others until 24hours after appropriate treatment has started
8. Avoid scratching the area, an antihistamine may be used to relieve itch.
59
What are 5 practice points for scabies?
1. In scabies, there is usually not many rashes to be seen because the mites bury into the skin. In elderly people, the rash may appear more widespread. In children, areas such as the face, scalp, palms, and soles of the feet are often affected
2. Symptoms usually develop two to four weeks after infestation. However, people who have previously been exposed may develop symptoms within 24 to 48 hours, because the immune system takes less time to respond.
3. Improvement usually occurs within 1 or 2 days of treatment. The itch may persist for 2-3 weeks after treatment, even if the scabies has been effectively treated. This is because the itch is caused by the body’s immune system responding to the mites and may take time to settle down. Reinvestigate if itch last >4 weeks
4. Generally, a person is no longer infectious 24 hours after treatment.
5. Sexual partners and family members also require treatment
60
What are 4 symptoms of Eczema/Dermatitis?
1. Red, itchy, and inflamed patches of skin
2. Dry, scaly, painful cracks in the skin
3. Known cause (irritant and allergic)
4. Poorly demarcated
61
What are the common locations for eczema/dermatitis in infants?
On the face and in the nappy area
62
What are the common locations for eczema/dermatitis in children?
On the flexures of elbows, knees, hands, feet
63
What are the common locations for eczema/dermatitis in adults?
On the flexures of elbows, knees, hands, feet, and face
64
What are 5 red flags for referral with eczema/dermatitis?
1. Secondary bacterial infections
2. Patch testing for allergens
3. Treatment of warts and molluscum contagiosum is difficult in eczema
4. Herpes simplex
5. Fungal infection
65
Is there a PSA Self-Care card for eczema/dermatitis?
Yes (Eczema and Dermatitis)
66
What are 3 over-the-counter treatment options for eczema/dermatitis?
1. QV cream (moisturising aqueous cream)
2. Dermaid® Cream (Hydrocortisone 1%)
3. Eumovate® Cream (clobetasone 0.05%)
67
What are the directions for QV® Cream (moisturising aqueous cream)?
Adult and Children over 2 years: Apply regularly, at least 2 times daily to rehydrate the skin.
68
What are the directions for Dermaid® Cream (Hydrocortisone 1%)?
Adult and children over 2 years: Apply to the affected areas 1 to 2 times daily as required for up to 7 days. DO NOT apply to broken skin.
69
What are the directions for Eumovate® Cream (clobetasone 0.05%)?
Adult and Children over 12 years: Apply to the affected areas 2 times daily for up to 7 days. DO NOT apply to broken skin.
70
Describe the use of QV® Cream (moisturising aqueous cream) in pregnancy?
QV® Cream (moisturising aqueous cream) is safe in pregnancy
71
Describe the use of Dermaid® Cream (Hydrocortisone 1%) in pregnancy
Dermaid® Cream (Hydrocortisone 1%) is safe in pregnancy
72
Describe the use of Eumovate® Cream (clobetasone 0.05%) in pregnancy
Eumovate® Cream (clobetasone 0.05%) is safe in pregnancy
73
Describe the use of QV® Cream (moisturising aqueous cream) in breastfeeding
QV® Cream (moisturising aqueous cream) is safe in breastfeeding
74
Describe the use of Dermaid® Cream (Hydrocortisone 1%) in breastfeeding
Dermaid® Cream (Hydrocortisone 1%) is safe in breastfeeding
75
Describe the use of Eumovate® Cream (clobetasone 0.05%) in breastfeeding
Eumovate® Cream (clobetasone 0.05%) is safe in breastfeeding
76
What is the age range for QV® Cream (moisturising aqueous cream)?
QV® Cream (moisturising aqueous cream) is safe in all ages
77
What is the age range for Dermaid® Cream (Hydrocortisone 1%)?
Dermaid® Cream (Hydrocortisone 1%) is safe in children over 2 years
78
What is the age range for Eumovate® Cream (clobetasone 0.05%)?
Eumovate® Cream (clobetasone 0.05%) is safe in children over 12 years
79
What are 8 pieces of non-pharmacological advice for eczema/dermatitis?
1. Avoid triggers, such as hot weather, allergens, irritants, etc.
2. Bathe with lukewarm water
3. Use a soap-free + pH balanced body wash (QV Gentle Wash)
4. When toweling dry the body, pat dry instead of rubbing
5. Moisturise skin at least twice daily
6. Wear soft materials, for example, cotton and avoid scratchy materials, such as wool, polyester, acrylic
7. Wear protective gloves when handling chemicals or irritants
8. When using a new fragrance, cosmetic, or cream, test it on a small area of your skin first
80
What are the 3 types of eczema/dermatitis?
1. Allergic dermatitis
2. Irritant dermatitis
3. Atopic dermatitis (eczema)
81
Describe 3 hallmark signs of allergic dermatitis
1. Related to exposure to allergens (for example, pollen, nickel)
2. Intense itch associated
3. May be a delayed reaction to allergen (can take 2 to 3 days to appear)
82
Describe 2 hallmark signs of irritant dermatitis
1. Related to exposure to irritants for example, soaps, chemicals etc.
2. More painful than itchy.
83
Describe 4 hallmark signs of eczema (atopic dermatitis)
1. Most commonly develops in the first year of life.
2. Result of genetic and environmental factors.
3. Chronic inflammatory skin disease - cannot cure
4. Unknown cause, however, risk factors include high socio-economic status, urban living environment and family history.
84
What are 3 practice points with eczema/dermatitis?
1. Allow sufficient time for absorption between application of a topical corticosteroid and a moisturiser.
2. It is better to use a potent corticosteroid short term, thana weak corticosteroid long term
3. For best results apply creams and lotions to damp or wet skin and ointments and oils to dry skin.
85
What are 5 symptoms of seborrhoeic dermatitis?
1. Mainly affects scalp
2. Patches of greasy skin covered with flaky white (dandruff) or yellow scales or crust
3. Red skin
4. Itchy scalp
5. Can also affect oily areas of the body, such as the face, ears, armpits, scrotum, upper chest and back
86
What are 2 red flags for referral with seborrhoeic dermatitis?
1. Treatment failure with OTC management
2. Lesions that appear after holidays to warm climates
87
What are 3 over-the-counter treatment options for seborrhoeic dermatitis?
1. Neutrogena T/Gel® (Coal Tar 0.5% Therapeutic Shampoo)
2. Ionil® Shampoo (Salicylic Acid 2%)
3. Nizoral® Shampoo (Ketoconazole 2%)
88
What are the directions for Neutrogena T/Gel® (Coal Tar 0.5% Therapeutic Shampoo)?
Adults and Children over 2 years: Wash hair thoroughly to massage into the scalp and leave for a few minutes before washing out. Repeat TWICE a week until symptoms resolve then as necessary to prevent recurrence.
89
What are the directions for Ionil® Shampoo (Salicylic Acid 2%)? Adult and Children over 2 years:
Use shampoo twice a week for 4 weeks. If maintenance treatment is required, use shampoo once a week or once a fortnight
90
What are the directions for Nizoral® Shampoo (Ketoconazole 2%)?
Adult and Children over 2 years: Use shampoo twice a week for 4 weeks. If maintenance treatment is required, use shampoo once a week or once a fortnight.
91
Describe the use of Neutrogena T/Gel® (Coal Tar 0.5% Therapeutic Shampoo) in pregnancy
Avoid in pregnancy
92
Describe the use of Neutrogena T/Gel® (Coal Tar 0.5% Therapeutic Shampoo) in breastfeeding
Avoid in breastfeeding
93
What is the age range for Neutrogena T/Gel® (Coal Tar 0.5% Therapeutic Shampoo)?
Neutrogena T/Gel® (Coal Tar 0.5% Therapeutic Shampoo) is safe in children over 2 years
94
Describe the use of Ionil® Shampoo (Salicylic Acid 2%) in pregnancy
Avoid in pregnancy
95
Describe the use of Ionil® Shampoo (Salicylic Acid 2%) in breastfeeding
Avoid in breastfeeding
96
What is the age range for Ionil® Shampoo (Salicylic Acid 2%)?
Children over 2 years
97
Describe the use of Nizoral® Shampoo (Ketoconazole 2%) in pregnancy
Avoid in pregnancy
98
Describe the use of Nizoral® Shampoo (Ketoconazole 2%) in breastfeeding
Nizoral® Shampoo (Ketoconazole 2%) is safe in breastfeeding
99
What is the age range for Nizoral® Shampoo (Ketoconazole 2%)?
Children over 2 years
100
What are 6 pieces of non-pharmacological advice for seborrhoeic dermatitis?
1. Avoid scratching because it can increase irritation and your risk of infection
2. Wash your skin regularly with a gentle cleanser
3. Soften and remove scales from your hair by applying mineral oil or olive oil to your scalp. Leave it in for an hour or so. Then comb or brush your hair and wash it.
4. Avoid products that contain alcohol. These can cause the disease to flare up.
5. Wear smooth-textured cotton clothing. This helps keep air circulating around your skin and reduces irritation.
6. If you have a beard or moustache, consider shaving it off because the condition can be worse under moustaches and beards. If this is the case for you, shaving might ease your symptoms.
101
What are 4 practice points for seborrhoeic dermatitis?
1. Seborrhoeic dermatitis isn't contagious, and it's not a sign of poor personal hygiene. It is usually a long-term condition. Cause is yet to be known
2. Scalps are typically affected but shampoos may also be used on areas other than the scalp
3. Corticosteroids can be used to help with inflammation and itch
4. Products containing salicylic acid and/or sulphur may be used to reduce scales
102
What are 4 symptoms of psoriasis?
1. Well defined, red papules coalescing to erythematous plaques.
2. Red plaques often covered by a silvery scale.
3. Can occur anywhere on the body but often appear on the extensor areas such as the elbows, knees or the trunk or scalp, or in the flexors.
4. Commonly get pitting of the fingernails.
103
What is a red flag for referral with psoriasis?
Refer cases of suspected but undiagnosed psoriasis
104
What are 5 over-the-counter treatment options for psoriasis?
1. QV® Cream (moisturising aqueous cream)
2. Dermaid® Cream (Hydrocortisone 1%)
3. Eumovate® Cream (clobetasone 0.05%)
4. Keratolytics
5. Coal tar
105
What are the directions for QV® Cream (moisturising aqueous cream) in psoriasis?
Adult and Children over 2 years: Apply regularly (at least 2 times daily) to rehydrate the skin.
106
What are the directions for Dermaid® Cream (Hydrocortisone 1%) in psoriasis?
Adult and children over 2 years: Apply to the affected areas 1 to 2 times daily as required for up to 7 days. DO NOT apply to broken skin. Note hydrocortisone is good for flare ups but prolonged use can cause skin atrophy
107
What are the directions for Eumovate® Cream (clobetasone 0.05%) for psoriasis?
Adult and Children over 12 years: Apply to the affected areas 2 times daily for up to 7 days. DO NOT apply to broken skin. Note clobetasone is good for flare ups but prolonged use can cause skin atrophy
108
What are the directions for keratolytics in psoriasis?
Salicylic acid and sulphur are used to lift and soften thick scale in psoriasis (usually salicylic acid 2% to 10% in sorbolene cream, emulsifying ointment, or white soft paraffin)
109
What is the purpose of using tars in psoriasis?
Tars are anti-inflammatory and antipruritic.
110
Describe the practicality of tars in psoriasis.
Although considered first-line therapy, use is limited by patient acceptability due to colour and smell.
111
What are the directions for tars in psoriasis?
LPC 2% to 10% cream or ointment topically twice daily
112
Describe the use of QV® Cream (moisturising aqueous cream) in pregnancy
QV® Cream (moisturising aqueous cream) is Safe in pregnancy
113
Describe the use of QV® Cream (moisturising aqueous cream) in breastfeeding
QV® Cream (moisturising aqueous cream) is Safe in breastfeeding
114
What is the age range for QV® Cream (moisturising aqueous cream)?
QV® Cream (moisturising aqueous cream) is Safe in all ages
115
Describe the use of Dermaid® Cream (Hydrocortisone 1%) in pregnancy
Dermaid® Cream (Hydrocortisone 1%) is Safe in pregnancy
116
Describe the use of Dermaid® Cream (Hydrocortisone 1%) in breastfeeding
Dermaid® Cream (Hydrocortisone 1%) is safe in breastfeeding
117
What is the age range for Dermaid® Cream (Hydrocortisone 1%)?
Dermaid® Cream (Hydrocortisone 1%) is safe in children over 2 years
118
Describe the use of Eumovate® Cream (clobetasone 0.05%) in pregnancy
Eumovate® Cream (clobetasone 0.05%) is Safe in pregnancy
119
Describe the use of Eumovate® Cream (clobetasone 0.05%) in breastfeeding
Eumovate® Cream (clobetasone 0.05%) is Safe in breastfeeding
120
What is the age range for Eumovate® Cream (clobetasone 0.05%)?
Eumovate® Cream (clobetasone 0.05%) is safe in children over 12 years
121
Describe the use of keratolytics in pregnancy
Keratolytics are safe in pregnancy
122
Describe the use of keratolytics in breastfeeding
Keratolytics are safe in breastfeeding
123
Describe the use of Coal tar in pregnancy
Coal tar is Safe pregnancy
124
Describe the use of coal tar in breastfeeding
Coal tar is safe in breastfeeding
125
What is 1 piece of non-pharmacological advice for psoriasis?
Avoid trauma (such as scratching and sunburn), frequent use of soaps and detergents, and alcoholic beverages.
126
What is 1 piece of non-pharmacological advice for psoriasis?
Avoid trauma (such as scratching and sunburn), frequent use of soaps and detergents, and alcoholic beverages.
127
What is a practice point for psoriasis?
Tar, dithranol and salicylic acid can be irritating on the skin and should not be used in acute inflammatory psoriasis, on the face or in the flexures
128
What are 3 types of fungal skin infections?
1. Tinea pedis (Athlete’s Foot)
2. Tinea corporis (ringworm)
3. Tinea cruris (Jock Itch)
129
What are 4 symptoms of tinea pedis (athlete's foot)?
1. Usually between toes
2. Itching/Flaking
3. Fissuring of skin (appears white and soggy due to maceration of the skin)
4. Odorous
130
What are 7 symptoms of Tinea Corporis (Ringworm)?
1. Infection of the major skin surfaces that does not involve the face, hands, groin or scalp
2. Itchy pink or red scaly
3. Patches
4. Well-defined border
5. Over time lesions show a ‘central clearing’
6. Can be a single lesion or
7. Numerous overlapping lesions to produce a single large lesion.
131
What are 5 symptoms of Tinea Cruris (Jock Itch)?
1. Usually isolated to groin and thighs but can spread to buttocks
2. Often bilateral
3. Intensely itchy
4. Reddish-brown
5. Well-defined edge
132
What are 2 over-the-counter treatment options for fungal skin infections?
1. Lamisil® Cream (Terbinafine 1%)
2. Canesten® Cream (Clotrimazole 1%)
133
What is the first line over-the-counter treatment option for fungal skin infections (including in pregnancy)?
Lamisil® Cream (Terbinafine 1%)
134
What are the directions for Lamisil® Cream (Terbinafine 1%)?
Adults and children over 12 years: Apply to the affected area ONCE daily for ONE week (2 to 4 weeks for moccasin-type tinea pedis). Continue using the treatment for the full course even if your skin looks better.
135
Clotrimazole 1% Cream (Canesten)
What are the directions for Canesten® Cream (Clotrimazole 1%)?
136
Adult and Children over 2 years: Apply to the affected area 2-3 times daily. Continue treatment for 2 weeks after symptoms disappear to avoid recurrence.
Clotrimazole is also available in combination with hydrocortisone as an S3 product (Hydrozole). Maximum 7 days due to the corticosteroid component then must switch to non-steroid formulation to complete course
137
Describe the use of Lamisil® Cream (Terbinafine 1%) in pregnancy
Lamisil® Cream (Terbinafine 1%) is Safe in pregnancy
138
Describe the use of Lamisil® Cream (Terbinafine 1%) in breastfeeding
Lamisil® Cream (Terbinafine 1%) is Safe in breastfeeding
139
What is the age range for Lamisil® Cream (Terbinafine 1%)
Adults and children over 12 years
140
Describe the use of Canesten® Cream (Clotrimazole 1%) in pregnancy
Canesten® Cream (Clotrimazole 1%) is safe in pregnancy
141
Describe the use of Canesten® Cream (Clotrimazole 1%) in breastfeeding
Canesten® Cream (Clotrimazole 1%) is safe in breastfeeding
142
What is the age range for Canesten® Cream (Clotrimazole 1%)
Children over 2 years
143
What are 9 pieces of non-pharmacological advice for fungal skin infections?
1. Maintain good hygiene, and keep the skin and feet clean and dry.
2. Wear loose-fitting cotton clothes.
3. Wear clean cotton socks, and shoes made of leather or breathable material.
4. Avoid walking barefoot.
5. Avoid sharing clothes, hairbrushes or towels.
6. Wear thongs, washable sandals or shoes if using communal showers at swimming centres or gyms.
7. Exclude children with tinea corporis from schools and swimming pools until at least 24 hours after starting treatment.
8. Using anti-fungal powder (for example, Daktarin powder) to maintain remission and prevent reinfection.
9. Family members and close contacts should be investigated for tinea infection and treated simultaneously.
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What are 3 practice points for fungal skin infections?
1. Consider predisposing factors such as diabetes, immunosuppression, obesity etc.
2. Family members should be evaluated for asymptomatic carriage, particularly if infection is persistent or recurrent
3. For the treatment of tinea, terbinafine (fungicidal: kills) is more effective than azoles (fungistatic: stops production).
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What are 7 red flags for referral with fungal skin infections?
1. Extensive or severe infection.
2. Signs of bacterial infection.
3. Recurrent infection
4. Unresponsive to topical therapy.
5. On the palms, soles or scalp, in hair-bearing areas or in the nail matrix.
6. Has been previously treated with corticosteroids.
7. Patients with diabetes.
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Are Fungal Nail Infections also called?
Dermatophyte Onychomycosis
147
What are the symptoms of fungal nail infections (dermatophyte onychomycosis)
Thickened, chalky, discoloured (yellow-white) and brittle nails which eventually separate from the nail bed and disintegrate.
148
What are 6 red flags for referral with fungal nail infections (dermatophyte onychomycosis)?
1. Involvement of the entire nail matrix
2. OTC Treatment Failure
3. Suspected poor compliance
4. Other forms of fungal infection.
5. Suspected bacterial infection.
6. Diabetic or immunocompromised patient.
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What is the first line over-the-counter treatment option for fungal nail infections (dermatophyte onychomycosis)?
Loceryl® nail lacquer (amorolfine 5% w/v), however it is unsafe in pregnancy
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What are the directions for Loceryl® nail lacquer (amorolfine 5% w/v)?
Adults and Children over 12 years:
1. File down infected areas on an infected nail (don’t use file on a healthy nail afterwards)
2. Clean nail surface with a cleaning pad
3. Dip spatula into lacquer
4. Paint over the entire nail surface
5. Close bottle tightly
6. Allow 3 to 5 minutes for nails to dry
7. Clean spatula and neck of bottle with same cleaning pad
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How often should Loceryl® nail lacquer (amorolfine 5% w/v) be used?
Apply ONCE or TWICE weekly to the affected nail.
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Describe the duration of treatment with Loceryl® nail lacquer (amorolfine 5% w/v)
Treatment takes around 6 months for fingernails and 9 to 12 months for toe nails.
153
How long should patients continue to use Loceryl® nail lacquer (amorolfine 5% w/v) for?
Continued until the infected nails are completely regrown.
154
What is considered treatment failure of Loceryl® nail lacquer (amorolfine 5% w/v)?
If there is minimal to no improvement after 6 months, refer the patient to the general practitioner
155
When is over-the-counter treatment with Loceryl® nail lacquer (amorolfine 5% w/v) appropriate?
156
Describe the use of Loceryl® nail lacquer (amorolfine 5% w/v) in pregnancy.
Loceryl® nail lacquer (amorolfine 5% w/v) should be avoided in pregnancy
157
Describe the use of Loceryl® nail lacquer (amorolfine 5% w/v) in breastfeeding
Loceryl® nail lacquer (amorolfine 5% w/v) should be avoided in breastfeeding
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What is the age range for Loceryl® nail lacquer (amorolfine 5% w/v)?
Children over 12 years.
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What are 3 pieces of non-pharmacological advice for Loceryl® nail lacquer (amorolfine 5% w/v)?
1. Each pack provides treatment for 3 months, which allows the pharmacist an opportunity to review treatment before further medication is given
2. The product is around $70 to $80 per 3 months, with treatment often greater than 12 months in duration.
3. If the patient is unlikely to commit to the treatment duration, it is best to refer to GP for systemic oral anti-fungal treatment i.e., Terbinafine.
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What are 4 practice points with fungal nail infections?
1. Most commonly affect the toenails
2. Often associated with chronic or recurrent tinea pedis.
3. Approximately half of those affected experience pain.
4. Incidence increases with age.
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For what reason is Ciclopirox (RejuveNail) only a second-line option for fungal nail infections?
It must be applied every day
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For what reason is Miconazole Tincture (Daktarin) only a second line option for fungal nail infections?
As it has poor nail bed perfusion
163
Describe the presentation of Chicken Pox (Varicella Zoster Virus)?
Small blisters surrounded by irregularly shaped patches, starting as small red lumps (papules), which then form fluid containing blisters (vesicles), which eventually rupture, forming crusted spots. They first form on the body then spreads to head and limbs. They are intensely itchy and ulcers may develop (for example in the mouth and vagina)
164
What are 3 Prodromal Symptoms of chickenpox (varicella zoster virus)?
1. Fever
2. Malaise
3. Headache
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What are 5 red flags for referral with chickenpox (varicella zoster virus)?
1. High fever, cough, shortness of breath, chest pain.
2. Severe headache/vomiting.
3. Pregnant women.
4. Infants under 1 month.
5. Immunocompromised patients.
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Is there a PSA Self-Care Card for chickenpox (varicella zoster virus)?
Yes (Chickenpox)
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Describe the basis of treatment for chickenpox (varicella zoster virus).
The condition is self-limiting (usually resolving within 7 to 14 days), so treatment is symptomatic treatment. good hygiene is important to avoid secondary infection.
168
What are the 4 over-the-counter treatment options for chickenpox?
1. Paracetamol (helps to reduce fever)
2. Hydrogel (Smith and Nephew Solosite)
3. Antihistamines (helps to relieve associated itch)
4. Pinetastol Bath Oil (Pine tar 2.3% w/w, Trolamine Lauril Sulfate 6% w/w)
169
What are the 4 over-the-counter treatment options for chickenpox?
1. Paracetamol (helps to reduce fever)
2. Hydrogel (Smith and Nephew Solosite)
3. Antihistamines (helps to relieve associated itch)
4. Pinetastol Bath Oil (Pine tar 2.3% w/w, Trolamine Lauril Sulfate 6% w/w)What is the dosage of paracetamol in chickenpox?
170
What are the directions for Solosite® (Hydrogel) in chickenpox?
Apply liberally to lesions as needed.
171
What are the directions for Solosite® (Hydrogel) in chickenpox?
Apply liberally to lesions as needed.What are the benefits of Solosite® (Hydrogel) in chickenpox?
