Skin

Question 1

What are ointments good for?

Answer 1

Greasy, more occlusive barrier and most hydrating

Question 2

What are creams useful for?

Answer 2

Less greasy, cosmetically acceptable, dries out quicker than ointments

Question 3

What are gels useful for?

Answer 3

High water content suitable for scalp and face

Question 4

Why are lotions useful?

Answer 4

Cooling effect

Large or hairy area

Can sting broken skin

Question 5

What needs to be known about excipients and sensitisation in skin formulations?

Answer 5

Patch test
Preparations containing salicylate can cause toxicity in neonates
Avoid benzyl alcohol in neonates as causes fatal toxicity syndrome

Question 6

What are emollients used for?

Answer 6

Mainstay treatment in eczema

Apply as often as required
Apply emollient in direction of hair growth
Apply after washing to maximise hydration

Question 7

What is the MHRA warning for emollients?

Answer 7

Clothes/dressings easily ignited by naked flame

Do not smoke

Question 8

What is the mechanism of action of topical corticosteroids?

Answer 8

Reduces inflammation in inflammatory skin conditions

Contraindicated in acne, rosacea, skin infections

Question 9

Which steroid creams are very potent?

Answer 9

Clobetasol - dermovate

Question 10

Which steroid creams are potent?

Answer 10

Betamethasone (0.1%) - betnovate

Hydrocortisone butyrate

Mometasone

Question 11

What are the moderate topical steroids?

Answer 11

Clobetasone (eumovate)

Betamethasone 0.025% (betnovate RD)

Question 12

What are the mild topical corticosteroids?

Answer 12

Hydrocortisone < 2.5%

Question 13

How do you apply topical steroids?

Answer 13

Apply thinly to affected areas no more than twice daily

Avoid prolonged use due to thinning and pigmentation

Emollient first the steroid 30 mins later

Question 14

How long is the treatment for rosacea?

Answer 14

6-12 week course. Repeat intermittently

Question 15

What is the MHRA warning for brimonidine?

Answer 15

Risk of systemic CV effects

Risk of exacerbation of rosacea

Question 16

What is used for rosacea treatment?

Answer 16

Topical - metronidazole, azelaic acid, ivermectin

Oral - oxytetracycline, tetracycline, erythromycin

Question 17

How long does effective contraception need to be used for while taking isotretinoin?

Answer 17

During, 1 month before and after treatment
POP is not effective contraception

Pregnancy test must be negative
Start treatment on 2nd or 3rd day of menstrual cycle

Seek urgent medical advice if you fall pregnant during treatment or up to 1 month after

Question 18

What are the other side effects of isotretinoin?

Answer 18

Teratogenic
Hyperglycaemia, hypertriglyceridaemia, high cholesterol, pancreatitis, hepatotoxicity 
Visual disturbances 
Skin peeling
Severe dryness of skin

Question 19

What is the MHRA advice for isotretinoin?

Answer 19

Erectile dysfunction

Decreased libido

Question 20

How do you manage isotretinoin side effects?

Answer 20

Risk of pancreatitis if triglycerides > 9mmol/L
- discontinue

Discontinue if severe skin peeling or haemorrhagic diarrhoea

Visual disturbances require expert referral

Question 21

What are the counselling points for isotretinoin?

Answer 21

Avoid during treatment and 6 months after - wax epilating, dermabrasion

Photosensitivity

Stop if psychiatric reactions