RTS - Skin 1 Flashcards by Samantha Hughes

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

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What bases are- creams, ointments, lotions (emollients)

Creams - water based, thicker
Ointments - oil based
Lotions - pourable, water based

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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

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what are topical corticosteroids?

used to treat inflammatory skin conditions - reduce skin irritation and inflammation. Help induce remission during a flare up

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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)

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What are the side effects of corticosteroids? (3)

skin thinning
vulnerable to infection
skin changing colour
(with long term use)

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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

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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.

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Indication Licensing for - hydrocortisone actetate 1% and clotbetasone butyrate 0.05% cream

hydrocortisone - on any inflammation/redness/stinging

Clobetasone - only for eczema and dermatitis

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How do topical antifungals work?

(a) killing the fungal cells - affect their cell walls and cells leak out
(b) prevent growth - prevent them reproducing

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Name examples of anti fungal treatments (4)

clotrimazole 1% - canesten
Ketoconazole 2% - daktarin intensiv
micronazole 2% - daktarin
Terbinafine 1% - lamisil

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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

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what symptoms are we looking out for/ asking about?

Rash
redness?
itchiness?
broken skin? 
inflamed?
hot to touch?
bleeding/ weeping?

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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

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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

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Common aggravating factors of eczema?

pollen, sweat, detergents, cosmetics, rubber, dyes

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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)

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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 ```