Management

Question 1

Broadly, what kinds of management are there for dermatological conditions?

Answer 1

Medical
-topical
-systemic treatment
Physical therapy
-cryotherapy
-phototherapy
-photodynamic therapy
-lasers
-surgery

Question 2

When are topical treatments indicated?

Answer 2

Suitable for localised and less severe skin conditions
Consist of active constituents transported into skin by a base
Active ingredients may include steroids, tar, immunomodulators, retinoids, abx
Common forms of base are
-lotion (liquid)
-cream (oil in water)
-gel (organic polymers in liquid, transparent)
-ointment (oil with little or no water)
-paste (powder in ointment)

Question 3

When is systemic treatment indicated?

Answer 3

Extensive, serious conditions
If treatment ineffective topically
Systemic involvement
Main disadvantage is causing of systemic side effects

Question 4

Emollients

a) examples
b) quantity
c) indications
d) side effects

Answer 4

a) aqueous cream, emulsifying ointment, liquid paraffin, white soft paraffin in equal parts (50:50)
b) 500g per tub

c) Rehydration of skin and re-establishment of surface lipid layer
Useful for dry, scaly conditions and as soap substitutes

d) Irritant/allergic reaction (e.g. due to preservatives or perfumes in creams)

Question 5

Topical/oral corticosteroids

a) examples
b) quantity
c) indications
d) side effects

Answer 5

a) For topical steroids:
-Mildly potent e.g. hydrocortisone
-Moderately potent e.g. clobetasone butyrate (Eumovate)
-Potent e.g. betamethasone valerate (betnovate)
-Very potent e.g. Clobetasol propionate (dermovate)
For oral steroids: prednisolone

b) 30 grams/tube (enough to cover whole body once)

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

d) Local (topical corticolsteroids)
-skin atrophy (thinning)
-telangiectasia
-striae
-may mask/cause/exacerbate skin infections/acne/perioral dermatitis and allergic contact dermatitis
Systemic (oral corticosteroids)
-Cushing’s syndrome
-immunosuppression
-HNT
-diabetes
-osteoporosis
-cataract
-steroid induced psychosis

Question 6

Oral acyclovir

a) examples
b) indications
c) side effects

Answer 6

a) acyclovir
b) viral infections from HSV/HZV

c) GI upsets
Raised LFTs
Reversible neurological reactions
Haematological disorders

Question 7

Oral antihistamines

a) examples
b) indications
c) side effects

Answer 7

a) Non-sedative (e.g. cetirizine, loratadine) and sedative antihistamines (e.g. chlorpheniramine, hydroxyzine)

b) Block histamine receptors (anti-pruritic effect)
Useful for type 1 hypersensitivity reaction and eczema (esp. sedative antihistamines for children)

c) Sedative antihistamines cause sedation and anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation)

Question 8

Topical/oral abx

a) examples
b) indications
c) side effects

Answer 8

a) Topical abx - fusidic acid, mupirocin (Bactroban), neomycin
Oral abx - normal abx regimens

b) Bacterial skin infections, sometimes used for acne

c) Local from topical (local skin irritation, allergy)
Systemic from oral
-GI upset
-rash
-anaphylaxis
-vaginal candidiasis
-abx-assoc infection e.g. C diff
-abx resistance (rapidly appears to fusidic acid)

Question 9

Topical antiseptics

a) examples
b) indications
c) side effects

Answer 9

a) Chlorhexidine, cetrimide, povidone-iodine
b) Treatment and prevention of skin infection
c) Local SEs e.g. local skin irritation, allergy

Question 10

Oral retinoids

a) examples
b) indications
c) side effects

Answer 10

a) Isotretinoin, acitretin
b) Acne, psoriasis and disorders of keratinisation

c) Mucocutaneous reactions e.g.
-dry skin, lips and eyes
-disordered liver function
-hypercholesterolaemia
-hypertriglyceridaemia
-myagia
-arthralgia
-depression
Teratogenicity (effective contraception 1 month before, during and at least 1 month after isotretinoin, but for 2y after acitretin)