PH1122 - feet Flashcards
What are warts and veruccas ?
Warts and verrucas are benign growths of the skin caused by the human papilloma virus (HPV).
How is HPV spread ?
HPV gains entry to the host by epithelial defects in the epidermis. It is transmitted by direct skin to skin contact, although contact with an infected person’s shed skin can also transmit the virus. Infection via the environment is more likely to occur if the skin is macerated and in contact with roughened surfaces; for example, in swimming pools and communal washing areas.
Patients, especially children, should be warned not to pick, bite, or scratch warts because this can allow viral particle shedding to penetrate skin breaks.
What are some symptom specific questions to ask when investigating warts or veruccas ?
AGE OF PATIENT Warts are unusual in very young children, such as infants. Young children and adolescents are most likely to get warts but this is also the age group in which molluscum contagiosum is most prevalent.
The likelihood that nodular lesions are caused by seborrhoeic warts or carcinoma increases with increasing age.
LOCATION Warts are common on the hands and knees; verrucas are usually on the weight-bearing parts of the sole.
Warts can occur on the face but so too can plane warts and carcinoma. Referral is always needed because all OTC treatments can cause scarring.
ASSOCIATED SYMPTOMS Itching and bleeding is not associated with warts and verrucas and must be viewed with suspicion, especially in older patients.
Pain on walking is often associated with verrucas.
COLOUR, APPEARANCE Typically, warts have a cauliflower appearance and are raised and pale.
WARTS WITH A REDDISH HUE or that change colour should be referred.
Lesions that are raised, smooth and have a central dimple suggest molluscum contagiosum.
What are some reasons to refer when suspecting warts and verrucas ?
Anogenital warts- Outside scope of OTC treatment- Refer As soon as practicable
Multiple and widespread warts -refer as soon as practical
Diabetic patients Treatment options can cause skin damage Nonurgent
Lesions on the face - Non urgent
Patients >50 years presenting with a first-time wart Potential sinister pathology- Refer Immediately to GP
Warts that itch or bleed without provocation- refer to GP immediately
Warts that have grown and changed colour - Refer to gp immediately
What would be the advise for managing a verruca ?
- Explains that verrucae are self-limiting and will resolve after within 2 years.
- Provides appropriate counselling advice on therapeutic option chosen. Salicylic acid
[[[[[ 1. Every night, soak the affected site in warm water for 2 to 3 minutes. - Dry thoroughly with the patient’s own towel.
- Carefully apply one or two drops of the gel to the lesion and allow to dry over its surface. Take care to avoid spreading on to surrounding normal skin. No adhesive plaster is necessary.
- The following evening, carefully remove and discard the elastic film formed from the previous application, and reapply the gel ]]]]]
- Advises to apply petroleum jelly (Vaseline) to skin around area to prevent damage to surrounding area of skin.
- Advises patient that resolution may take up to 12 weeks.
- Explains that transmission occurs on contact with infected area and often in communal areas where people are bare foot.
- Advise parent to contact GP if no resolution after 12 weeks.
What would be the advise for managing a wart ?
1.Explains warts are self limiting and should heal within 2 years.
- Provides appropriate counselling advice on therapeutic option chosen. Salicylic acid
[[[[[ 1. Every night, soak the affected site in warm water for 2 to 3 minutes. - Dry thoroughly with the patient’s own towel.
- Carefully apply one or two drops of the gel to the lesion and allow to dry over its surface. Take care to avoid spreading on to surrounding normal skin. No adhesive plaster is necessary.
- The following evening, carefully remove and discard the elastic film formed from the previous application, and reapply the gel ]]]]]
- Advises patient that resolution may take up to 12 weeks.
- Explains that transmission occurs on contact with infected area and often in communal areas where people are bare foot.
- Advise parent to contact GP if no resolution after 12 weeks.
How would you advise someone suffering from athletes foot and contact dermatitis ?
Explains to the patient that they are suffering from Athlete’s foot
If there is concurrent dermatitis a mild steroid (hydrocortisone) may be supplied alongside an antifungal cream but not alone.
Provides appropriate counselling advice on therapeutic option chosen.[Clotrimazole-The cream should be applied thinly 2-3 times daily and rubbed in gently or terbinafine -Apply just enough cream to form a thin layer on the affected skin and surrounding areas.]
Provides non-pharmacological advice e.g wash and dry feet thoroughly, wear footwear that keeps feet cool and dry, change socks daily, remove shoes when at home to let air get to the feet.
Advise patient to contact GP if no improvement in symptoms after 7 days of treatment
Advise patient to contact if any signs of secondary bacterial infection or extensive disease.
What would be the advise for someone suffering from a fungal nail infection ?
Amorolfine is a broad-spectrum antifungal agent
The product licenses restrict use to no more than two nails in people older than 18 years and who have no underlying medical conditions that predispose them to fungal infection (e.g., immunocompromised individuals and diabetics). To apply amorolfine, the nail must first be filed and cleaned.
What are the main differences between the three main fungal nail infections ?
Distal lateral subungual onychomycosis (DLSO) Mainly big toe Yellowing starts at distal part of toe or side of nail
Proximal subungual onychomycosis (PCO)
Immunocompromised patients White or yellow spots appear at the base of the nail (i.e., in the half-moon area of the nail)
Superficial white onychomycosis Often occurs in previously damaged nails
Chalky-white in appearance and can be scraped off the nail surface Located on the surface of the nail
What are reason to refer someone with Distal lateral subungual onychomycosis (DLSO)
Fungal infection other than DLSO Requires medical confirmation and possible oral treatment Nonurgent, as soon as practicable
OTC treatment failure or suspected poor compliance Suggests misdiagnosis or the need for oral treatment
diabetic to determine whether diabetes is being controlled.
When would you refer with athletes foot ?
Toenails becoming black or discoloured.
If fungal infections start to spread under the nails.
If the fungal infection spreads to other areas of the body.
If there is no response after 1 weeks of treatment.
Evidence of other infection (including pus exudate)
What are some symptom related questions linked to corns and calluses ?
Location Lesions on the tops or between the toes suggest a corn compared with verrucas, which are on the plantar surface of the foot.
Aggravating or relieving factors Pain experienced with corns is a result of pressure between footwear and the toes. If footwear is taken off, then the pain is relieved.
Pain associated with verrucas will be felt whether or not footwear is worn.
Appearance Corns and calluses appear as white or yellow hyperkeratinized areas of skin, unlike verrucas, which show black thrombosed capillaries seen as black dots on the surface of the verruca.
Previous history Patients with corns will often have a previous history of foot problems. The cause is usually due to poorly fitting shoes, such as high heels. Prolonged wear of such footwear can lead to calluses and permanent deformity of bunions.
What are some clinical features of corns ?
Corns have been classified into a number of types, although only soft and hard corns are commonly seen in practice. Hard corns (heloma durum) are generally located on the top of the toes. Corns exhibit a central core of hard grey skin surrounded by a painful, raised, yellow ring of inflammatory skin. Any of the toes can be affected but a corn is most common on the second toe. Soft corns (heloma molle) form between the toes rather than on the tops of toes and are due to pressure exerted by one toe against another. They have a whitened appearance and remain soft due to moisture being present between the toes, causing maceration of the corn. Soft corns are most common in the fourth web space.
What are some clinical features of calluses?
Calluses, depending on the cause and site involved, can range in size from a few millimetres to centimetres. They appear as flattened, yellow-white, thickened skin. In women, the balls of the feet are a common site. Other sites that can be affected are the heel and lower border of the big toe. Patients frequently complain of a burning sensation, resulting from fissuring of the callus.
What are reasons to refer someone when suspecting corns and calluses ?
Discomfort, pain causing difficulty in walking Better assessed and managed by a podiatrist Nonurgent
Soft corns are present
Treatment failure - after 3 weeks
Impaired peripheral circulation (e.g., with diabetes) Needs assessment by podiatrist or doctor As soon as practicable
