(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
2
Q
Does skin permeability vary?
A
Yes
3
Q
How much can skin permeability vary on the same body site between patients ?
A
Up to 40%
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
5
Q
In which ethnicity is melanoma skin cancer most and least prevalent?
A
Most = White/ Caucasian
Least = Black
6
Q
Is melanoma skin cancer more common in men or women in the UK?
A
Women
But same incidence in Asians
7
Q
What are the different skin type classifications?
A
(1) Normal
(2) Dry
(3) Oily
(4) Combination
8
Q
How is a skin type of a ‘combination’ classified?
A
Oily in T-zone
Dry/ normal elsewhere
9
Q
How is dermatology/ skin type most commonly classified?
A
Fitzpatrick skin scale
10
Q
What is the Fitzpatrick skin scale?
A
A classification scale for dermatology/ skin type
11
Q
What is the Fitzpatrick skin scale based on?
A
Skin response to UV therapy for psoriasis
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
13
Q
How many types of skin are there in the Fitzpatrick skin scale?
A
6
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
15
Q
How is ivory skin characterised?
A
Pale skin + light/ red hair
Prone to freckles
Burns easily + rarely tans
16
Q
How is beige skin characterised?
A
Fair skin + likely to have light hair
Blue OR brown eyes
Usually burns but gradually tan
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
18
Q
How is medium brown skin characterised?
A
Brown eyes + dark hair
Burns only with excessive exposure
Always tans easily
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
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
21
Q
Describe the sun protection of ivory skin.
A
Greatest risk of developing skin cancer
Needs to protect skin
Best protection from clothing
22
Q
Describe the sun protection of beige skin.
A
Greatest risk of developing skin cancer
Needs to protect skin
Best protection from clothing
23
Q
Describe the sun protection of light brown skin.
A
Should use protection in strong sunshine
24
Q
Describe the sun protection of medium brown skin.
A
Should use protection in strong sunshine
25
Describe the sun protection of dark brown skin.
Should use protection for long outside exposure
26
Describe the sun protection of very dark brown skin.
Should use protection for long outside exposure
27
Does a product being natural deem it safe?
No
e.g. botulism toxin (Botox)
28
Can natural products be patented?
Yes
But not usually
29
What is a benefit of a therapeutically ineffective natural remedy?
Placebo effect
30
Despite most often being used for bruising (amongst other things), what has been observed to be a benefit of arnica?
Mental/ emotional symptoms
Forgetfulness/ memory loss
Severe headaches
31
What is arnica applied topically for?
(1) Bruising
(2) Arthritis
(3) Oedema - due to fracture
(4) Inflammation - e.g. insect bites
32
What is Arnica flos?
The flower of the herb Arnica montana
33
How many phytochemicals have been identified in Arnica flos?
More than 150
34
What is a phytochemical?
Any biologically active compound found in plants
35
What are the main active constituents of arnica?
Sesquiterpene lactones
Other esters
36
What is sesquiterpene lactones?
Some of the main active constituents of arnica
37
What do sesquiterpene lactones do?
Affect inflammatory processes
Inhibit NF-kappaB + NF-AT
38
How do sesquiterpene lactones affect inflammatory processes?
Inhibit
NF-kappaB
NF-AT
39
What is NF-kappaB?
A transcription factor affecting inflammatory responses
Inhibited by sesquiterpene lactones
Influence the release of cytokines
40
What is NF-AT?
A transcription factor affecting inflammatory responses
Inhibited by sesquiterpene lactones
influence the release of cytokines
41
Define moiety.
A part of a molecule
42
Which compounds of sesquiterpene lactones exhibit stronger activity?
Unsaturated acetyl moieties
43
Which compounds of sesquiterpene lactones exhibit weaker activity?
Acetate derivatives
44
What is the significance of unsaturated acetyl moieties of sesquiterpene lactones in arnica?
Exhibit increased activity
45
What is the significance of acetate derivative moieties of sesquiterpene lactones in arnica?
Exhibit decreased activity
46
What is/ are the main permeant(s) of Arnica flos?
(1) 11-alpha, 13-dihydrohelenalin methacrylates ester
| (2) 11-alpha, 13-dihydrohelenalin tiglinate esters
47
How many main permeants of Arnica flos are there in humans?
Two
48
What effect does nicotinic acid have on the skin?
Produces reddening of the skin
Increases vasodilation
49
What effect does 0.1% betamethasone have on skin?
Blanching effect
Increase vasoconstriction
50
Do 0.1% betamethasone and nicotinic acid have the same effect on the skin?
No
Nicotinic acid causes vasoDILATION
0.1% betamethasone causes vasoCONSTRICTION
51
Describe the effect of nicotinic acid, in terms of concentration.
Concentration dependent
52
When is vasodilation observed following treatment with arnica?
3 hours after application
53
What effect does arnica have on blood vessels?
| vasodilation/ vasoconstriction
Vasodilation
54
What thoughts to consider does the effect of arnica on blood vessels raise, for the indication of bruising?
Causes vasodilation
Counter-intuitive, vasodilation would be expected for treatment of indication
55
How many of the phytochemicals in arnica have been observed to elicit a therapeutic effecft?
2/150
56
What should be considered when advising a patient on the use of a natural product?
(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?
57
How many different skin disorders affect adults and children?
69
58
How many people, on average, suffer from a skin disorder?
1 in 3
59
What are some of the most common skin disorders?
- Acne
- Rosacea
- Psoriasis
- Eczema
- Cancers
- Fungal infections
60
Name some important cancers of the skin.
(1) Basal cell carcinoma (rodent ulcer)
(2) Squamous cell carcinoma
(3) Malignant melanoma
61
What is the most common form of skin cancer?
Basal cell carcinoma (rodent ulcer)
62
What is another name for basal cell carcinoma?
Rodent ulcer
63
What is a rodent ulcer?
Basal cell carcinoma
64
Describe the malignancy of basal cell carcinoma.
Least malignant skin cancer
65
What percentage of Caucasians are expected to get basal cell carcinoma in their lifetime?
>30%
66
In what skin types is basal cell carcinoma most common?
(1) 1 - Ivory
| (2) 2 - Beige
67
In what skin types is basal cell carcinoma least common?
(1) 4 - Medium brown skin
(2) 5 - Dark brown skin
(Does not occur in very dark brown skin)
68
Where does basal cell carcinoma (rodent ulcer) most commonly present?
The face
| Rarely the ears
69
Describe the appearance of a rodent ulcer (basal cell carcinoma).
Shiny
Dome-shaped nodules
Later, develop central ulcer
70
What is telangiectasia?
Small visible blood vessels
71
What is the name given to small visible blood vessels?
Telangiectasia
72
How fast do basal cell carcinomas grow?
Relatively slow growing
73
What is the treatment for basal cell carcinoma (rodent ulcers)?
Surgical excision
74
What is the percentage of successful treatment of basal cell carcinoma?
>99%
75
When is radiotherapy used for basal cell carcinoma (rodent ulcers)?
For large superficial forms
76
When is cryotherapy used for basal cell carcinoma (rodent ulcers)?
For very superficial forms
77
What is the treatment for large superficial forms of basal cell carcinoma (rodent ulcers)?
Radiotherapy
78
What is the treatment for very large superficial forms of basal cell carcinoma (rodent ulcers)?
Cryotherapy
79
What drugs can be prescribed for basal cell carcinoma (rodent ulcers)?
(1) Fluorouracil
| (2) Imiquimod
80
What is squamous cell carcinoma?
A type of skin cancer
81
Where does squamous cell carcinoma arise?
From keratinocytes
In stratified squamous epithelium
82
Describe the appearance of squamous cell carcinoma.
Lesions
Red + scaly papules
Can ulcerate + bleed
83
Where does squamous cell carcinoma most often present?
On the head
- Scalp/ ears/ lower lip
Also hands + legs
84
Describe the growth of squamous cell carcinoma.
Rapid growth
Metastasises if not removed
85
What effect can immunosuppression have on squamous cell carcinoma.
Can allow growth of multiple tumours
86
What is the most common form of skin cancer on black skin?
Squamous cell carcinoma
87
What is the treatment for squamous cell carcinoma?
(1) Surgical excision
(2) Radiation therapy
Must be caught early
88
What is essential when treating squamous cell carcinoma?
Must be caught early
89
What is malignant melanoma?
Most dangerous type of skin cancer
90
What is the most dangerous form of skin cancer?
Malignant melanoma
91
Which type of skin cancer can occur in the eye?
Malignant melanoma
92
Where can malignant melanoma present, that other skin cancers cannot?
Eye
93
What percentage of all skin cancers does malignant melanoma account for?
Approximately 5%
94
What are the most important risk factors for development of malignant melanoma?
(1) History of childhood sun exposure
| (2) Positive family history
95
Which type of skin cancer is most resistant to chemotherapy?
Malignant melanoma
96
In which type of cell does malignant melanoma occur?
Melanocytes
| Wherever there is pigment
97
What percentage of malignant melanoma comes from pre-existing moles?
Approximately 30%
98
What is the estimated 5 year survival rate for black patients with malignant melanoma?
70%
99
What is the estimated 5 years survival rate for white patients with malignant melanoma?
94%
100
Where does malignant melanoma most commonly present in black, asian, and native Hawaiian patients?
Non-exposed skin with less pigment
e.g. soles, palms, mucous membranes, nail regions
101
What is the most common site of malignant melanoma in non-white patients?
Plantar portion of the foot
30-40% of all cases
102
In which patient groups are late-stage melanomas more prevalent?
(1) Hispanic
| (2) Black
103
What is the treatment of malignant melanoma?
Urgent + wide surgical excision + chemotherapy
Consider immunotherapy (IL-2)
104
What is the significance of a malignant melanoma lesion that is >4mm thick?
Chance of survival is poor
105
What is the advice given by pharmacists and healthcare professionals for prevention of development of skin cancer?
(1) Avoid sun exposure from 11am-3pm
(2) Wear a sun hat
(3) Application of a high protection suncream
(4) Reapply suncream regularly
106
What is the percentage increased risk of development of squamous cell carcinoma for those who have used tanning beds?
83%
107
What is the method used to recognise melanoma?
ABCD(E)
108
What does ABCD(E) stand for?
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
109
In which country is ABCD(E) used to diagnose melanoma?
USA
110
In which country is the Glasgow 7-point checklist of melanoma used?
UK
111
What is the standardised method of melanoma diagnosis in the UK?
Glasgow 7-point checklist of melanoma
112
What are the subtypes of the Glasgow 7-point checklist of melanoma?
(1) Major criteria
| (2) Minor criteria
113
How many major criteria are there in the Glasgow 7-point checklist of melanoma?
3
114
How many minor criteria are there in the Glasgow 7-point checklist of melanoma?
4
115
What are the major criteria in the Glasgow 7-point checklist of melanoma?
(1) Change in size
(2) Change in shape
(3) Change in colour
116
What are the minor criteria in the Glasgow 7-point checklist of melanoma?
(1) Diameter >6mm
(2) Inflammation
(3) Oozing/ bleeding
(4) Mild itch/ altered sensation
117
Is 'change in size' a minor or major criteria in Glasgow 7-point checklist of melanoma?
Major
118
Is 'change in shape' a minor or major criteria in the Glasgow 7-point checklist of melanoma?
Major
119
Is 'change in colour' a minor or major criteria in the Glasgow 7-point checklist of melanoma?
Major
120
Is a diameter of >6mm a major or minor criteria in the Glasgow 7-point checklist of melanoma?
Minor
121
Is inflammation a major or minor criteria in the Glasgow 7-point checklist of melanoma?
Minor
122
Is oozing a major or minor criteria in the Glasgow 7-point checklist of melanoma?
Minor
123
Is bleeding a major or minor criteria in the Glasgow 7-point checklist of melanoma?
Minor
124
Is a mild itch a major or minor criteria in the Glasgow 7-point checklist of melanoma?
Minor
125
Is altered sensation a major or minor criteria in the Glasgow 7-point checklist of melanoma?
Minor
126
What is the role of a community pharmacist in skin cancers?
Recognition of suspicious lesions/ moles etc
127
What is a dermatophyte?
A pathogenic fungus that grows on skin
128
What is candidiasis?
A pathogenic fungus
Thrush
129
How are fungal organisms identified in suspected fungal infections?
Microscopy
Culture of skin/ hair/ nail samples
130
How are fungal infections spread between infected humans?
Direct contact
131
Define tinea.
Medical term for ringworm
Used to describe skin mycoses
132
How are superficial dermatophyte infections named?
According to body site affected
133
What is Tinea capitis?
Ringworm on the scalp
134
What is Tinea corporis?
Ringworm on the body
135
What is Tinea cruris?
Ringworm on the groin
136
What is Tinea pedis?
Ringworm on the feet
137
What is ringworm of the scalp called?
Tinea capitis
138
What is ringworm of the body called?
Tinea corporis
139
What is ringworm of the groin called?
Tinea cruris
140
What is ringworm of the feet called?
Tinea pedis
141
In which patient group is Tinea capitis most common?
Children
142
What causes Tinea capitis?
(1) Microsporum
| (2) Trichophyton
143
How is Tinea capitis spread?
Close contact
144
What effect can hairdressers have on Tinea capitis?
Can spread indirectly accidentally
145
How can Tinea capitis be recognised?
Alopecia typically seen on head
Can be inflammatory
146
In which type of ringworm can alopecia be expected?
Tinea capitis
147
Where does Tinia pedis present?
In toe clefts
148
What is Tinia pedis also known as?
Athlete's foot
149
How does Tinia pedis present?
Red + scaly
Itchy
150
What can Tinia pedis lead to if not treated?
Fissures and maceration of the area
151
How can Tinea corporis be contracted?
From animals or humans
152
Which species of fungi is normally responsible for Tinea corporis?
Trichophyton
153
How does Tinea corporis present?
Scaly lesions
Clusters of round/ oval red patches
154
What is Tinea cruris also known as?
(1) Jock itch
(2) Gym itch
(3) Crotch rot
155
What is jock itch?
Tinea cruris
156
What is gym itch?
Tinea cruris
157
What is crotch rot?
Tinea cruris
158
How does Tinea cruris usually present?
Itching in groin
Itching in anus
Itching in thigh skin folds
159
What is the first line treatment for Tinea cruris?
Self-care
(1) Keep skin clean + dry
(2) Wear loose clothing
(3) Prevent further irritation from friction
(4) Apply a topical OTC antifungal
160
What should be done if Tinea cruris does not respond to self-care after two weeks?
See GP
161
What is onchomyosis?
Fungal nail infection
162
What is the treatment for onchomyosis?
Lacquers + paints
163
What is Tinea manuum?
Ringworm of the hands
164
What is ringworm of the hands called?
Tinea manuum
165
What is Tinea incognito?
A fungal skin infection which can be modified by a topical steroid treatment
Condition improves with steroid
Worsens again following treatment
166
What characterises Tinea incognito?
Condition improves with steroid but worsens after treatment cessation
167
What is the general treatment for tinea infections?
Topical
Broad-spectrum antifungals
e. g. imidazoles (clotrimazole or miconazole)
e. g. terbinafine
168
What is the treatment for Tinea pedis?
Terbinafine 1% cream/ spray
169
What is the treatment for Athlete's foot?
Terbinafine 1% cream/ spray
170
Why is terbinafine 1% cream/ spray used instead of imidazoles for Athlete's foot?
Cochrane review + trials support use
171
Why is terbinafine 1% cream/ spray used instead of imidazoles for Tinea pedis?
Cochrane review + trials support use
172
What is the treatment for Tinea capitis?
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
(1) When is ketoconazole shampoo recommended?
| (2) Who should use it?
(1) Tinea capitis infection
| (2) Infected individual + family for first 2 weeks
174
How are widespread fungal infections treated?
Oral antifungal therapy
e. g. terbinafine 250 mg OD
e. g. itraconazole 100 mg OD
Used for 1-2 months
175
What is the role of the pharmacist in fungal infections?
Advice on common Tinea infections
Referral to GP if oral therapy may be required, e.g. Tinea capitis
176
For which type of ringworm infection is GP referral likely?
Tinea capitis
Risk of scarring due to alopecia
177
What is epidermal differentiation?
Differentiation of basal cells to stratum corneum, regulated by enzymes
178
Which skin layer regulates water loss?
Stratum corneum
179
Which skin layer mediates hydrolytic enzymes?
Stratum corneum
180
What is NMF?
Natural Moisturising Factor
181
What is Natural Moisturing Factor (NMF)?
Endogenous breakdown product from filaggrin hydrolysis
Hygroscopic mixture
Includes amino acids
182
What are the components of Natural Moisturing Factor (NMF)?
(1) Amino acids
(2) Pyrrolidone carboxylic acid - PCA
(3) Lactic acid
(4) Urea
183
What is PCA?
Pyrrolidone carboxylic acid
184
What is the role of Natural Moisturing Factor (NMF)?
Maintains free water within the stratum corneum
185
Which processes are responsible for the maintenance of free water within the stratum corneum?
(1) Natural Moisturing Factor (NMF)
(2) Corneocyte maturation
(3) Desquamation
(4) Lipid biosynthesis
186
How does the stratum corneum exhibit biosensory function?
Responds to external humidity by regulating internal water content accordingly
187
How is Natural Moisturing Factor (NMF) produced?
(1) Profilaggrin is desphosphorylated to filaggrin
| 2) Filaggrin is hydrolysed to Natural Moisturing Factor (NMF
188
How is filaggrin produced?
Profilaggrin is dephosphorylated
189
What can be observed if too little Natural Moisturing Factor (NMF) is produced?
Dry skin
190
What is the role of Natural Moisturing Factor (NMF) in the stratum corneum?
(1) Flexibility
(2) Integrity
(3) Cohesion
(4) Hydration
(5) Buffers
191
How does Natural Moisturing Factor (NMF) act as a buffer?
When Natural Moisturing Factor (NMF) decreases, pH increases
192
What happens if insufficient filaggrin is produced?
(1) Corneocyte deformation
(2) Reduction in Natural Moisturing Factor - NMF
(3) Increase in skin pH
193
What is corneocyte deformation?
Flattening of surface skin cells
194
How can the activity of serine proteases be increased in the stratum corneum?
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
What can be observed if serine proteases in the stratum corneum are overactive?
Inflammation
196
How do serine proteases cause inflammation?
Serine proteases produce cytokines
Cytokines promote inflammation
197
Which cytokines do serine proteases produce?
(1) Interleukin-1a
| (2) Interleukin-1-beta
198
How common is loss-of-function in the filaggrin gene, as a percentage?
10% of the population
199
What are filaggrin mutations a risk factor for?
(1) Eczema
| (2) Allergies - e.g. asthma, rhinitis, peanuts
200
What percentage of all eczema presence in the population is due to a mutation of at least 1 filaggrin gene?
50%
201
What difference does a 20% increase of filaggrin in skin make in reduction of eczema?
40% reduction in risk of getting eczema
202
What role does filaggrin have in eczema?
Deficiency increases risk of eczema
Sufficiency decreases risk of eczema
203
What percentage of the population are approximated to have eczema?
10%
204
What are the common features of eczema?
Dry + flaky skin
Oedematous
Crusty
Itchy
205
What are the common features present in chronic eczema, that are not usually seen in acute eczema?
- Thickened skin
| - Lichenified skin
206
What percentage of childhood eczema clears up by adulthood, on average?
75%
207
What is meant by atopic march?
A typical sequence of immunoglobulin E (IgE) antibody responses
208
Which other medical conditions are associated with eczema?
Asthma (50% with atopic eczema get it)
Allergic rhinitis (75% with asthma get it)
209
What can trigger bouts of eczema?
(1) Internal inflammation
(2) Externally applied chemicals
(3) Humidity (environment)
210
How do the triggers for eczema cause eczema to arise?
Lead to an overproduction of proteases
Proteases break down corneodesmosomes
Breaks epidermal cohesion
Disrupts differentiation
211
What is a corneodesmosome?
Class of proteins
Hold corneocytes together
212
(1) What are the types of eczema?
| (2) Give examples of each
(1) Irritant/ allergic contact eczema
| 2
- Irritant: soaps, cleansers, garlic
- Allergic: Allergens
213
What is the treatment for eczema?
Emollients - maintain hydration of stratum corneum
Topical corticosteroids, e.g. 1% hydrocortisone cream
Sedating oral antihistamines - e.g. chlorphenamine
Avoid soap + irritating fabrics
214
What is the reason for an emollient in the treatment of eczema?
Main hydration of the stratum corneum
215
What is the reason for a topical corticosteroid in the treatment of eczema?
Reduce inflammation + itchiness
216
What is the reason for sedating oral antihistamines in the treatment of eczema?
Reduce scratching at night
217
What is the reason for avoiding soap in the treatment of eczema?
Soap dries the skin
218
What is the reason for avoiding wool fabrics in the treatment of eczema?
Irritates the skin
219
What is the reason for avoiding synthetic materials in the treatment of eczema?
Irritates the skin
220
What is a researched drawback in the recommendation of aqueous cream in treatment of eczema?
Contains 1% sodium lauryl sulphate (SLS)
221
What is sodium lauryl sulphate (SLS)?
A harsh anionic surfactant
222
Give an examples of a harsh anionic surfactant.
Sodium lauryl sulphate
223
What is SLS?
Sodium lauryl sulphate
Harsh anionic surfactant
224
What types of emollient are recommended in treatment of eczema?
Those without SLS - sodium lauryl sulphate
Recommend E45
225
How many finger tip units of topical corticosteroids should be recommended for eczema on the face?
2.5
226
How many finger tip units of topical corticosteroids should be recommended for eczema on the neck?
2.5
227
How many finger tip units of topical corticosteroids should be recommended for eczema on the entire arm?
4
228
How many finger tip units of topical corticosteroids should be recommended for eczema on the entire hand?
4
229
How many finger tip units of topical corticosteroids should be recommended for eczema on the entire leg?
8
230
How many finger tip units of topical corticosteroids should be recommended for eczema on the entire foot?
8
231
How many finger tip units of topical corticosteroids should be recommended for eczema on the front of chest and abdomen?
7
232
How many finger tip units of topical corticosteroids should be recommended for eczema on the back and buttocks?
7
233
How may applying multiple topical treatments together affect their absorption?
One could act as a permeation enhancer
OR act as another barrier to second drug
234
What is the current safest recommendation for order of application of a topical corticosteroid and an emollient, for the indication of eczema?
(1) Apply corticosteroid
(2) Wait an hour
(3) Apply emollient
235
What is seborrhoeic eczema?
Harmless scaling rash
Affects the scalp, eyebrows, ears, face, folds of underarms, groin
236
What is dandruff?
Seborrhoeic eczema of the scalp
237
What is pityriasis capitis?
Dandruff
Seborrhoeic eczema of the scalp
238
Is seborrhoeic eczema contagious?
No
239
Which patient groups are at increased risk of development of seborrhoeic eczema?
(1) Parkinson's - neurological disorders
| (2) Stroke patients - neurological disorders
240
What is the self-care advice for seborrhoeic eczema?
(1) Reduce exposure to allergens
(2) Keep cool
(3) Loose clothing
(4) Soap-free cleansers
241
What is the general treatment for seborrhoeic eczema in adults?
(1) Regular use of antifungal agents
| (2) Intermittent applications of topical steroids
242
What is the treatment for seborrhoeic eczema in infants?
Usually clears up within 6 months
Mild emollients
Hydrocortisone cream
Topical ketoconazole
243
How is seborrhoeic eczema on the scalp treated?
Medicated shampoos - containing ketoconazole - 2x/week for 4 weeks
244
Why are steroid scalp applications recommended for seborrhoeic eczema of the scalp?
Reduce symptoms
245
What are tar creams used for in seborrhoeic eczema of the scalp?
Applied to scaled areas
Removed with shampoo several hours later
246
What is the treatment of seborrhoeic eczema of the face, ears, chest or back?
(1) Cleanse affected areas 1-2x/day
(2) Ketoconazole cream OD for 2-4 weeks
(3) Hydrocortisone cream BD for 1-2 weeks
247
What is the treatment for severe seborrhoeic eczema of the face, ears, chest or back?
(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
What can eczema be mistaken for, as a serious mistake?
Systemic lupus erythematosus (SLE)
249
What is a classic symptoms of systemic lupus erythematosus (SLE)?
Butterfly rash on cheeks and nose
Can include trunk/ extremities
250
What can exacerbate the butterfly rashes seen systemic lupus erythematosus (SLE)?
Sunlight
Stresses that increase skin circulation
251
What are the symptoms of systemic lupus erythematosus (SLE)?
(1) Butterfly rash on cheeks + nose
(2) Non-specific joint pains (morning stiffness)
(3) Fatigue
(4) Rapid hair loss (regrows in remission)
252
How is systemic lupus erythematosus (SLE) contracted?
Genetic origin
253
What is psoriasis?
Chronic autoimmune disorder
254
How is psoriasis contracted?
Genetic predisposition
Other factors also required
255
In which ethnic group is psoriasis most common?
Caucasian
256
What is early onset psoriasis?
16-22 years old
257
What is late onset psoriasis?
55-60 years old
258
Is psoriasis more common in males or females?
No difference in incidence
Females tend to have early onset
259
How does psoriasis present?
Chronic
Scaling
Inflammation
Skin redness (skin types 1-4)
Skin greyness (skin types 4-5)
260
What factors can trigger psoriasis?
(1) Infection - can lower threshold for psoriasis
(2) Trauma
(3) Emotional stress/ anxiety
(4) Climatic factors - sunlight
(5) Certain drugs
261
Name some examples of drugs which can trigger psoriasis.
(1) ACE inhibitors
(2) NSAIDs
(3) Chloroquine
(4) B-blockers
(5) Lithium
(6) Alcohol abuse
262
What is the most common form of psoriasis?
Plaque psoriasis
>90% of all cases
263
How does plaque psoriasis present?
Scattered lesions
Raised + scaly
Often on knees, elbows, scalp
264
What is Guttate psoriasis?
Teardrop shaped
Numerous small + discrete patches
Commonly seen in the young
265
What percentage of patients with Guttate psoriasis spontaneously recover?
1/3
33%
266
What is flexural psoriasis?
Inverse psoriasis
Affects areas of skin-skin contact
Tends to occur later in life
267
Which type of psoriasis tends to occur in younger patients?
Guttate psoriasis
268
Which type of psoriasis tends to occur in older patients?
Flexural psoriasis
269
Give another name for flexural psoriasis.
Inverse psoriasis
270
Give another name for inverse psoriasis.
Flexural psoriasis
271
What is generalised pustular psoriasis?
Acute + severe eruption of superficial pustules
Reddening of the skin + high fever
Pustules do NOT contain bacteria, NOT caused by infection
272
When does generalised pustular psoriasis most commonly occur?
Following use of large quantities of steroid cream/ tablets
273
What is chronic pustular psoriasis?
Localised form of pustular psoriasis
Occurs on hands + feet
Reddening of skin + high fever
Severe eruption of superficial pustules
274
What is psoriatic arthritis?
Inflammatory joint disease
Usually affects small joints, e.g. hands/ feet
Skin changes before joint pain
275
What happens to the nails in psoriasis?
Pitting - small indentation
Onycholysis - lifting up of nails
Discolouration
Thickening
Crumbling
276
What percentage of patients with psoriasis experience nail changes?
25-50%
277
What is the purpose of psoriasis treatment?
Control + management
NOT cure
278
What are the potential options for treatment of psoriasis?
(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
What is dovonex?
Calcipotriol
280
What is an example of calcipotriol?
Dovonex
281
Give an example of a synthetic D3 analogue.
Calcipotriol - Dovonex
282
What are some examples of emollients?
(1) E45
| (2) Diprobase cream
283
What is the treatment for chronic psoriasis?
(1) Emollient
| (2) Steroid + vitamin D analogue
284
What is the most appropriate treatment for mild/ onset psoriasis?
Corticosteroids > calcipotriol
285
What is coal tar used for in the treatment of psoriasis?
Anti-inflammatory + anti-scaling properties
Crude coal tar most effective
286
What is salicylic acid used for in the treatment of psoriasis?
Used as a keratolytic
287
What is dithranol?
Drug used for the treatment of psoriasis
288
What is dithranol used for in the treatment of psoriasis?
To induce remission
Especially effective for chronic plaque psoriasis
Not to be used on the skin/ flexures
289
When can dithranol not be used?
On the face/ flexures
290
What are retinoids?
Drug used for the treatment of psoriasis
291
What are retinoids used for in the treatment of psoriasis?
Used topically for mild-moderate plaque psoriasis
292
Give an example of a retinoid.
0.05% tazarotene
293
Give an example of a vitamin A analogue
0.05% tazarotene
294
Which skin condition can phototherapy be used to treat?
Psoriasis
295
What methods of phototherapy can be used for treatment of psoriasis?
(1) UVB light
| (2) PUVA therapy
296
What is UVB light used for?
Treatment of psoriasis
297
What is PUVA therapy used for?
Treatment of psoriasis
298
What types of psoriasis can UBV light be used for?
Method of treatment of chronic stable psoriasis
Method of treatment for guttate psoriasis
299
When should UVB light be recommended?
(1) Stable/ chronic psoriasis
(2) Guttate psoriasis
(3) When topical treatment has failed
300
When is UVB light contraindicated?
Inflammatory psoriasis
301
What is PUVA therapy?
Combination of long-wave UVA radiation with psoralen
302
Where can patients receive PUVA therapy?
Dermatology centres
303
What does psoralen do?
Enhances effect of UVA
Usually taken 2 hours before UVA exposure
304
When is psoralen normally taken?
During PUVA therapy
2 hours before UVA exposure
305
What does PUVA therapy stand for?
P = Psoralen
UVA = Type of radiation
306
What is UVA?
Type of radiation used in phototherapy for treatment of psoriasis
307
For which type of psoriasis is PUVA therapy normally used?
Effective in most types of psoriasis
308
What happens if patients receive high doses of PUVA therapy?
(1) Skin ageing
(2) Risk of cataracts
(3) Skin cancer
309
When is systemic treatment of psoriasis required?
(1) Severe psoriasis
(2) Resistant psoriasis
(3) Unstable psoriasis
(4) Complicated psoriasis
ONLY under specialist supervision
310
What drugs are available for systemic treatment of psoriasis?
(1) Acitretin
(2) Cyclosporin
(3) Methotrexate
311
What is acitretin?
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
What is cyclosporin?
Drug used for systemic treatment of severe psoriasis AND severe eczema
Taken by mouth
313
What is methotrexate?
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
Which defining features are there of methotrexate toxicity?
(1) Bone marrow suppression
| (2) Liver damage
315
What does the suffix 'man' on a drug name mean?
mab = monoclonal antibody
316
What is adalimumab?
First fully human monoclonal antibody approved
317
What is adalimumab used to treat?
(1) Rheumatoid arthritis
(2) Psoriatic arthritis
(3) Ankylosing spondylitis
(4) Crohn's disease
(5) Ulcerative colitis
(6) Chronic psoriasis
318
Which molecule does adalimumab inhibit?
TNF
319
What effect does adalimumab have on the body?
Anti-inflammatory
320
What is acne vulgaris?
(1) Cystic acne
(2) Pimples
(3) Zits
321
How is acne vulgaris characterised?
(1) Comedones - blackheads/ whiteheads
(2) Papules - pinheads
(3) Nodules - large than a papule
(4) Cysts - cavity containing a fluid
322
Where does acne vulgaris most commonly present?
(1) Face
| (2) Shoulders
323
How is acne vulgaris caused?
Hair follicles and sebaceous glands become obstructed with sebum and dead keratinocytes
Become infected with skin anaerobe
324
What causes the formation of papule, nodules and cysts in acne vulgaris?
Rupturing of inflamed follicles
325
What is the most common trigger for acne vulgaris?
Puberty - from surges in androgen
Stimulates sebum production + hyper proliferation of keratinocytes
326
How does diet affect acne vulgaris?
It does not
327
How many classifications of acne vulgaris are there?
3
328
What are the classifications of acne vulgaris?
(1) Mild
(2) Moderate
(3) Severe
329
What is the main aim of treatment for acne vulgaris?
Reduce sebum production
Reduce infection
Reduce inflammation
330
How is mild-moderate acne vulgaris usually treated?
Topically
331
How is moderate-severe acne vulgaris usually treated?
Systemic antibiotics
When topical has failed
332
How is severe acne vulgaris usually treated?
Referral to dermatologist
May require isotretinoin (more aggressive therapy)
333
What is azelaic acid?
Anti-microbial
Anti-comidonal (blackheads/ whiteheads)
334
Give two examples of retinoids.
(1) Tretinoin
| (2) Adapalene
335
For which type of acne is systemic oral antibiotics used?
Give examples of the antibiotics used.
Moderate
Tetracycline/ doxycycline/ erythromycin
336
How is severe acne vulgaris treated?
Oral isotretinoin
337
What are some of the side effects of isotretinoin?
(1) Dryness of mucous membranes
(2) Depression
(3) Arthralgias
(4) Birth defects
(5) Hyperlipidaemia
338
What is rosacea?
Skin condition affecting the middle third of the face
339
What is rosacea most commonly mistaken for?
Acne
Due to pimples
340
What are the symptoms of rosacea?
Persistent redness of face
Dilation of blood vessels under skin (appears as thread veins)
341
How does rosacea compare in males and females?
More prevalent in women
Increased severity in men
342
If left untreated, what can rosacea cause?
Progressive development
Affects eyes, ears, and nose
Can cause the nose to significantly disfigure
343
What is rhinophyma?
Significant disfigurement of the nose
Often due to rosacea
344
What causes rosacea?
Unknown
Could be genetic/ environmental
345
Which medications have been linked with rosacea?
(1) Corticosteroids
| (2) Vasodilators
346
Will rosacea resolve itself without treatment?
Unlikely
347
Will acne vulgaris resolve itself without treatment?
Most likely
348
Do the skin treatments for acne vulgaris treat rosacea also?
Not usually
Can make rosacea worse
349
What is the most common treatment for rosacea?
Topical metronidazole
350
What effect does topical metronidazole have on rosacea?
Reduces inflammatory papule and pustules
351
What effect does topical azelaic acid have on rosacea?
Reduces redness + inflammation
352
When is isotretinoin used for treatment of rosacea?
Severe cases of rosacea
353
What risk is there with isotretinoin treatment?
Teratogenic side-effects
354
What is the treatment for rhinophyma?
Surgery
Laser/ electro surgery
355
What is the advice for patients with rosacea?
(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
