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PM3A copy (dvw) > (PM3A) Skin & Skin Diseases > Flashcards

(PM3A) Skin & Skin Diseases Flashcards

1
Q

How does skin permeability vary between body sites?

A

Different between body sites

Palms not very permeable

Eyelids very permeable

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2
Q

Does skin permeability vary?

A

Yes

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3
Q

How much can skin permeability vary on the same body site between patients ?

A

Up to 40%

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4
Q

Between what groups is there no difference in skin permeability?

(Based solely on the difference of group, not individual variation)

A

(1) Racial skin types

(2) Gender/ sex

(3) Ageing

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5
Q

In which ethnicity is melanoma skin cancer most and least prevalent?

A

Most = White/ Caucasian

Least = Black

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6
Q

Is melanoma skin cancer more common in men or women in the UK?

A

Women

But same incidence in Asians

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7
Q

What are the different skin type classifications?

A

(1) Normal

(2) Dry

(3) Oily

(4) Combination

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8
Q

How is a skin type of a ‘combination’ classified?

A

Oily in T-zone

Dry/ normal elsewhere

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9
Q

How is dermatology/ skin type most commonly classified?

A

Fitzpatrick skin scale

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10
Q

What is the Fitzpatrick skin scale?

A

A classification scale for dermatology/ skin type

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11
Q

What is the Fitzpatrick skin scale based on?

A

Skin response to UV therapy for psoriasis

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12
Q

What is the significance of psoriasis in the Fitzpatrick skin scale?

A

The scale is based on skin response to UV therapy for psoriasis

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13
Q

How many types of skin are there in the Fitzpatrick skin scale?

A

6

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14
Q

What are the different skin classifications in the Fitzpatrick skin scale?

A

(1) Ivory

(2) Beige

(3) Light Brown

(4) Medium Brown

(5) Dark Brown

(6) Very Dark Brown

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15
Q

How is ivory skin characterised?

A

Pale skin + light/ red hair

Prone to freckles

Burns easily + rarely tans

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16
Q

How is beige skin characterised?

A

Fair skin + likely to have light hair

Blue OR brown eyes

Usually burns but gradually tan

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17
Q

How is light brown skin characterised?

A

Light olive skin + dark hair

Brown OR green eyes

Burns with long exposure to sun

Tans quite easily

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18
Q

How is medium brown skin characterised?

A

Brown eyes + dark hair

Burns only with excessive exposure

Always tans easily

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19
Q

How is dark brown skin characterised?

A

Naturally brown skin

Brown eyes + dark hair

Burns only with excessive exposure

Skin further darkens when exposed to sun

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20
Q

How is very dark brown skin characterised?

A

Black skin + dark brown eyes

Black hair

Burns only with extreme sun exposure

Skin very easily darkens further

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21
Q

Describe the sun protection of ivory skin.

A

Greatest risk of developing skin cancer

Needs to protect skin

Best protection from clothing

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22
Q

Describe the sun protection of beige skin.

A

Greatest risk of developing skin cancer

Needs to protect skin

Best protection from clothing

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23
Q

Describe the sun protection of light brown skin.

A

Should use protection in strong sunshine

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24
Q

Describe the sun protection of medium brown skin.

A

Should use protection in strong sunshine

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25
Q

Describe the sun protection of dark brown skin.

A

Should use protection for long outside exposure

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26
Q

Describe the sun protection of very dark brown skin.

A

Should use protection for long outside exposure

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27
Q

Does a product being natural deem it safe?

A

No

e.g. botulism toxin (Botox)

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28
Q

Can natural products be patented?

A

Yes

But not usually

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29
Q

What is a benefit of a therapeutically ineffective natural remedy?

A

Placebo effect

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30
Q

Despite most often being used for bruising (amongst other things), what has been observed to be a benefit of arnica?

A

Mental/ emotional symptoms

Forgetfulness/ memory loss

Severe headaches

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31
Q

What is arnica applied topically for?

A

(1) Bruising

(2) Arthritis

(3) Oedema - due to fracture

(4) Inflammation - e.g. insect bites

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32
Q

What is Arnica flos?

A

The flower of the herb Arnica montana

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33
Q

How many phytochemicals have been identified in Arnica flos?

A

More than 150

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34
Q

What is a phytochemical?

A

Any biologically active compound found in plants

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35
Q

What are the main active constituents of arnica?

A

Sesquiterpene lactones

Other esters

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36
Q

What is sesquiterpene lactones?

A

Some of the main active constituents of arnica

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37
Q

What do sesquiterpene lactones do?

A

Affect inflammatory processes

Inhibit NF-kappaB + NF-AT

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38
Q

How do sesquiterpene lactones affect inflammatory processes?

A

Inhibit

NF-kappaB

NF-AT

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39
Q

What is NF-kappaB?

A

A transcription factor affecting inflammatory responses

Inhibited by sesquiterpene lactones

Influence the release of cytokines

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40
Q

What is NF-AT?

A

A transcription factor affecting inflammatory responses

Inhibited by sesquiterpene lactones

influence the release of cytokines

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41
Q

Define moiety.

A

A part of a molecule

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42
Q

Which compounds of sesquiterpene lactones exhibit stronger activity?

A

Unsaturated acetyl moieties

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43
Q

Which compounds of sesquiterpene lactones exhibit weaker activity?

A

Acetate derivatives

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44
Q

What is the significance of unsaturated acetyl moieties of sesquiterpene lactones in arnica?

A

Exhibit increased activity

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45
Q

What is the significance of acetate derivative moieties of sesquiterpene lactones in arnica?

A

Exhibit decreased activity

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46
Q

What is/ are the main permeant(s) of Arnica flos?

A

(1) 11-alpha, 13-dihydrohelenalin methacrylates ester

(2) 11-alpha, 13-dihydrohelenalin tiglinate esters

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47
Q

How many main permeants of Arnica flos are there in humans?

A

Two

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48
Q

What effect does nicotinic acid have on the skin?

A

Produces reddening of the skin

Increases vasodilation

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49
Q

What effect does 0.1% betamethasone have on skin?

A

Blanching effect

Increase vasoconstriction

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50
Q

Do 0.1% betamethasone and nicotinic acid have the same effect on the skin?

A

No

Nicotinic acid causes vasoDILATION

0.1% betamethasone causes vasoCONSTRICTION

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51
Q

Describe the effect of nicotinic acid, in terms of concentration.

A

Concentration dependent

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52
Q

When is vasodilation observed following treatment with arnica?

A

3 hours after application

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53
Q

What effect does arnica have on blood vessels?

(vasodilation/ vasoconstriction)

A

Vasodilation

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54
Q

What thoughts to consider does the effect of arnica on blood vessels raise, for the indication of bruising?

A

Causes vasodilation

Counter-intuitive, vasodilation would be expected for treatment of indication

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55
Q

How many of the phytochemicals in arnica have been observed to elicit a therapeutic effecft?

A

2/150

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56
Q

What should be considered when advising a patient on the use of a natural product?

A

(1) Will it cause harm? e.g. skin reaction

(2) Will it cause an interaction?

(3) Will it prevent patient’s use of evidence-based therapy?

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57
Q

How many different skin disorders affect adults and children?

A

69

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58
Q

How many people, on average, suffer from a skin disorder?

A

1 in 3

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59
Q

What are some of the most common skin disorders?

A
  • Acne
  • Rosacea
  • Psoriasis
  • Eczema
  • Cancers
  • Fungal infections
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60
Q

Name some important cancers of the skin.

A

(1) Basal cell carcinoma (rodent ulcer)

(2) Squamous cell carcinoma

(3) Malignant melanoma

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61
Q

What is the most common form of skin cancer?

A

Basal cell carcinoma (rodent ulcer)

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62
Q

What is another name for basal cell carcinoma?

A

Rodent ulcer

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63
Q

What is a rodent ulcer?

A

Basal cell carcinoma

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64
Q

Describe the malignancy of basal cell carcinoma.

A

Least malignant skin cancer

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65
Q

What percentage of Caucasians are expected to get basal cell carcinoma in their lifetime?

A

> 30%

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66
Q

In what skin types is basal cell carcinoma most common?

A

(1) 1 - Ivory

(2) 2 - Beige

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67
Q

In what skin types is basal cell carcinoma least common?

A

(1) 4 - Medium brown skin

(2) 5 - Dark brown skin

(Does not occur in very dark brown skin)

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68
Q

Where does basal cell carcinoma (rodent ulcer) most commonly present?

A

The face

(Rarely the ears)

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69
Q

Describe the appearance of a rodent ulcer (basal cell carcinoma).

A

Shiny

Dome-shaped nodules

Later, develop central ulcer

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70
Q

What is telangiectasia?

A

Small visible blood vessels

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71
Q

What is the name given to small visible blood vessels?

A

Telangiectasia

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72
Q

How fast do basal cell carcinomas grow?

A

Relatively slow growing

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73
Q

What is the treatment for basal cell carcinoma (rodent ulcers)?

A

Surgical excision

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74
Q

What is the percentage of successful treatment of basal cell carcinoma?

A

> 99%

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75
Q

When is radiotherapy used for basal cell carcinoma (rodent ulcers)?

A

For large superficial forms

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76
Q

When is cryotherapy used for basal cell carcinoma (rodent ulcers)?

A

For very superficial forms

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77
Q

What is the treatment for large superficial forms of basal cell carcinoma (rodent ulcers)?

A

Radiotherapy

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78
Q

What is the treatment for very large superficial forms of basal cell carcinoma (rodent ulcers)?

A

Cryotherapy

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79
Q

What drugs can be prescribed for basal cell carcinoma (rodent ulcers)?

A

(1) Fluorouracil

(2) Imiquimod

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80
Q

What is squamous cell carcinoma?

A

A type of skin cancer

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81
Q

Where does squamous cell carcinoma arise?

A

From keratinocytes

In stratified squamous epithelium

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82
Q

Describe the appearance of squamous cell carcinoma.

A

Lesions

Red + scaly papules

Can ulcerate + bleed

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83
Q

Where does squamous cell carcinoma most often present?

A

On the head
- Scalp/ ears/ lower lip

Also hands + legs

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84
Q

Describe the growth of squamous cell carcinoma.

A

Rapid growth

Metastasises if not removed

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85
Q

What effect can immunosuppression have on squamous cell carcinoma.

A

Can allow growth of multiple tumours

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86
Q

What is the most common form of skin cancer on black skin?

A

Squamous cell carcinoma

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87
Q

What is the treatment for squamous cell carcinoma?

A

(1) Surgical excision

(2) Radiation therapy

Must be caught early

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88
Q

What is essential when treating squamous cell carcinoma?

A

Must be caught early

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89
Q

What is malignant melanoma?

A

Most dangerous type of skin cancer

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90
Q

What is the most dangerous form of skin cancer?

A

Malignant melanoma

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91
Q

Which type of skin cancer can occur in the eye?

A

Malignant melanoma

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92
Q

Where can malignant melanoma present, that other skin cancers cannot?

A

Eye

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93
Q

What percentage of all skin cancers does malignant melanoma account for?

A

Approximately 5%

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94
Q

What are the most important risk factors for development of malignant melanoma?

A

(1) History of childhood sun exposure

(2) Positive family history

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95
Q

Which type of skin cancer is most resistant to chemotherapy?

A

Malignant melanoma

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96
Q

In which type of cell does malignant melanoma occur?

A

Melanocytes

(Wherever there is pigment)

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97
Q

What percentage of malignant melanoma comes from pre-existing moles?

A

Approximately 30%

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98
Q

What is the estimated 5 year survival rate for black patients with malignant melanoma?

A

70%

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99
Q

What is the estimated 5 years survival rate for white patients with malignant melanoma?

A

94%

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100
Q

Where does malignant melanoma most commonly present in black, asian, and native Hawaiian patients?

A

Non-exposed skin with less pigment

e.g. soles, palms, mucous membranes, nail regions

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101
Q

What is the most common site of malignant melanoma in non-white patients?

A

Plantar portion of the foot

30-40% of all cases

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102
Q

In which patient groups are late-stage melanomas more prevalent?

A

(1) Hispanic

(2) Black

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103
Q

What is the treatment of malignant melanoma?

A

Urgent + wide surgical excision + chemotherapy

Consider immunotherapy (IL-2)

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104
Q

What is the significance of a malignant melanoma lesion that is >4mm thick?

A

Chance of survival is poor

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105
Q

What is the advice given by pharmacists and healthcare professionals for prevention of development of skin cancer?

A

(1) Avoid sun exposure from 11am-3pm

(2) Wear a sun hat

(3) Application of a high protection suncream

(4) Reapply suncream regularly

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106
Q

What is the percentage increased risk of development of squamous cell carcinoma for those who have used tanning beds?

A

83%

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107
Q

What is the method used to recognise melanoma?

A

ABCD(E)

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108
Q

What does ABCD(E) stand for?

A

A = Asymmetry

B = Border irregularity - edges are ragged

C = Colour - pigmentation not uniform

D = Diameter - >6mm

(E) = Evolution + Elevation - mole changing size/ shape/ colour rapidly

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109
Q

In which country is ABCD(E) used to diagnose melanoma?

A

USA

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110
Q

In which country is the Glasgow 7-point checklist of melanoma used?

A

UK

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111
Q

What is the standardised method of melanoma diagnosis in the UK?

A

Glasgow 7-point checklist of melanoma

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112
Q

What are the subtypes of the Glasgow 7-point checklist of melanoma?

A

(1) Major criteria

(2) Minor criteria

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113
Q

How many major criteria are there in the Glasgow 7-point checklist of melanoma?

A

3

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114
Q

How many minor criteria are there in the Glasgow 7-point checklist of melanoma?

A

4

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115
Q

What are the major criteria in the Glasgow 7-point checklist of melanoma?

A

(1) Change in size

(2) Change in shape

(3) Change in colour

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116
Q

What are the minor criteria in the Glasgow 7-point checklist of melanoma?

A

(1) Diameter >6mm

(2) Inflammation

(3) Oozing/ bleeding

(4) Mild itch/ altered sensation

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117
Q

Is ‘change in size’ a minor or major criteria in Glasgow 7-point checklist of melanoma?

A

Major

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118
Q

Is ‘change in shape’ a minor or major criteria in the Glasgow 7-point checklist of melanoma?

A

Major

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119
Q

Is ‘change in colour’ a minor or major criteria in the Glasgow 7-point checklist of melanoma?

A

Major

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120
Q

Is a diameter of >6mm a major or minor criteria in the Glasgow 7-point checklist of melanoma?

A

Minor

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121
Q

Is inflammation a major or minor criteria in the Glasgow 7-point checklist of melanoma?

A

Minor

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122
Q

Is oozing a major or minor criteria in the Glasgow 7-point checklist of melanoma?

A

Minor

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123
Q

Is bleeding a major or minor criteria in the Glasgow 7-point checklist of melanoma?

A

Minor

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124
Q

Is a mild itch a major or minor criteria in the Glasgow 7-point checklist of melanoma?

A

Minor

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125
Q

Is altered sensation a major or minor criteria in the Glasgow 7-point checklist of melanoma?

A

Minor

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126
Q

What is the role of a community pharmacist in skin cancers?

A

Recognition of suspicious lesions/ moles etc

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127
Q

What is a dermatophyte?

A

A pathogenic fungus that grows on skin

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128
Q

What is candidiasis?

A

A pathogenic fungus

Thrush

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129
Q

How are fungal organisms identified in suspected fungal infections?

A

Microscopy

Culture of skin/ hair/ nail samples

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130
Q

How are fungal infections spread between infected humans?

A

Direct contact

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131
Q

Define tinea.

A

Medical term for ringworm

Used to describe skin mycoses

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132
Q

How are superficial dermatophyte infections named?

A

According to body site affected

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133
Q

What is Tinea capitis?

A

Ringworm on the scalp

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134
Q

What is Tinea corporis?

A

Ringworm on the body

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135
Q

What is Tinea cruris?

A

Ringworm on the groin

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136
Q

What is Tinea pedis?

A

Ringworm on the feet

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137
Q

What is ringworm of the scalp called?

A

Tinea capitis

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138
Q

What is ringworm of the body called?

A

Tinea corporis

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139
Q

What is ringworm of the groin called?

A

Tinea cruris

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140
Q

What is ringworm of the feet called?

A

Tinea pedis

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141
Q

In which patient group is Tinea capitis most common?

A

Children

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142
Q

What causes Tinea capitis?

A

(1) Microsporum

(2) Trichophyton

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143
Q

How is Tinea capitis spread?

A

Close contact

144
Q

What effect can hairdressers have on Tinea capitis?

A

Can spread indirectly accidentally

145
Q

How can Tinea capitis be recognised?

A

Alopecia typically seen on head

Can be inflammatory

146
Q

In which type of ringworm can alopecia be expected?

A

Tinea capitis

147
Q

Where does Tinia pedis present?

A

In toe clefts

148
Q

What is Tinia pedis also known as?

A

Athlete’s foot

149
Q

How does Tinia pedis present?

A

Red + scaly

Itchy

150
Q

What can Tinia pedis lead to if not treated?

A

Fissures and maceration of the area

151
Q

How can Tinea corporis be contracted?

A

From animals or humans

152
Q

Which species of fungi is normally responsible for Tinea corporis?

A

Trichophyton

153
Q

How does Tinea corporis present?

A

Scaly lesions

Clusters of round/ oval red patches

154
Q

What is Tinea cruris also known as?

A

(1) Jock itch

(2) Gym itch

(3) Crotch rot

155
Q

What is jock itch?

A

Tinea cruris

156
Q

What is gym itch?

A

Tinea cruris

157
Q

What is crotch rot?

A

Tinea cruris

158
Q

How does Tinea cruris usually present?

A

Itching in groin

Itching in anus

Itching in thigh skin folds

159
Q

What is the first line treatment for Tinea cruris?

A

Self-care

(1) Keep skin clean + dry

(2) Wear loose clothing

(3) Prevent further irritation from friction

(4) Apply a topical OTC antifungal

160
Q

What should be done if Tinea cruris does not respond to self-care after two weeks?

A

See GP

161
Q

What is onchomyosis?

A

Fungal nail infection

162
Q

What is the treatment for onchomyosis?

A

Lacquers + paints

163
Q

What is Tinea manuum?

A

Ringworm of the hands

164
Q

What is ringworm of the hands called?

A

Tinea manuum

165
Q

What is Tinea incognito?

A

A fungal skin infection which can be modified by a topical steroid treatment

Condition improves with steroid

Worsens again following treatment

166
Q

What characterises Tinea incognito?

A

Condition improves with steroid but worsens after treatment cessation

167
Q

What is the general treatment for tinea infections?

A

Topical

Broad-spectrum antifungals

e.g. imidazoles (clotrimazole or miconazole)

e.g. terbinafine

168
Q

What is the treatment for Tinea pedis?

A

Terbinafine 1% cream/ spray

169
Q

What is the treatment for Athlete’s foot?

A

Terbinafine 1% cream/ spray

170
Q

Why is terbinafine 1% cream/ spray used instead of imidazoles for Athlete’s foot?

A

Cochrane review + trials support use

171
Q

Why is terbinafine 1% cream/ spray used instead of imidazoles for Tinea pedis?

A

Cochrane review + trials support use

172
Q

What is the treatment for Tinea capitis?

A

Usually systemic, due to risk of scarring from alopecia

Topical treatment, e.g. ketoconazole shampoo, recommended twice weekly for first 2 weeks of treatment

173
Q

(1) When is ketoconazole shampoo recommended?

(2) Who should use it?

A

(1) Tinea capitis infection

(2) Infected individual + family for first 2 weeks

174
Q

How are widespread fungal infections treated?

A

Oral antifungal therapy

e.g. terbinafine 250 mg OD
e.g. itraconazole 100 mg OD

Used for 1-2 months

175
Q

What is the role of the pharmacist in fungal infections?

A

Advice on common Tinea infections

Referral to GP if oral therapy may be required, e.g. Tinea capitis

176
Q

For which type of ringworm infection is GP referral likely?

A

Tinea capitis

Risk of scarring due to alopecia

177
Q

What is epidermal differentiation?

A

Differentiation of basal cells to stratum corneum, regulated by enzymes

178
Q

Which skin layer regulates water loss?

A

Stratum corneum

179
Q

Which skin layer mediates hydrolytic enzymes?

A

Stratum corneum

180
Q

What is NMF?

A

Natural Moisturising Factor

181
Q

What is Natural Moisturing Factor (NMF)?

A

Endogenous breakdown product from filaggrin hydrolysis

Hygroscopic mixture

Includes amino acids

182
Q

What are the components of Natural Moisturing Factor (NMF)?

A

(1) Amino acids

(2) Pyrrolidone carboxylic acid - PCA

(3) Lactic acid

(4) Urea

183
Q

What is PCA?

A

Pyrrolidone carboxylic acid

184
Q

What is the role of Natural Moisturing Factor (NMF)?

A

Maintains free water within the stratum corneum

185
Q

Which processes are responsible for the maintenance of free water within the stratum corneum?

A

(1) Natural Moisturing Factor (NMF)

(2) Corneocyte maturation

(3) Desquamation

(4) Lipid biosynthesis

186
Q

How does the stratum corneum exhibit biosensory function?

A

Responds to external humidity by regulating internal water content accordingly

187
Q

How is Natural Moisturing Factor (NMF) produced?

A

(1) Profilaggrin is desphosphorylated to filaggrin

(2) Filaggrin is hydrolysed to Natural Moisturing Factor (NMF)

188
Q

How is filaggrin produced?

A

Profilaggrin is dephosphorylated

189
Q

What can be observed if too little Natural Moisturing Factor (NMF) is produced?

A

Dry skin

190
Q

What is the role of Natural Moisturing Factor (NMF) in the stratum corneum?

A

(1) Flexibility

(2) Integrity

(3) Cohesion

(4) Hydration

(5) Buffers

191
Q

How does Natural Moisturing Factor (NMF) act as a buffer?

A

When Natural Moisturing Factor (NMF) decreases, pH increases

192
Q

What happens if insufficient filaggrin is produced?

A

(1) Corneocyte deformation

(2) Reduction in Natural Moisturing Factor - NMF

(3) Increase in skin pH

193
Q

What is corneocyte deformation?

A

Flattening of surface skin cells

194
Q

How can the activity of serine proteases be increased in the stratum corneum?

A

A reduction in filaggrin decreases Natural Moisturing Factor (NMF)

A reduction in Natural Moisturing Factor (NMF) increases the skin pH

Increased skin pH favours serine protease activity

195
Q

What can be observed if serine proteases in the stratum corneum are overactive?

A

Inflammation

196
Q

How do serine proteases cause inflammation?

A

Serine proteases produce cytokines

Cytokines promote inflammation

197
Q

Which cytokines do serine proteases produce?

A

(1) Interleukin-1a

(2) Interleukin-1-beta

198
Q

How common is loss-of-function in the filaggrin gene, as a percentage?

A

10% of the population

199
Q

What are filaggrin mutations a risk factor for?

A

(1) Eczema

(2) Allergies - e.g. asthma, rhinitis, peanuts

200
Q

What percentage of all eczema presence in the population is due to a mutation of at least 1 filaggrin gene?

A

50%

201
Q

What difference does a 20% increase of filaggrin in skin make in reduction of eczema?

A

40% reduction in risk of getting eczema

202
Q

What role does filaggrin have in eczema?

A

Deficiency increases risk of eczema

Sufficiency decreases risk of eczema

203
Q

What percentage of the population are approximated to have eczema?

A

10%

204
Q

What are the common features of eczema?

A

Dry + flaky skin

Oedematous

Crusty

Itchy

205
Q

What are the common features present in chronic eczema, that are not usually seen in acute eczema?

A
  • Thickened skin
  • Lichenified skin
206
Q

What percentage of childhood eczema clears up by adulthood, on average?

A

75%

207
Q

What is meant by atopic march?

A

A typical sequence of immunoglobulin E (IgE) antibody responses

208
Q

Which other medical conditions are associated with eczema?

A

Asthma (50% with atopic eczema get it)

Allergic rhinitis (75% with asthma get it)

209
Q

What can trigger bouts of eczema?

A

(1) Internal inflammation

(2) Externally applied chemicals

(3) Humidity (environment)

210
Q

How do the triggers for eczema cause eczema to arise?

A

Lead to an overproduction of proteases

Proteases break down corneodesmosomes

Breaks epidermal cohesion

Disrupts differentiation

211
Q

What is a corneodesmosome?

A

Class of proteins

Hold corneocytes together

212
Q

(1) What are the types of eczema?

(2) Give examples of each

A

(1) Irritant/ allergic contact eczema

(2)
- Irritant: soaps, cleansers, garlic
- Allergic: Allergens

213
Q

What is the treatment for eczema?

A

Emollients - maintain hydration of stratum corneum

Topical corticosteroids, e.g. 1% hydrocortisone cream

Sedating oral antihistamines - e.g. chlorphenamine

Avoid soap + irritating fabrics

214
Q

What is the reason for an emollient in the treatment of eczema?

A

Main hydration of the stratum corneum

215
Q

What is the reason for a topical corticosteroid in the treatment of eczema?

A

Reduce inflammation + itchiness

216
Q

What is the reason for sedating oral antihistamines in the treatment of eczema?

A

Reduce scratching at night

217
Q

What is the reason for avoiding soap in the treatment of eczema?

A

Soap dries the skin

218
Q

What is the reason for avoiding wool fabrics in the treatment of eczema?

A

Irritates the skin

219
Q

What is the reason for avoiding synthetic materials in the treatment of eczema?

A

Irritates the skin

220
Q

What is a researched drawback in the recommendation of aqueous cream in treatment of eczema?

A

Contains 1% sodium lauryl sulphate (SLS)

221
Q

What is sodium lauryl sulphate (SLS)?

A

A harsh anionic surfactant

222
Q

Give an examples of a harsh anionic surfactant.

A

Sodium lauryl sulphate

223
Q

What is SLS?

A

Sodium lauryl sulphate

Harsh anionic surfactant

224
Q

What types of emollient are recommended in treatment of eczema?

A

Those without SLS - sodium lauryl sulphate

Recommend E45

225
Q

How many finger tip units of topical corticosteroids should be recommended for eczema on the face?

A

2.5

226
Q

How many finger tip units of topical corticosteroids should be recommended for eczema on the neck?

A

2.5

227
Q

How many finger tip units of topical corticosteroids should be recommended for eczema on the entire arm?

A

4

228
Q

How many finger tip units of topical corticosteroids should be recommended for eczema on the entire hand?

A

4

229
Q

How many finger tip units of topical corticosteroids should be recommended for eczema on the entire leg?

A

8

230
Q

How many finger tip units of topical corticosteroids should be recommended for eczema on the entire foot?

A

8

231
Q

How many finger tip units of topical corticosteroids should be recommended for eczema on the front of chest and abdomen?

A

7

232
Q

How many finger tip units of topical corticosteroids should be recommended for eczema on the back and buttocks?

A

7

233
Q

How may applying multiple topical treatments together affect their absorption?

A

One could act as a permeation enhancer

OR act as another barrier to second drug

234
Q

What is the current safest recommendation for order of application of a topical corticosteroid and an emollient, for the indication of eczema?

A

(1) Apply corticosteroid

(2) Wait an hour

(3) Apply emollient

235
Q

What is seborrhoeic eczema?

A

Harmless scaling rash

Affects the scalp, eyebrows, ears, face, folds of underarms, groin

236
Q

What is dandruff?

A

Seborrhoeic eczema of the scalp

237
Q

What is pityriasis capitis?

A

Dandruff

Seborrhoeic eczema of the scalp

238
Q

Is seborrhoeic eczema contagious?

A

No

239
Q

Which patient groups are at increased risk of development of seborrhoeic eczema?

A

(1) Parkinson’s - neurological disorders

(2) Stroke patients - neurological disorders

240
Q

What is the self-care advice for seborrhoeic eczema?

A

(1) Reduce exposure to allergens

(2) Keep cool

(3) Loose clothing

(4) Soap-free cleansers

241
Q

What is the general treatment for seborrhoeic eczema in adults?

A

(1) Regular use of antifungal agents

(2) Intermittent applications of topical steroids

242
Q

What is the treatment for seborrhoeic eczema in infants?

A

Usually clears up within 6 months

Mild emollients

Hydrocortisone cream

Topical ketoconazole

243
Q

How is seborrhoeic eczema on the scalp treated?

A

Medicated shampoos - containing ketoconazole - 2x/week for 4 weeks

244
Q

Why are steroid scalp applications recommended for seborrhoeic eczema of the scalp?

A

Reduce symptoms

245
Q

What are tar creams used for in seborrhoeic eczema of the scalp?

A

Applied to scaled areas

Removed with shampoo several hours later

246
Q

What is the treatment of seborrhoeic eczema of the face, ears, chest or back?

A

(1) Cleanse affected areas 1-2x/day

(2) Ketoconazole cream OD for 2-4 weeks

(3) Hydrocortisone cream BD for 1-2 weeks

247
Q

What is the treatment for severe seborrhoeic eczema of the face, ears, chest or back?

A

(1) Cleanse affected areas 1-2x/day

(2) Ketoconazole cream OD for 2-4 weeks

(3) Hydrocortisone cream BD for 1-2 weeks

(4) Course of UV radiation

248
Q

What can eczema be mistaken for, as a serious mistake?

A

Systemic lupus erythematosus (SLE)

249
Q

What is a classic symptoms of systemic lupus erythematosus (SLE)?

A

Butterfly rash on cheeks and nose

Can include trunk/ extremities

250
Q

What can exacerbate the butterfly rashes seen systemic lupus erythematosus (SLE)?

A

Sunlight

Stresses that increase skin circulation

251
Q

What are the symptoms of systemic lupus erythematosus (SLE)?

A

(1) Butterfly rash on cheeks + nose

(2) Non-specific joint pains (morning stiffness)

(3) Fatigue

(4) Rapid hair loss (regrows in remission)

252
Q

How is systemic lupus erythematosus (SLE) contracted?

A

Genetic origin

253
Q

What is psoriasis?

A

Chronic autoimmune disorder

254
Q

How is psoriasis contracted?

A

Genetic predisposition

Other factors also required

255
Q

In which ethnic group is psoriasis most common?

A

Caucasian

256
Q

What is early onset psoriasis?

A

16-22 years old

257
Q

What is late onset psoriasis?

A

55-60 years old

258
Q

Is psoriasis more common in males or females?

A

No difference in incidence

Females tend to have early onset

259
Q

How does psoriasis present?

A

Chronic

Scaling

Inflammation

Skin redness (skin types 1-4)

Skin greyness (skin types 4-5)

260
Q

What factors can trigger psoriasis?

A

(1) Infection - can lower threshold for psoriasis

(2) Trauma

(3) Emotional stress/ anxiety

(4) Climatic factors - sunlight

(5) Certain drugs

261
Q

Name some examples of drugs which can trigger psoriasis.

A

(1) ACE inhibitors

(2) NSAIDs

(3) Chloroquine

(4) B-blockers

(5) Lithium

(6) Alcohol abuse

262
Q

What is the most common form of psoriasis?

A

Plaque psoriasis

> 90% of all cases

263
Q

How does plaque psoriasis present?

A

Scattered lesions

Raised + scaly

Often on knees, elbows, scalp

264
Q

What is Guttate psoriasis?

A

Teardrop shaped

Numerous small + discrete patches

Commonly seen in the young

265
Q

What percentage of patients with Guttate psoriasis spontaneously recover?

A

1/3

33%

266
Q

What is flexural psoriasis?

A

Inverse psoriasis

Affects areas of skin-skin contact

Tends to occur later in life

267
Q

Which type of psoriasis tends to occur in younger patients?

A

Guttate psoriasis

268
Q

Which type of psoriasis tends to occur in older patients?

A

Flexural psoriasis

269
Q

Give another name for flexural psoriasis.

A

Inverse psoriasis

270
Q

Give another name for inverse psoriasis.

A

Flexural psoriasis

271
Q

What is generalised pustular psoriasis?

A

Acute + severe eruption of superficial pustules

Reddening of the skin + high fever

Pustules do NOT contain bacteria, NOT caused by infection

272
Q

When does generalised pustular psoriasis most commonly occur?

A

Following use of large quantities of steroid cream/ tablets

273
Q

What is chronic pustular psoriasis?

A

Localised form of pustular psoriasis

Occurs on hands + feet

Reddening of skin + high fever

Severe eruption of superficial pustules

274
Q

What is psoriatic arthritis?

A

Inflammatory joint disease

Usually affects small joints, e.g. hands/ feet

Skin changes before joint pain

275
Q

What happens to the nails in psoriasis?

A

Pitting - small indentation

Onycholysis - lifting up of nails

Discolouration

Thickening

Crumbling

276
Q

What percentage of patients with psoriasis experience nail changes?

A

25-50%

277
Q

What is the purpose of psoriasis treatment?

A

Control + management

NOT cure

278
Q

What are the potential options for treatment of psoriasis?

A

(1) Emollients: Hydrate skin + anti-proliferative effect

(2) Topical corticosteroids: Initial improvement

(3) Calcipotriol: Dovonex - synthetic D3 analogue, interferes with cell division and differentiation

279
Q

What is dovonex?

A

Calcipotriol

280
Q

What is an example of calcipotriol?

A

Dovonex

281
Q

Give an example of a synthetic D3 analogue.

A

Calcipotriol - Dovonex

282
Q

What are some examples of emollients?

A

(1) E45

(2) Diprobase cream

283
Q

What is the treatment for chronic psoriasis?

A

(1) Emollient

(2) Steroid + vitamin D analogue

284
Q

What is the most appropriate treatment for mild/ onset psoriasis?

A

Corticosteroids > calcipotriol

285
Q

What is coal tar used for in the treatment of psoriasis?

A

Anti-inflammatory + anti-scaling properties

Crude coal tar most effective

286
Q

What is salicylic acid used for in the treatment of psoriasis?

A

Used as a keratolytic

287
Q

What is dithranol?

A

Drug used for the treatment of psoriasis

288
Q

What is dithranol used for in the treatment of psoriasis?

A

To induce remission

Especially effective for chronic plaque psoriasis

Not to be used on the skin/ flexures

289
Q

When can dithranol not be used?

A

On the face/ flexures

290
Q

What are retinoids?

A

Drug used for the treatment of psoriasis

291
Q

What are retinoids used for in the treatment of psoriasis?

A

Used topically for mild-moderate plaque psoriasis

292
Q

Give an example of a retinoid.

A

0.05% tazarotene

293
Q

Give an example of a vitamin A analogue

A

0.05% tazarotene

294
Q

Which skin condition can phototherapy be used to treat?

A

Psoriasis

295
Q

What methods of phototherapy can be used for treatment of psoriasis?

A

(1) UVB light

(2) PUVA therapy

296
Q

What is UVB light used for?

A

Treatment of psoriasis

297
Q

What is PUVA therapy used for?

A

Treatment of psoriasis

298
Q

What types of psoriasis can UBV light be used for?

A

Method of treatment of chronic stable psoriasis

Method of treatment for guttate psoriasis

299
Q

When should UVB light be recommended?

A

(1) Stable/ chronic psoriasis

(2) Guttate psoriasis

(3) When topical treatment has failed

300
Q

When is UVB light contraindicated?

A

Inflammatory psoriasis

301
Q

What is PUVA therapy?

A

Combination of long-wave UVA radiation with psoralen

302
Q

Where can patients receive PUVA therapy?

A

Dermatology centres

303
Q

What does psoralen do?

A

Enhances effect of UVA

Usually taken 2 hours before UVA exposure

304
Q

When is psoralen normally taken?

A

During PUVA therapy

2 hours before UVA exposure

305
Q

What does PUVA therapy stand for?

A

P = Psoralen

UVA = Type of radiation

306
Q

What is UVA?

A

Type of radiation used in phototherapy for treatment of psoriasis

307
Q

For which type of psoriasis is PUVA therapy normally used?

A

Effective in most types of psoriasis

308
Q

What happens if patients receive high doses of PUVA therapy?

A

(1) Skin ageing

(2) Risk of cataracts

(3) Skin cancer

309
Q

When is systemic treatment of psoriasis required?

A

(1) Severe psoriasis

(2) Resistant psoriasis

(3) Unstable psoriasis

(4) Complicated psoriasis

ONLY under specialist supervision

310
Q

What drugs are available for systemic treatment of psoriasis?

A

(1) Acitretin

(2) Cyclosporin

(3) Methotrexate

311
Q

What is acitretin?

A

Drug used for systemic treatment of psoriasis

Retinoid

Effect takes 2-4 weeks

Maximum effect at 4-6 weeks

Only available in hospital pharmacies

312
Q

What is cyclosporin?

A

Drug used for systemic treatment of severe psoriasis AND severe eczema

Taken by mouth

313
Q

What is methotrexate?

A

Drug used for systemic treatment of severe psoriasis

10-25 mg weekly

Taken by mouth

Folic acid often given to reduce risk of methotrexate toxicity

314
Q

Which defining features are there of methotrexate toxicity?

A

(1) Bone marrow suppression

(2) Liver damage

315
Q

What does the suffix ‘man’ on a drug name mean?

A

mab = monoclonal antibody

316
Q

What is adalimumab?

A

First fully human monoclonal antibody approved

317
Q

What is adalimumab used to treat?

A

(1) Rheumatoid arthritis

(2) Psoriatic arthritis

(3) Ankylosing spondylitis

(4) Crohn’s disease

(5) Ulcerative colitis

(6) Chronic psoriasis

318
Q

Which molecule does adalimumab inhibit?

A

TNF

319
Q

What effect does adalimumab have on the body?

A

Anti-inflammatory

320
Q

What is acne vulgaris?

A

(1) Cystic acne

(2) Pimples

(3) Zits

321
Q

How is acne vulgaris characterised?

A

(1) Comedones - blackheads/ whiteheads

(2) Papules - pinheads

(3) Nodules - large than a papule

(4) Cysts - cavity containing a fluid

322
Q

Where does acne vulgaris most commonly present?

A

(1) Face

(2) Shoulders

323
Q

How is acne vulgaris caused?

A

Hair follicles and sebaceous glands become obstructed with sebum and dead keratinocytes

Become infected with skin anaerobe

324
Q

What causes the formation of papule, nodules and cysts in acne vulgaris?

A

Rupturing of inflamed follicles

325
Q

What is the most common trigger for acne vulgaris?

A

Puberty - from surges in androgen

Stimulates sebum production + hyper proliferation of keratinocytes

326
Q

How does diet affect acne vulgaris?

A

It does not

327
Q

How many classifications of acne vulgaris are there?

A

3

328
Q

What are the classifications of acne vulgaris?

A

(1) Mild

(2) Moderate

(3) Severe

329
Q

What is the main aim of treatment for acne vulgaris?

A

Reduce sebum production

Reduce infection

Reduce inflammation

330
Q

How is mild-moderate acne vulgaris usually treated?

A

Topically

331
Q

How is moderate-severe acne vulgaris usually treated?

A

Systemic antibiotics

When topical has failed

332
Q

How is severe acne vulgaris usually treated?

A

Referral to dermatologist

May require isotretinoin (more aggressive therapy)

333
Q

What is azelaic acid?

A

Anti-microbial

Anti-comidonal (blackheads/ whiteheads)

334
Q

Give two examples of retinoids.

A

(1) Tretinoin

(2) Adapalene

335
Q

For which type of acne is systemic oral antibiotics used?

Give examples of the antibiotics used.

A

Moderate

Tetracycline/ doxycycline/ erythromycin

336
Q

How is severe acne vulgaris treated?

A

Oral isotretinoin

337
Q

What are some of the side effects of isotretinoin?

A

(1) Dryness of mucous membranes

(2) Depression

(3) Arthralgias

(4) Birth defects

(5) Hyperlipidaemia

338
Q

What is rosacea?

A

Skin condition affecting the middle third of the face

339
Q

What is rosacea most commonly mistaken for?

A

Acne

Due to pimples

340
Q

What are the symptoms of rosacea?

A

Persistent redness of face

Dilation of blood vessels under skin (appears as thread veins)

341
Q

How does rosacea compare in males and females?

A

More prevalent in women

Increased severity in men

342
Q

If left untreated, what can rosacea cause?

A

Progressive development

Affects eyes, ears, and nose

Can cause the nose to significantly disfigure

343
Q

What is rhinophyma?

A

Significant disfigurement of the nose

Often due to rosacea

344
Q

What causes rosacea?

A

Unknown

Could be genetic/ environmental

345
Q

Which medications have been linked with rosacea?

A

(1) Corticosteroids

(2) Vasodilators

346
Q

Will rosacea resolve itself without treatment?

A

Unlikely

347
Q

Will acne vulgaris resolve itself without treatment?

A

Most likely

348
Q

Do the skin treatments for acne vulgaris treat rosacea also?

A

Not usually

Can make rosacea worse

349
Q

What is the most common treatment for rosacea?

A

Topical metronidazole

350
Q

What effect does topical metronidazole have on rosacea?

A

Reduces inflammatory papule and pustules

351
Q

What effect does topical azelaic acid have on rosacea?

A

Reduces redness + inflammation

352
Q

When is isotretinoin used for treatment of rosacea?

A

Severe cases of rosacea

353
Q

What risk is there with isotretinoin treatment?

A

Teratogenic side-effects

354
Q

What is the treatment for rhinophyma?

A

Surgery

Laser/ electro surgery

355
Q

What is the advice for patients with rosacea?

A

(1) Wear protective suncream

(2) Protect face in winter

(3) Do not irritate face (mechanical/ chemical)

(4) Avoid alcohol

(5) Use products which are labelled as non-comedogenic

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