Skin Flashcards
What are the signs and symptoms of eczema (dermatitis)?
- Itching
- Vague an poorly defined borders
- Can be chronic inflammatory condition, but may be due to irritant… remove triggers!
What are the RED FLAGS for eczema (dermatitis)?
- Treatment failure
- Lesions on face (think difigurement)
- Widespread or severe
Signs of infection
* Bacterial- crusting skin? (oozing, yellow/green)
* Viral- blisters and bubbles (colourless weeping)
* Fungal- Flaking/circular lesions?
What is the treatment goal for eczema (deramtitis)?
Hydrate/ reduce imflammation where possible
What are the treatment options for eczema (dermatitis)?
In order of treatment steps
- Emollients, applied liberally e.g. hydromol
- Hydrocortisone 1%, applied sparingly BD for 7 days (aged >10)
- Clobetasone 0.05%, applied sparingly BD for 7 days (aged >12) e.g. EUMOVATE
Are the treatments available for eczema (dermatitis) safe for use in pregnancy?
Inadequate evidence of safety in human pregnancy. Topical corticosteroid use in animals is shown to cause abnormalities of foetal development, including cleft palate
Dermacort (hydrocortisone) should not be used in pregnancy
IF RTS, advise patient speak with GP
Important safety advice for treatment options for eczema (dermatitis)
- Do NOT apply to cracked or broken skin
- Do NOT supply if patient taking oral steroids e.g. prednisolone
- Ensure 45 minute gap between applying agents
What are the signs and symptoms of headlice?
and how would you definitively diagnose?
- Itching
- Sighting of shells and/or bodies
Only definitive diagnosis is through direct visual confirmation
What can
What are the treatment options for headlice?
Dimeticone lotion or spray e.g. Hedrin Once
- Treat whole head of hair and leave on overnight for 8 hours
- Wash off in morning
- Treat AGAIN in 2 WEEKS (imperitive as dimeticone only kills live lice)
Effectively suffocates (live louse) and lice can’t develp resistance to
What are the signs and symptoms of seborrheic dermatitis?
- Red, flaky and itchy rash on skin
- Affects greasier areas of skin e.g. face, scalp and chest
What is cradle cap?
Form of seborrheic dermatitis affecting babies scalps
What are the treatment options for cradle cap?
In order of treatment steps
- Topical emollient- to loosen scales, and brush off with shampoo
- Topical imidazole cream
* Clotrimazole 1% cream- apply BD-TDS for up to 4 weeks
* Miconazole 2% cream- apply BD up to 4 weeks
If symptoms persist longer than 4 weeks with treatment- seek specialist help
What are the treatment options for dandruff?
- Coal tar shampoo (Neutrogena Therapeutic shampoo)
- Zinc pyrithione
- Ketoconazole (Nizoral)
Leave in hair for a few minutes before washing off
What are the signs and symptoms of psoriasis?
- Areas of inflamed skin with scaly skin
- Commonly found on elbows, knees, forehead and less often on the back
Scales can help differentiate from dermatitis
What are the RED FLAGS for acne?
- Treatment failure
- Widespread or severe (e.g. cysts or nodules)
- Signs of infection
What are the treatment options for acne?
- Benzoyl peroxide (acnecide)- apply sparingly BD (avoid UV etc)
- Nicotinamide (Freederm 4% gel)- Apply sparingly BD
S/E can be drying of skin- reduce to OD if necessary
What are the signs and symptoms of scabies?
- Features very similar to eczema or psoriasis (difficult to diagnose)
- Commonly found in finger webs , under arms or other bodily crevices
- Intense itching
What are the RED FLAGS for scabies?
- Widespread or severe
- Signs of infection
What are the treatment options for scabies?
- Premethrine (e.g. Lyclear 5% cream)- apply once weekly for 2 doses over whole body and leave overnight. Wash off in morning
- Malathion (e.g. Derbac- M 0.5% liquid)- same as above
Where are each of these fungal infections found?
- *Tinea curis
- Tinea corporis
- Tinea pedis
- Tinea capitis*
- Groin
- General body
- Foot
- Head
What are the signs and symptoms of ring worm?
- Circular, flaky skin
- Can cause itching
What are the RED FLAGS for ring work/ fungal infections?
- Treatment failure
- Lesions on face
- Widespread or severe
- Signs of infection
What are the treatment options for fungal infections?
- Ketoconazole- apply BD (foot), OD/BD (non-foot)
- Clotrimazole 1%- apply BD/TDS
- Miconazole (e.g. Daktarin)- apply BD/TDS
For all ages - Terbinafine- apply cream OD/BD up to two weeks. Oral- 250mg OD for 2-4 weeks
Aged > 16
Continue treatment for up to 1 week after clearance of lesion
What are the treatment options for fungal nail infection?
When would you refer to GP?
- Amorolfine 5%- apply 1-2 times weekly for 6 months. Allow to dry for approx. 3 mins
File and clean nails before administration
Aged > 18
Referral:
* > 2 nails affected
* Diabetes
* Pregnancy
* Treatment Failure
What are the RED FLAGS for warts, corns and verucas?
- Treatment failure
- Lesions on face
- Widespread or severe
- Diabetics/ immunocompromised patients
- Corns causing pain when walking (best reviewed by GP or podiatrist)
- Signs of infection
What are the treatment options for warts, corns and verucas
- Silver nitrate pencil- apply moistened pencil tip every 24 hours. for up to 3 applications (warts) or 6 applications (verucas)
- Salicylic acid (e.g. Salactol)- apply daily, ma need to for up to 3 months
All ages
Which Herpes simplex virus causes coldsores and which causes genital herpes?
- HSV1- coldsores
- HSV2- genital herpes
What are the RED FLAGS for coldsores?
- Repeat infections
- Diabetic/ immunocompromised patients
- Lesions lasting > 14 days
- Severe or widespread
- Secondary infection
Can also spread to the eyes!
What are the treatment options for coldsores?
Aciclovir 5%- apply 5 times daily for 5 days
Avoid contact with eyes
What are SCC, BCC and MM?
- SCC- Squamous cell carcinoma
- BCC- Basal cell carcinoma
- MM- Melanoma skin cancer
Beware of complacency
Can also mimic other conditions
What are the RED FLAGS for skin lesions (Cancerous etc)?
A: asymmetrical?
B: Border jagged?
C: colour variation?
D: Diameter? Larger than a pencil rubber (6 mm)?
E: Evolving? Is this lesion different or changing?
- New lesion in patient > 60
- Immunocompromised patients
All referral criteria for assessment
Best methods to prevent skin lesions
PREVENTION!
- Suncream > SPF 30
- stay out of mid-day sun (10:00-14:00)
What are the signs and symptoms of chickenpox?
- Fever
- Headache
- Fatigue
- Red spots first appear on chest, face and back
- Decreased appetite
- Spots turn to itchy blisters
What are the treatment options for chickenpox?
- Oral antihistamines
- Paracetamol
- Calamine lotion or zinc oxide creams
Keep nails short!
What are the signs and symptoms of measles?
- Fever
- Red, inflamed eyes
- Runny nose
- Hacking cough and sore throat
- Kopliks spots inside the mouth
- Red, blotchy rash first appears on forehead
NOTE: the rash is often the LAST SIGN of measles
