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Low Weighted Topics > Skin > Flashcards

Skin Flashcards

1
Q

Creams, gels, lotions, ointment, paste and dilutions

A

Creams - emulsions of oil and water, LESS greasy than ointments and easier to apply
Gels - higher water content, suitable hydrophilic/hydrophobic bases in active ingredient
Lotions - cooling effect, preferred if applying to hairy areas
Ointment - greasy, preparation, insoluble in water and are more occlusive than creams, can be combined with mixture paraffin
Pastes - contain high proportion of finely powdered solid, less occlusive than ointments
Dilutions - avoid to prevent microbial contaminations, if diluted don’t use more than 2 weeks

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2
Q

Emollients and barrier preparations

A

Smooth, smooth and hydrate the skin and indicated for all dry or scaly disorders
Apply frequently, apply in direction of hair growth (prevent folliculitis) and apply gayer washing or bathing (maximise hydration)

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3
Q

ACBS

A

Advisory committee on borderline substances
Responsible for advising NHS
On prescribing items specially formulated for medical conditions
E.g enteral feeds but can include toiletries and sun blocks

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4
Q

Emolllient bath and shower preparations

A

Emollient bath additive; e.g oilatum
Added to bath water ; use a clean spoon to prevent contamination
Soak in 10-20 mins to improve hydration
Some bath emollients can be applied to wet skin undiluted and rinsed
Avoid soap in dry skin conditions it will make it worse
Slipping hazard

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5
Q

Paraffin

A

MHRA fire risk hazard
With paraffin based skin emollients on dressings and clothing
Cover up, not to use smoke or be near naked flame
Change bedding regularly as they can soak up the sheets or mattress or bedding

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6
Q

Barrier preparations

A

Contain watery repellent substances, such as dimeticone or other silicones
Used on the skin around stomas, bedsores and pressure areas in the elderly

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7
Q

Nappy rash

A

1st line to change nappies regularly
2nd line antifungals - clotrimazole
Alternatively zinc oxide cream or ointment - titanium or bepanthen
Barrier methods ; sudo cream and above

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8
Q

Cellulitis

A

Draw line around to help track if it is growing
Need flucloxacillin or clarithromycin
Rapid spreading infection needs systemic treatment

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9
Q

Impetigo

A

Fusidic acid
Mupirocin
If long lasting or bad use antibiotics oral

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10
Q

Infected burn

A

Flamazine used - silver Sulfasalazine

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11
Q

Fusidic acid

A

Staph infections
Impetigo
Angular chelitis

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12
Q

Metronidazole

A

Rosacea
Anaerobic infections first choice

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13
Q

Antifungals treatment

A

Topical first line
1-2 weeks to prevent relapse
Systemic treatment by oral route if it doesn’t get better or if its necessary

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14
Q

Dermatophytoses

A

Ringworm - tines captitis
Body - tines corpora’s
Groin - tines cruris
Hand - tines monium
Foot - tine pedi a or atheletes foot
Nail - tines linguin

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15
Q

Pityriasis versicolor

A

Ketoconazole or selenium sulfide shampoo
Candidiasis - topical imidazole antifungals
Refractory candiadiasis requires systemic treatment e.g Fluconazole
Angular cheilitis - miconazole

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16
Q

Antivirals

A

Aciclovir cream for herpes simples or zoster
Apply early as possible - from signs of tingling
5 times a day
Penciclovir cream for herpes labialis
Systemic treatment if frequently recur - oral tablets

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17
Q

Scabies

A

Permethrin or malathion
Treat all house members at the same time
Apply to the whole body
Reapply if washed hands
Pay attention when applying to webs and fingers and toes
Itching - can lasts a few weeks after; can have antihistamine at night

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18
Q

Head lice

A

Dimeticone (hedrin) coats head lice
Interferes with water balance in lice
By preventing the excretion of water
Repeat after 7 days
Malathion (Derbac M)- alternative to dimeticone; NOT use if asthmatic or if hedrin not helped or allergic
Crab lice - refer

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19
Q

Eczema

A

Irritant, allergic contact, atopic, various and discoid
Atopic eczema is most common, dry skin
Can lead to infection and lichenification
Management; apply emollients regularly and liberally, keep using even if it gets better
Topical corticosteroids decided by severity and applying

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20
Q

Risk factor eczema

A

Genetics
Environment
Skin irritants
Extremes in temperature or climate
Lack of moisturising after bathing

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21
Q

The skin

A

Age - epidemiology of skin conditions various with age
Site - certain parts of the body linked with different aetiologies e.g warm, moist-areas ideal for fungal growth
Number of lesions - allows to determine extent of problem and rule out certain aetiologies e.g most bacterial infections confined to a specific area
Characteristics; shape, edge, colour, secondary features
Distribution patterns - e.g excess likely inside of joints, psoriasis on outside
Associated symptoms; itching, pain, discomfort

22
Q

Characteristics

A

Flat <0.5 cm; macula
Flat >0.5 cm; patch, plaque
Raised <0.5 cm; papule, vesicle and pustule
Raised >0.5 cm; nodule, bulla
Shape; circular, linear, annular, irregular
Edge; well-demarcated, ill defined
Colour; erythematous, depigmented, pigmented
Secondary features; crusted, scaly, lichenified, eroded, fissured, ulcerated

23
Q

Infection

A

Lichenification - potent corticosteroid needed
Excessive rubbing and itching leading to thick, leathery patches of skin
Non-sedating antihistamines to itching
A sedating antihistamines to help sleep
Exudative ‘weeping’ - potent corticosteroid
Severe refractory eczema - phototherapy

24
Q

Seborrheic dermatitis (cradle cap)

A

Yeast infection
Very common in infants usually before 6 months,
Yellow scale/crusts on the scalp; greasy to touch
Self-limiting and does not cause the baby any itching or distress, not contagious
1st line; topical emollient; olive or veg oil massaged to loosen the scales, brush with soft brush and wash with shampoo, thicker scales to be soaked overnight and washed in morning
2nd line - clotrimazole 1% cream or miconazole 2%
REFER; secondary infection (caused by picking), self management/OTC failure

25
Q

Eczema and psoriasis drugs affecting the immune response

A

Used to treat eczema and psoriasis
Under specialise supervision
Pimercrolimus or tacrolimus used for atopic eczema or psoriasis
Methotrexate in severe cases of psoriasis with folic acid

26
Q

Psoriasis

A

Worsened by; lithium, hyrdroxychloroquinine, BBS, NSAIDS and ACEI
Emollients used as adjuvant
Can be used for plaque psoriasis
Scalp psoriasis use tar based shampoo
Mild to moderate corticosteroid; facial, flexible and genital psoriasis
Calcitriol for long term treatment
Coal tar for chronic plaque psoriasis; anti scaling properties

27
Q

Topical corticosteroids

A

Treat inflammatory skin conditions
When emollients are ineffective
Not recommended for acne
Can cause rebound withdrawn
Can cause skin thinning if overused

28
Q

Choice of formulation steroid

A

Apply thinly no more than BD
Avoid prolonged use especially on face
Emollient is applied first wait half an hour then apply steroid for max absorption
Urea/salicylic acid increase penetration of the steroid
Occlusive polythene or hydrocolloid dressing increase absorbtion

29
Q

Mild potency steorid

A

Mild - hydrocortisone 0.1 % to 2.5 %
Dioderm, mildison
Generic

30
Q

Mild potency steroid with Antimicrobials

A

Canesten HC
Fusidic H
Timodine

31
Q

Moderate steroid

A

Betamethasone 0.025% - betnovateRD
Clobetasone butyrate 0.05% - eumovate / clobavate
Fluocinolone acetonide 0.001% - synalar 1 in 4 dilution

32
Q

Moderate with Antimicrobials steroid

A

Trimovate

33
Q

Moderate steroid with urea

A

Alphaderm

34
Q

Potent steroid

A

Betamethasone vale rate 0.1% - betnovate
Fluticasone propionate 0.05% - cutivate
Hydrocortisone butyrate 0.01% - locoid
Mometasone furoate 0.1% - elcon

35
Q

Potent with anti microbial steroids

A

Synalar C
Sylvaner N

36
Q

Potent with salycilic acid steroid

A

Diprosalic

37
Q

Very potent steroid and very potent steroid with Antimicrobials

A

Dermovate - clobetasone propionate

Dermovate NN

38
Q

Acne

A

Tetracycline systemic if topical doesn’t help
Minocycline has greater risk of lupus erythematosus like syndrome
Trimethoprim if acne resistant
Diannete (co-cyprindiol)
Oral retinoids

39
Q

Isotretinoin

A

Reduced sebum secretion and used for systemic treatment of severe acne
Consultant dermatologist - new rule under 18 need 2 dr
For at least 16 weeks
MHRA; rare reports erectile dysfunction and decreased libido
S/e; severe dryness of the skin and mucous membranes, nose bleeds,
Teratogenic and must be given to women as last resort with effective contraction PPP
Prescription valid for 7 days from negative test, can dispense 30 caps
Avoid; UV sunlight, avoid during 6 months after; dermabrasion and waxing
Stop if psychiatric reaction occur

40
Q

Rosacea

A

Brimonidine - mirvasc (MHRA; risk CVD effects, can exacerbate rosacea; apply small then increase)
Low dose doxycycline
6-12 week course

41
Q

Pustules and papules

A

Topical - metronidazole azelaic acid, ivermectin
Oral - oxytetracyline, tetracycline, erythromycin

42
Q

Rubella

A

German measles
RNA virus and spread by close personal contact or airborne droplets
Less infectious than measles and symptoms usually less severe
Prodromal period of up to 5 days; cold symptoms, fever, swollen glands, aching joints
Pinpoint macular rash; red pink rash with small spots
Treatment; improves with 7-10 days, simple analgesics

43
Q

Mumps

A

Raised temperature, headache and joint pain, swelling at side of face and under ears, distinctive ‘hamster face’
Refer to GP - notifiable disease
Simple analgesia for relieve pain
Complications; rare, viral meningitis, inflammation of other organs (reproductive), infertility

44
Q

Measles

A

Most dangerous childhood virus, serious complications more common
Respiratory conditions such as pneumonia occur in 7% cases
Encephalitis in 1 in every 600-1000
Self limiting; red blotchy rash around ears and face first then spread to trunk and limbs
Paramyxovirus spread by droplet inhalation
Prodromal symptoms 4-5 days before rash appears; URTI, conjunctivitis and small red spots inside mouth (koplik spots)

45
Q

Chickenpox

A

Varicella zoster virus
Droplet infection
10-20 day incubation and ineffective for 7 days after vesicles appeared and until crusted
Fever, headache, sore throat, off food, grizzly
Red lumps appear rapidly develop into vesicles - crus over in 3-5 days rash is very itchy
Advice; hydrated, short fingernails and clean, cotton clothing, dress appropriately
Calamine lotion and chlorphenamine to help itch
Paracetamol for pain
Aciclovir for immunocompromised

46
Q

Wart and verruca

A

Both small, rough non-cancerous lumps of skin caused by HPV virus
Excessive keratin in epidermis
Highly contagious
Verruca; plantar war; black dot in centre of white lump = blood vessel
Treatment not 100% effective, mostly harmless, take years to go away
Salicylic acid; OTC limited evidence, bazuka (has lactic acid as well)
Cyrotherapy
Advice; dont bite, pick or scratch at warts as will cause ‘autoinoculation’
Refer; bleed, changed appearance or spread, pain, distress or embarrassment diabetic patients, poor circulation such as peripheral vascular disease

47
Q

Scalp psoriasis

A

Silver plaque is indicator
Reduce weight and alcohol intake

1st like - topical corticosteroid OD for 4 weeks
2nd like trial alternative formulation of potent topical corticosteroid e.g shampoo or moose) and / or topical agent remover or softener
3rd line Betamethasone in combination with calcipotriol (vitamin D analogue)
4th very potent steroid BD for 2 weeks OR coal tar or Refer

48
Q

Types of eczema

A

Irritant
Allergic contact
Atopic
Venous
Discoid

49
Q

What shouldn’t be given in chickenpox

A

Ibuprofen

50
Q

Ring worm treatment

A

Miconazole 2%

Low Weighted Topics (13 decks)

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