RTS - Dermatology Flashcards
The skin is the largest organ in the body, list its functions.
1) barrier
2) acting as a sensory organ
3) protects tissues
4) homoeostatic balance
Describe what emollients are and what they are used for.
1) Emollients are moisturising treatments applied directly to the skin to reduce the amount of water loss
2) they cover the skin and form a protective film
3) they help to manage dry or scaly skin conditions
4) they soften cracks in the skin
5) ease itching of the skin
outline the four different types of emollients
emollients are available as - creams, ointments, lotions or sprays, both oils and shower products
1) occlusive emollients- create a film over the skin to prevent water evaporating (diprobase)
2) Humectant-containing emollients- contain additives such as urea, propylene glycol and lactic acid to attract and hold water in the top layer of the skin (doublebase)
3) Antipruritic emollients- contain ingredients to prevent/combat itching (Eurax)
4) Antiseptic emollients- contain ingredients to combat/prevent infection (dermol)
Explain what topical corticosteroids are and what they are used for.
1) topical steroids are used to treat inflammatory skin conditions.
2) they reduce skin inflammation and skin irritation
3) they help induce remission during a flare up
hydrocortisone acetate 1% cream HC45, clobetasone butyrate 0.05% cream Eumovate.
describe how topical corticosteroids are classified and their side effects.
1) Mild, Moderate, Potent, Very potent (last 2 are prescription only). you want to use the least potient one to treat the condition.
side effects
1) skin thinning
2) skin more vulnerable to infection
3) skin changing colour
The skin is the largest organ in the body, list its functions.
1) barrier
2) acting as a sensory organ
3) protects tissues
4) homoeostatic balance
outline the restrictions to corticosteroid sale
patient factors
1) patient must be over 10 years (hydrocortisone), over 12 years (clobetasone)
2) not allowed in pregnancy/ breastfeeding
Treatment duration
3) applied TWICE a day, MAX 7 days use.
Pack size
4) can only sell 15g max at any one time.
site
5) cannot be used on face, anogenital, broken or infected skin.
Describe the application of a corticosteroid cream.
The finger tip unit
1) one FTU is the amount of topical steroid that is squeezed out from a standard tube along an adults fingertip.
2) a finger tip is from the very end of the finger to the first crease in the finger.
3) one FTU is enough to treat an area of skin twice the size of the flat of an adults hand.
Describe what Antifungals are and how they work.
1) killing the fungal cells: affecting the cell walls, causing the cells to leak out
2) prevent growth: prevent the fungal cells from reproducing.
available: cream, sprays, gels, powders
clotrimazole 1% canesten - athletes foot
Describe what emollients are and what they are used for.
1) Emollients are moisturising treatments applied directly to the skin to reduce the amount of water loss
2) they cover the skin and form a protective film
3) they help to manage dry or scaly skin conditions
4) they soften cracks in the skin
5) ease itching of the skin
outline the four different types of emollients
emollients are available as - creams, ointments, lotions or sprays, both oils and shower products
1) occlusive emollients- create a film over the skin to prevent water evaporating (diprobase)
2) Humectant-containing emollients- contain additives such as urea, propylene glycol and lactic acid to attract and hold water in the top layer of the skin (doublebase)
3) Antipruritic emollients- contain ingredients to prevent/combat itching (Eurax)
4) Antiseptic emollients- contain ingredients to combat/prevent infection (dermol)
list the possible causative reasons for a rash.
a rash is a symptom- it is not a disease
1) eczema
2) psoriasis
3) bacterial, viral or fungal infections
4) allergies
5) infestations
explain what Atopic eczema is and list some aggravating factors.
1) an allergic condition normally affecting infants and children. patients often have other sensitivities e.g asthma, hay fever. sensitisation occurs leading to an inflammatory response.
aggravating factors:
1) pollen, sweat, detergents/soaps, cosmetics, rubber and latex, dyes and colouring.
outline the presenting features of Atopic eczema
1) itching
2) redness
3) inflammation
4) papules
5) rash
6) dry skin
7) scaly skin
8) cracked skin
9) pruritus- itching sensation.
describe the treatment for Atopic eczema
1) emollient therapy- apply liberally
2) topical corticosteroid
- not for under 10 years
- not during pregnancy
- not for treatment on face
outline the referral criteria for Atopic eczema
1) treatment failure
2) presenting on the face
3) child
4) broken skin
5) pregnant or breastfeeding
red flag symptoms:
6) bleeding
7) weeping
8) infection (yellow crusts)
9) non-blanching rash.
describe the additional advice you would give to a patient suffering from Atopic eczema
1) avoid triggers
2) certain fabrics can irritate the skin , avoid these. wear : soft, fine-weave clothing or natural materials such as cotton
3) heat can aggravate eczema- keep rooms cool
4) avoid using soaps or detergents that affect your skin. use soap substitutes instead
describe what contact dermatitis is and list the parameters affecting the response.
1) inflammatory response of the skin after exposure to an irritant
2) an “agent” must penetrate the outer layer of skin - the stratum corneum
parameters affecting the response: ( All affect the severity of reaction)
1) type of irritant- acid
2) the concentration
3) quantity involved
4) length of exposure
this can occur with a single exposure , more commonly frequent exposures, the irritant accumulates on the skin.
list the aggravating factors for contact dermatitis
1) detergents/ soaps
2) cosmetics
3) rubber and latex
4) dyes and colouring
5) acid/ alkali - cement
6) jewellery - nickel
list the presenting features of contact dermatitis
1) itching
2) redness
3) Inflammation
4) papules
5) rash
6) dry skin
7) scaly skin
8) cracked skin
9) pruritis
Explain what topical corticosteroids are and what they are used for.
1) topical steroids are used to treat inflammatory skin conditions.
2) they reduce skin inflammation and skin irritation
3) they help induce remission during a flare up
hydrocortisone acetate 1% cream HC45, clobetasone butyrate 0.05% cream Eumovate.
outline the treatment options for contact dermatitis
1) emollient therapy
2) topical corticosteroid - not under 10 years, pregnant or breastfeeding, not for face.
3) remove the causative agent
describe the referral criteria for contact dermatitis
1) treatment failure
2) lesions on the face
3) child
4) pregnant/breastfeeding
5) broken / bleeding/ weeping skin
6) widespread
7) infection
8) red flag symptom - non blanching rash
outline the additional advice you would give to patients suffering from contact dermatitis
1) remove trigger
2) avoid scented/fragranced products
3) clean your skin
4) use protective clothing
5) change products
6) regular use of emollients
explain what psoriasis is, and where it commonly develops.
1) relapsing inflammatory disorder
2) lesions are present
3) can present at any time in life
4) rare in infants and uncommon in children
psoriasis develops:
5) at sites of skin trauma
6) at sunburnt areas
7) round cuts
8) during periods of stress.
symmetrical distribution - usually scalp, knees, elbows
outline the presenting features of psoriasis
1) characteristic “salmon pink” lesions
2) silvery-white scales
3) well defined boundaries
4) raised
5) large
6) redness
7) scaling
8) patches
9) plaques
10) history
11) long term
12) symmetry
outline the treatment options for psoriasis
pharmacist can be involved in diagnosis, suitably placed to refer patients, involved in treatment options. however treatment is likely to be initiated by doctor/dermatologist
1) emollients- alone or in conjunction with active therapy
2) coal tar based preparations- efficacious in management of psoriasis. e.g capasal- messy to use, can stain skin/clothing
3) keratolytics- incorporated into emollients. aid in clearing scale. Evidence vs practice , e.g. urea or salicylic acid.
explain the additional advice you would give to a patient with psoriasis
1) keep up with the treatment , if it feels better do not stop treatment
2) regular review with dermatology team
3) eating a healthy, balanced diet and exercising regularly can also relieve stress, which may help improve the psoriasis.
describe how topical corticosteroids are classified and their side effects.
1) Mild, Moderate, Potent, Very potent (last 2 are prescription only). you want to use the least potient one to treat the condition.
side effects
1) skin thinning
2) skin more vulnerable to infection
3) skin changing colour
The skin is the largest organ in the body, list its functions.
1) barrier
2) acting as a sensory organ
3) protects tissues
4) homoeostatic balance
describe what chicken pox is and its duration
1) classed as a childhood illness, caused by varicella- zoster virus
2) must prevent spread of infection- isolate patient, protect vulnerable patient groups
3) presents on the trunk
4) duration is 14 days , scabs from after 5 days
list the presenting features of chicken pox
1) rash
2) itchy spots
3) fluid filled blisters
4) fever
5) loss of appetite
6) aching body
7) trunk
outline the treatment options for chicken pox
1) pain - analgesic paracetamol
2) fever - antipyretic paracetamol
3) itching- antihistamines chlorphenamine, emollients aqueous cream, cooling gels poxclin
describe the referral criteria for chicken pox
1) infected blisters
2) pregnant/breastfeeding
3) immuno-suppressed patients
4) red flag symptoms- non blanching rash
outline the additional advice given to patients suffering from chicken pox
1) hydration- drink plenty of fluid to avoid dehydration
2) cool clothing- loose fitting, smooth, cotton fabrics are best and will help stop the skin from becoming sore and irritated.
3) wiping any objects or surfaces with a sterillising solution and making sure that any infected clothing and bedding is washed.
describe what shingles is
1) the same virus as chicken pox
2) infection of the nerves and skin
3) unilateral condition- one side of the body
4) painful rash
5) duration 2-4 weeks
explain the treatment options for shingles
1) pain- analgesics paracetamol, NSAIDs
2) fever- analgesic : paracetamol
3) rash - keep it clean , wear loose fitting clothing, use non-adherent dressing
outline the restrictions to corticosteroid sale
patient factors
1) patient must be over 10 years (hydrocortisone), over 12 years (clobetasone)
2) not allowed in pregnancy/ breastfeeding
Treatment duration
3) applied TWICE a day, MAX 7 days use.
Pack size
4) can only sell 15g max at any one time.
site
5) cannot be used on face, anogenital, broken or infected skin.
list the presenting features for shingles
1) burning
2) itching
3) fever
4) malaise
5) nerve pain
6) red blotches
7) blistering rash
outline the referral criteria fro shingles
early referral reduces;
1) antiviral treatment
2) neuropathic pain relief ( if required)
3) severity of symptoms
4) risk of complications
5) red flag symptoms- non blanching rash
Describe the application of a corticosteroid cream.
The finger tip unit
1) one FTU is the amount of topical steroid that is squeezed out from a standard tube along an adults fingertip.
2) a finger tip is from the very end of the finger to the first crease in the finger.
3) one FTU is enough to treat an area of skin twice the size of the flat of an adults hand.
describe the additional advice you would give to a patient suffering from shingles
1) hydration - drink plenty of water
2) cool clothing- loose fitting, smooth, cotton fabrics are best and will help stop the skin fro becoming sore and irritated
3) wipe any objects and surfaces with a sterilising solution and making sure that any infected clothing or bedding is washed regularly.
describe what ring worm is and the presenting features.
fungal infection- Tinea corporis
1) itchy
2) pink or red
3) scaly
4) raised
5) patches
6) inflamed
7) defined border
8) central clearing
outline the treatment options for ring worm
1) anti fungal topical preparations - clotrimazole 1% cream canesten. apply TWO or THREE times a day - max 14 days
explain the referral criteria fro ring worm
1) large areas of body
2) treatment failure
3) facial involvement
4) scalp and anogenital involvement
5) pregnant/ breastfeeding
6) red flag symptoms - non blanching rash
describe the additional advice given to patients suffering from ring worm
1) avoid sharing items - combs , towels, bedding
2) wash bed linen, pillow cases and towels on hot cycles
3) wash different peoples clothing separately
4) ensure every member washes hands
5) avoid scratching the affected area of your skin as it could spread infection to other parts of your body
describe what bites and stings are
initiation of an inflammatory response upon injection of the venom from animals, insects or plants.
more common in warmer climates , produce a localised reaction on the body.
list the presenting features of bites and stings
Bites
1) itchy , papules, weals, pain
stings
2) intense burning pain , erythema, oedema, systemic response- breathing difficulties
outline the treatment options for stings and bites
1) pain - analgesics paracetamol
2) itchiness- antihistamines oral tablet chlorphenamine (piriton), topical cream mepyramine (anthisan)
3) Wheals, swelling, erythema- topical corticosteroid hydrocortisone 1% cream
describe the referral criteria for stings and bites
1) intense swelling
2) bleeding
3) restriction to blood flow
4) insect or sting still present
red flag symptoms:
5) anaphylaxis- difficulty breathing, swelling lips
6) flu like symptoms- temperature, malaise
outline the additional advice given to patients suffering from bites and stings
1) move away slowly and don’t panic
2) cover exposed skin
3) wear shoes when outdoors
4) apply insect repellent to exposed areas of skin
5) avoid using products with strong perfumes
6) avoid camping near water
7) keep food and drink covered and windows closed.
Describe what Antifungals are and how they work.
1) killing the fungal cells: affecting the cell walls, causing the cells to leak out
2) prevent growth: prevent the fungal cells from reproducing.
available: cream, sprays, gels, powders
clotrimazole 1% canesten - athletes foot
describe what meningitis is
1) there are two types- bacterial meningitis and viral meningitis. bacterial is very serious and should be treated as a medical emergency
2) anyone can develop meningitis, however, babies and the young are at greater risk
list the presenting features of meningitis
1) have a high fever
2) vomit
3) feel agitated
4) become drowsy
5) grunt or breathe rapidly
6) unusual high pitched or moaning cry
7) have a stiff neck
8) dislike bright lights
9) have convulsions or seizures
10) have pale blotchy skin, and a red rash that doesn’t fade when a glass is rolled over it
11) have a tense, bulging soft spot on the head
describe the treatment options for meningitis
ACCIDENT AND EMERGENCY NOW!
describe what a melanoma is
1) type of cancer that begins in the skin
2) cells in the skin begin to develop abnormally
3) exposure to UV light fro natural or artificial sources may be responsible
explain what can increase your risk of developing melanoma
1) lots of moles or freckles
2) pale skin that burns easily
3) red and blonde hair
4) family member who has it
5) radiotherapy treatment
6) a condition that suppresses your immune system
7) medicines that suppress your immune system
8) a previous diagnosis of skin cancer
describe where melanomas commonly appear on the body
1) back , face , legs , arms - in the sun exposed areas
list the presenting features of melanomas
1) getting bigger
2) changing shape
3) changing colour
4) itchy or painful
5) bleeding or becoming crusty
when referring to melanomas explain what the acronym ABCDE stands for
Asymmetrical- melanomas have two very different halves and are an irregular shape
Border - notched or ragged border
Colours- mix of two or more colours
Diameter- larger than 6mm in diameter
Enlargement or elevation - a mole that changes size over time is more likely to be a melanoma
describe the treatment for melanomas
See the doctor
explain what cellulitis is
1) an infection of the deeper layers of the skin and the underlying tissue
2) the main symptoms are the skin suddenly turning red, painful swollen and hot
3) it affects the legs, but can occur anywhere
explain how cellulitis develops
1) cellulitis develops when bacteria or fungi move down through the skins surface through a damaged or broken area of skin. e.g cuts, burns, bites, eczema, athletes foot
2) having a skin condition can cause small breaks and cracks to develop in the surface of the skin, this makes a person more vulnerable to cellulitis.
list the presenting features of cellulitis
1) nausea and vomiting
2) shivering and chills
3) a general sense of feeling unwell
4) high temperature
5) rapid spreading of the area of redness
6) confusion
7) rapid heartbeat
8) rapid breathing
9) dizziness particularly when standing
describe the treatment options for cellulitis
depending on severity, see doctor today or A&E
