RTS - Skin 1 Flashcards
what are emollients?
applied directly to the skin to reduce water loss - keep moisture.
They form a protective film and help manage dry, itchy skin conditions
Soften cracks in skin
What bases are- creams, ointments, lotions (emollients)
Creams - water based, thicker
Ointments - oil based
Lotions - pourable, water based
what are the 4 types of emollients?
- occlusive - film over skin to prevent water evaporation (moisture) - diprobase
- humectant containing - contain additives e.g urea, lactic acid, propylene glycol that holds water in the skin = double base
- antipruritic - contains ingredients to stop itching = Eurax
- antiseptic = contains ingredients to combat infection = dermol
what are topical corticosteroids?
used to treat inflammatory skin conditions - reduce skin irritation and inflammation. Help induce remission during a flare up
Name 2 examples of topical corticosteroids
- hydrocortisone acetate 1% cream - HC45 (used for anything)
- Clobetastone Butyrate 0.05% cream - eumovate. (only licensed for use in eczema/dermatitis, NOT redness/stinging)
What are the side effects of corticosteroids? (3)
skin thinning
vulnerable to infection
skin changing colour
(with long term use)
what are the legal restrictions imposed on the sale of topical corticosteroids?
- PATIENT: patient must be >10 years for hydrocortisone, >12 years for clobetasone. Cannot be used in pregnancy/BF
- Maximum of 7 days use and only applied twice a day
- Can only sell a maximum of 15g at any one time
- Cannot be used on - face, anogenital, broken or infected skin
How are topical corticosteroids applied?
The finger tip unit - One FTU is the amount of steroid squeezed out from a standard tube along the adults fingertip = very end of the finger to the first crease.
One FTU is enough to treat an area the size of the flat of an adults hand.
Indication Licensing for - hydrocortisone actetate 1% and clotbetasone butyrate 0.05% cream
hydrocortisone - on any inflammation/redness/stinging
Clobetasone - only for eczema and dermatitis
How do topical antifungals work?
(a) killing the fungal cells - affect their cell walls and cells leak out
(b) prevent growth - prevent them reproducing
Name examples of anti fungal treatments (4)
clotrimazole 1% - canesten
Ketoconazole 2% - daktarin intensiv
micronazole 2% - daktarin
Terbinafine 1% - lamisil
Name the different formulations of antifungals and why there are different ones
Sprays, creams, gels, powders
they can be used in different areas e.g athletes foot, some people may not be flexible enough to put cream on their feet so a spray is a more convenient way
what symptoms are we looking out for/ asking about?
Rash redness? itchiness? broken skin? inflamed? hot to touch? bleeding/ weeping?
General referral points for - rashes/eczema/dermatitis
signs of infection e.g yellow crusts on face children / pregnancy/ BF bleeding, weeping non blanching rash broken skin widespread
what is eczema?
Allergic condition - usually infants and children. They often have other sensitivities e.g hay fever and asthma.
Sensitisation cocues leading to an inflammatory response
Common aggravating factors of eczema?
pollen, sweat, detergents, cosmetics, rubber, dyes
Treatments for eczemA? and contact dermatitis
1- emollient use whenever -
2- topical corticosteroid twice a day for 7 days
(CD = remove the causative agent also)
lifestyle advice for eczema?
avoid triggers
avoid fabrics that can irritate the skin and wear soft fine weave/cotton
keep cool as heat aggravates
avoid soaps / detergents that can irritate
use soap substitutes e.g dermol that are unperfumed
what is contact dermatitis?
inflammatory response of the skin after exposure to an irritant - the severity of response depends on - type of irritant, the concentration, quantity and length of exposure
Symptoms of eczema and contact dermatitis
itching redness inflammation papules (contact = usually red around the area of contact)
what is psoriasis
relapsing inflammatory disorder - lesions, can present at any time in life but not common in infants and children.
It develops at sights of skin trauma, sunburnt areas, around cuts and stress
what is the location and symptoms of psoriasis?
usually symmetrical distribution - scalp, knees, elbows
Salmon pink lesions/silvery white scales, defined boundaries, usually a history of It
What are the OTC treatments for psoriasis?
ideally treatment should be initiated by Dr. But there are:
(a) emollients - moisturise
(b) coal tar based - management, capasal, cocos, T/Gel
(c) keratolytics - clearing, not much evidence, contains salicylic acid and urea
Lifestyle advice for psoriasis
keep up with treatment even if it feels better
regular dermatology reviews
healthy eating and exercise and stress relief
referral signs for psoriasis
extensive lesions infected first time having hair loss abnormal lumps bleeding pregnant/bf
what is chicken pox?
common childhood illness - varicella zoster virus, very contagious.
Present on the trunk, scabs form after 5 days and lasts around 14 days
Symptomatic treatments for chicken pox
pain - analgesic, paracetamol
fever- anti-pyretic - paracetamol (calpol)
itching - anti histamines (chlorphenamine - piriton), or cetirizine.
emollients e.g eurax
cooling gels e.g poxclin, viraschoothe, - keep In moisture
but they are expensive and usually paracetamol is best and will go alone in 14 days
referral signs for chicken pox
infected blisters
pregnancy/BF
immunocompromised
non blanching rash
lifestyle advice for chicken pox and shingles?
hydration
cool clothing - loose, cotton - stops it getting sore and irritated
stop the virus from spreading - sterilising, hygiene, wash clothes/bedding, don’t share towels
what is shingles?
same virus as chicken pox - infection of nerves and skin - unilateral condition and painful
duration is 2-3 weeks
symptoms= burning, fever, malaise, nerve pain, blistering rash/red patches, crescent shape - radiates from ribcage down to belly button
symptomatic treatment for shingles
pain - analgesics, para or NSAIDS - neuropathic meds to target nerves
fever - anti-pyretic = para
rash - keep it clean, loose, non adherent dressings over it to not stimulate the nerves
referral of shingles?
early referral is important as it reduces:
1- time to treatment - antiviral meds (aciclovir) and neuropathic pain relief
2- reduces severity of symptoms
3- reduces the risk of complications eg. in immunocompromised etc
what is ringworm?
not a parasite- a fungal infection - Tinea corporis -
itchy, pink red raised patches, inflamed, ring border
treatments for ringworm
Antifungal topical - clotrimazole 1% cream (canesten) apply 2-3 times a day, max 14 days
lifestyle advice for ringworm
don’t share personal items - contagious
wash bed linen and clothes at high temperatures and wash separately to other peoples
hygiene - wash hands
avoid scratching as could spread
symptoms of bites
itching
papules
weals - red and angry
pain
symptoms of stings
intense burning pain
erythema (redness)
oedema (swelling)
systemic response e.g if allergic to bee stings -anaphylaxis
treatments for bites and stings
Pain= - analgesic - para Itchiness = antihistamines Oral tablet - chlorphenamine (piriton) Topical cream - mepyramine (anthisan) DO NOT USE TOGETHER
Weals/swelling/redness = topical corticosteroid hydrocortisone 1% cream
referral for bites and stings
intense swelling bleeding restriction of blood flow insect still present in skin anaphylaxis = breathing difficulties, swelling of the lips/mouth temperature, malaise
Symptoms of meningitis (bacterial)
high fever seizures non blanching rash (tumbler test) drowsy light sensitivity stiff neck grunting fontanelle
REFER TO A&E STRAIGHT AWAY.
What is melanoma?
skin cancer - cells in the skin develop abnormally, usually due to exposure to UV light, there are also factors that increase the risk e.g moles, freckles, light hair, family history, previously sunburnt, immunocompromised / immunosuppressants medication
REFER
what is the model for detecting symptoms of melanoma?
ABCDE MODEL
A = asymmetrical - 2 very different halves and irregular shape
B = border, notched, ragged
C = colours - mix of 2 or more coloures
D = diameter, larger than 6mm
E = enlargement or elevation - mole size changes
what is cellulitis?
infection of the deeper layers of the skin and underlying tissue - bacteria or fungi move down through the skin surface through a damaged area (cuts, bites, athletes foot) - causes small cracks
Symptoms of cellulitis?
Nausea, vomiting, shivering, malaise unwell fever of 38 degrees or more Confusion dizziness skin turns red, painful, swollen and hot
