Skin 1 Flashcards
Applications
Are usually viscous solutions, emulsions for application.
Collodions
Are painted on the skin and allowed to dry to leave a flexible film
Creams
Are emulsions of oil and water and are generally well absorbed into the skin. Creams are less great and easier to apply compared to ointments
Gels
Consist of API in a suitable hydrophilic or hydrophobic bases; they generally have a higher water content. Particularly suitable for face and scalp
Lotions
Have a cooling effect and maybe preferred for hairy areas.
Ointment
Are greasy preparations which are normally anhydrous and insoluble in water, and are more inclusive than water
Pastes
Are stiff preparation containing high proportion of finely powered solids such as zinc oxide and starch suspended in an ointment
Dusting powder
are used only rarely. They reduce friction between opposing skin surfaces. Dusting powders should not be applied to moist areas because they can cake and abrade the skin. Talc is a lubricant but it does not absorb moisture; it can cause respiratory irritation. Starch is less lubricant but absorbs water.
Quantities for specific areas of body
Face
Cream: 15-30g
Lotion: 100ml
Quantities for specific areas of body
Both hands
Cream: 25-50g
Lotion: 200ml
Quantities for specific areas of body
Scalp
Cream: 50-100g
Lotion: 200ml
Quantities for specific areas of body
Both arms or both legs
Cream: 100-200g
Lotion: 200ml
Quantities for specific areas of body
Trunk
Cream: 400g
Lotion: 500ml
Quantities for specific areas of body
Groin and genitals
Cream: 15-25g
Lotion: 100ml
What dose ACBS stand for?
Advisory committee on borderline substances
MHRA alert: fire risk with paraffin containing emollients
There is a danger that smoking or using a naked flame may cause a fire while emollients are in contact with their medical dressing or clothing.
Barrier preparations
contain a water repelamt
Nappy rash
change nappies frequently
expose to air
mild corticosteroid - no longer than a week.
Skin infections
cellulitis
systemic antibacterial
Staph aureus
e.g. flucloxacillin
Skin infections
impetigo
topical fusidic acid
mupirocin - MRSA
extensive or long standing - fluclox/clari
Skin infections Ring worm Tinea capitis Tinea Corporis Tinea cruris Tinea manuum Tinea pedis Tinea uguium
scalp, body, groin, hand, foot, nail
Imidazole antifungal - clotrimazole, ketoconazole, miconazole,
Skin infections
Pityriasis versicolor
Ketoconazole shampoo
is a common fungal infection that causes small patches of skin to become scaly and discoloured.
is caused by a type of yeast called Malassezi
Skin infections
Candidiasis
Imidazole antifungal - clotrimazole, ketoconazole, miconazole,
Nystatin
thrush
Angular cheilitis
miconazole
is inflammation of one or both corners of the mouth. Often the corners are red with skin breakdown and crusting.
Herpes simplex
Aciclovir
Suitable quantities of parasiticidal preparations
Scalp (head lice)
lotion/ cream rinse - 50-100ml
Suitable quantities of parasiticidal preparations
body (scapies + crap lice)
cream - 30-60g lotion - 100ml
scabies
Permethrin
Malathion
all members of household should be treated
head lice
Dimeticone - suffocates
Malathion - insectaside
MHRA: head lice eradication products: seroius risk of burns if treated hair exposed to open flame
Eczema
Skin dryness
Skin dryness and the consequent irritant eczema requires emollients applied regularly (at least twice daily) and liberally to the affected area;
Eczema
Mild corticosteroids
Mild corticosteroids are generally used on the face and on flexures; potent corticosteroids are generally required for use on adults with discoid or lichenified eczema or with eczema on the scalp, limbs, and trunk. Treatment should be reviewed regularly, especially if a potent corticosteroid is required. In patients with frequent flares (2–3 per month), a topical corticosteroid can be applied on 2 consecutive days each week to prevent further flares.
Eczema
Bacterial infections
(commonly with Staphylococcus aureus and occasionally with Streptococcus pyogenes) can exacerbate eczema and requires treatment with topical or systemic antibacterial drugs. Antibacterial drugs should be used in short courses (typically 1 week) to reduce the risk of drug resistance or skin sensitisation.
Lichenification
which results from repeated scratching is treated initially with a potent corticosteroid. Bandages containing ichthammol paste (to reduce pruritus) and other substances such as zinc oxide can be applied over the corticosteroid or emollient. Coal tar and ichthammol can be useful in some cases of chronic eczema.
A non-sedating antihistamine may be of some value in relieving severe itching or urticaria associated with eczema. A sedating antihistamine can be used if itching causes sleep disturbance.
psoriasis is provoked or exacerbated by drugs
lithium, chloroquine and hydroxychloroquine, beta-blockers, non-steroidal anti-inflammatory drugs, and ACE inhibitors. Psoriasis may not be seen until the drug has been taken for weeks or months.
treatment for chronic stable plaque psoriasis
vitamin D analogues, coal tar, dithranol, and the retinoid tazarotene.
Systemic treatments for psorasis
Pimecrolimus, tacrolimus - mild to moderate eczema
Corticosteroids for flare ups
Ciclosporin severe psoriasis and eczema
Methotrexate severe psoriasis
Etanercept adalimumab infliximab - tumour necrosis factor - severe plaque psoriasis
Secukinumab, ixekizumab interleukin-17A
Corticosteroid
suppress the inflammatory reaction during use; they are not curative and on discontinuation a rebound exacerbation may occur
Quanities of corticosteroids for specific areas face and neck both hands Scalp Both arms Both legs trunk Genitalia
15-30g 15-30g 15-30g 30-60g 100g 100g 15-30g
Corticosteroids in children
are particularly susceptible to side effects
Corticosteroids MHRA
rare risk of central chorioretinopathy with local as well as systemic administration
Hyperhidrosis
Excessive sweating Aluminium chloride potent antipersperant oxybutynin - limited evidence glycopyrronium - plantar and palmar areas Botox - botulinum toxin type A
Pruritis - cause
jaundice, endocrine disease, CKD, iron deficiency, malignant disease, skin condiditons - eczema, poriasis, scabies
Acne - mild to moderate
generally treated with topical preparations. Benzoyl peroxide Azelaic acid tretinoin erythromycin and clindamycin. nicotinamide
Acne - moderate to severe
Systemic treatment with oral antibacterials is generally used for moderate to severe acne or where topical preparations are not tolerated or are ineffective or where application to the site is difficult. Another oral preparation used for acne is the hormone treatment co-cyprindiol ( cyproterone acetate with ethinylestradiol); it is for women only.
Acne - severe
Severe acne, acne unresponsive to prolonged courses of oral antibacterials, scarring, or acne associated with psychological problems calls for early referral to a consultant dermatologist who may prescribe isotretinoin for administration by mouth.
Isotretinoin - counselling points
Isotretinoin is a toxic drug that should be prescribed only by, or under the supervision of, a consultant dermatologist. It is given for at least 16 weeks; repeat courses are not normally required.
Side-effects of isotretinoin include severe dryness of the skin and mucous membranes, nose bleeds, and joint pains. The drug is teratogenic and must not be given to women of child-bearing age unless they practise effective contraception (oral progestogen-only contraceptives not considered effective) and then only after detailed assessment and explanation by the physician. Women must also be registered with a pregnancy prevention programme.
Although a causal link between isotretinoin use and psychiatric changes (including suicidal ideation) has not been established, the possibility should be considered before initiating treatment; if psychiatric changes occur during treatment, isotretinoin should be stopped, the prescriber informed, and specialist psychiatric advice should be sought.
Rosacea
Rosacea is not comedonal (but may exist with acne which may be comedonal). Brimonidine tartrate is licensed for the treatment of facial erythema in rosacea. The pustules and papules of rosacea respond to topical azelaic acid, topical ivermectin or to topical metronidazole. Alternatively oral administration of oxytetracycline or tetracycline, or erythromycin, can be used; courses usually last 6–12 weeks and are repeated intermittently. Isotretinoin is occasionally given in refractory cases [unlicensed indication]. Camouflagers may be required for the redness.
Hirsutism drug SE
minoxidil, corticosteroids, anabolic steroids, androgens, danazol, and progestogens.
Warts and calluses
HPV
Wart - self limiting, salicylic acid, formaldehyde or silver nitrate, cryotherapy
