Skin

Question 0

Even though cradle cap is self limiting, it can be treated. How?

Answer 0

Daily use of baby shampoo followed by gentle brushing. Apply olive oil to the scalp, leave overnight and wash out with baby shampoo in the morning. Can try a cradle cap shampoo.

Question 1

What is cradle cap?

Answer 1

It is infantile seborrhoeic dermatitis. It is large, yellow, greasy scales and crusts on the head. Usually appears in first months of life. Cause is unknown - maternal hormones causing increased sebum production?

Usually affects scalp but can spears to FACE and NAPPY AREA.

Cure - self limiting - clears up in a couple of months.

Differential diagnosis - cradle cap DOES NOT ITCH.

Question 2

Non-pharmacological advice for cradle cap?

Answer 2

Never pick scales and crusty bits - risk of secondary bacterial infection.

Out an extra sheet over the coffee mattress if leaving olive oil on hair overnight - can get messy.

Cradle cap is normal don’t worry. It is not a sign of poor hygiene and it is not infectious!

Question 3

When to refer cradle cap?

Answer 3

• if the baby is itching.
• if the baby appears fractious and miserable - could be atopic eczema.
• if OTC treatment have failed.
• if scales have spread from the scalp - May need anti fungal cream from GP.

Question 4

What is seborrhoeic dermatitis in adults?

Answer 4

Rash is distributed where there is a high number of sebaceous glands - central part of face, scalp and mid chest.

Can be confused with psoriasis but psoriasis rarely affects eyebrows and eyelids.

Question 5

Treatment for seborrhoeic dermatitis?

Answer 5

Treat like with dandruff
Zinc pyrithione 
Selenium 
Ketoconazole 
Refer if seborrhoeic dermatitis is on the face and torso.

Question 6

Treatments for psoriasis?

Answer 6

Salicyclic acid (keratolytic)
Coal tar
Dithranol

Question 7

Cautions for supplying corticosteroids for skin conditions.

Answer 7

Age - not for under 10 for hydrocortisone, not under 12 for clobetasone.
Should not be used on the face, ano-genital region and on weeping/broken/infected skin - can reduce immune response.
Can’t be used for more than 7 days.
Should not be used OTC in pregnant women.
However can be prescribed for children and on the face by doctor.

Question 8

When applying a corticosteroid and emollient, which can be applied first?

Answer 8

Does not matter which is applied first but leave 15 minutes between each application.

Question 9

How much hydrocortisone must be applied?

Answer 9

Fingertip unit - from the tip of the index finger to the first crease. Reduce amount for children.
Apply in direction of hair growth.

Question 10

How must an emollient be used?

Answer 10

Apply it liberally and often, replace it with soaps and continue to use it even after eczema to prevent flare-ups.

Children should use 250g a week, be careful in bath because oil is slippery. Fire risk with emollients containing paraffin.

Question 11

What is the difference between irritant and allergic contact dermatitis?

Answer 11

Irritant - arises first time skin is exposed to irritant. Mostly seen on hands and arms. Exception is nappy rash - irritation due to detergent in reusable nappies.

Allergic - reaction to something most people will tolerate. Needs repeated exposure (sensitisation). Rash can appear away from the site of contact.

Question 12

What is impetigo?

Answer 12

Contagious bacterial infection on skin which causes sores and blisters.

Question 13

What is scabies?

Answer 13

Tiny mites burrow into the skin causing intense itching and is worse at night. Skin rash caused by long periods of skin contact or sexual contact with an infectious person.

Can be spread by sharing clothing, towels and beddings.

Question 14

What is a comedone?

Answer 14

A papule that is plugged with keratin and sebum.

Question 15

What is a pustule?

Answer 15

A pus filled lesion less than 1cm in diameter (called a whitehead in acne - filled with neutrophils).

Question 16

What is a nodule?

Answer 16

A raised solid lesion greater than 1cm in diameter.

Question 17

What is a papule?

Answer 17

A raised solid lesion less than 1cm in diameter.

Question 18

What do you need to know about individuals requesting for products to treat acne?

Answer 18

Severity
Age of onset
Any medication tried?
Other symptoms? WHAM

Question 19

Which kind of acne can be treated OTC?

Answer 19

Mild acne - acne vulgaris.

Question 20

What is the first line of treatment for acne?

Answer 20

Recommend benzoyl peroxide (4% lowest strength) and increase if needed. Apply thinly, once daily or on alternate days - can increase frequency to max twice daily.

Benzoyl peroxide - permanently bleach clothing - wash hands.
It can also irritate the skin.

Question 21

Treatment of warts

Answer 21

Usually found on hands and knees.
Always refer warts on face!
Use salicyclic acid, formaldehyde, freezing, surgery or duct tape method.
Appearance - raised and pale,
Age - uncommon in infants more common in young children and adolescents.
It is a viral infection.

Question 22

What is molluscum contagiosum?

Answer 22

Primarily affects children under 5. It is self limiting and caused by a pox virus. Each papule has a small dimple.

Question 23

Which one of the anti-fungals are applied once daily?

Answer 23

Terbinafine spray - most effective antifungal.

Question 24

Non-pharmacological advice for bites and stings.

Answer 24

Remove ticks with tweezers. Wash with soap and water - apply ice. Do not scratch. If anaphylactic shock - refer.

Question 25

Pharmacological treatment for bites and stings.

Answer 25

Cold compresses and oral analgesics. Treat itching with crotamiton cream. Hydrocortisone topically if suitable. Topical antihistamines for itching (diphenhydramine and mepyramine) but topical ones are not recommended only oral antihistamines are useful.

Question 26

What do ticks cause?

Answer 26

Be careful not to leave ticks (head parts) under the skin. Lyme disease is a bacterial infection caused by ticks - there is a bulls eye rash, flu like symptoms, tiredness, nausea, vomiting and diarrhoea.