Skin Flashcards
What are the advantages of different formulations for the skin?
Creams - well absorbed, less greasy, easy to apply
Gels - particularly suitable for face and scalp.
Lotions - cooling, better for Hairy areas.
Ointments - occlusive for chronic dry lesions
How long after diluting a cream should it be used?
2 weeks
How can aqueous cream be used and not used?
Soap substitute for hand washing and in the bath. Not as leave on.
In dry skin conditions, soap should be avoided. True or false.
True
What advice should be given alongside a corticosteroid cream given for nappy rash?
Barrier preparations should be applied after to prevent further damage. Discontinue as sson as inflammation subsides. Occlusive effect of nappies and waterproof pants may increase its absorption.
Should antifungal treatment be continued after disappearance of infection?
Yes for 1 to 2 weeks
Which ringworm infection generally requires systemic treatment?
Scalp
What preparations can be used in angular chelitis?
Fusidic acid if staph. Miconazole if candida.
What drug is used systemically if scabies does not respond to topical treatment?
Ivermectin
Should patients take a hot bath before applying permethrin cream?
No evidence of increased absorption into blood from skin
A patient has been treated for scabies but is still itching 2 weeks later, what should be done?
Can occur. Can use crotamiton, corticosteroids and sedating antihistamines. If persists, retreat
How long should headlice treatments be applied and with what formulations?
8 to 12 hours with Lotions and liquids. Shampoos diluted too much and 2 hour contact times not recommended.
What routine of wet combing can be adopted for headlice?
30 minutes each time at 4 day intervals for minimum 2 weeks. Continue until no lice found on 3 concecutive occasions.
What monitoring may be required with silver sulfadiazine?
Blood counts as leucopenia can occur within 2 to 3 days of starting in burns patients. But does not need discontinuing as long as return to normal within a few days.
What advice should be given with oral terbinafine?
Immediately report signs of liver dysfunction such as Pruritis, unexplained nausea, decreased appetite, anorexia, jaundice, vomiting, fatigue, dark urine, pale stools. Should also discontinue with progressive skin rash.
When should alcoholic lotions not be used? What does this include?
In children with eczema or asthma, or in scabies or crab lice. Malathion.
Where are mild corticosteroids used in eczema?
Face and flexures
When are corticosteroids adopted for prevention of eczema flares?
If at least 2 to 3 flares per month. Applied for 2 concecutive days per week.
For what maximum duration are antibacterial drugs used in eczema?
1 week
What can be used for lichenification associated with eczema?
Potent corticosteroid. Maybe bandages with ichtammol or zinc over top. Antihistamines.
What can be used in exudative eczema?
Potent corticosteroid. Potassium permanganate until stops.
What drugs can provoke or exacerbate psoriasis?
Lithium, chloroquine, hydroxychloroquine, beta blockers, nsaids, ACEIs
Which drugs should be discontinued in the inflammatory phases of psoriasis? When should these drugs be reviewed?
Vitamin D analogues, coal tar, dithranol and tazarotene. Also assess these after 4 to 6 weeks.
What disadvantages do tar and dithranol products pose?
Smell, messy. Irritant, stains skin/clothing.
Is tazarotene irritant, staining or odoured?
Irritant
How long should acitretin be trialled for?
4 months
How long is acitretins teratogenicity risk valid for?
3 years after stopping.
When can TNF alpha inhibitors be considered for psoriasis?
Severe plaque refractory to at least 2 standard systemic treatments and photochemotherapy or when they cannot be used.
What decides between use of a corticosteroid cream or ointment?
Cream if moist/weeping. Ointment if dry, lichenified for more occlusion.
Order the potency of these topical corticosteroids using the drugs and strengths; Betnovate, Betnovate RD, Dermovate, Elocon, Eumovate, Canesten HC, Locoid.
Mild: hydrocortisone 0.1 - 2.5% (canesten HC)
Moderate: betamethasone 0.025% (betnovate RD) and clobetasone (eumovate)
Potent: betamethasone 0.1% (betnovate), hydrocortisone butyrate (Locoid) and mometasone (Elocon)
Very potent: clobetasol (dermovate)
In what instance may moderate/potent corticosteroids be used in children?
Severe atopic eczema on the limbs for 1 to 2 weeks
How much should a fingertip unit cover for corticosteroids?
2 palms
What can be used in Hyperhidrosis?
Aluminium chloride hexahydrate - potent antiperspirant and incorporated with fungal infection preparations.
Oxybutynin - unlicensed
Glycopyrronium - severe cases
Botox
What diseases cause pruritus? What drug class may be responsible?
Obstructive jaundice, endocrine, renal.
Iron deficiency, malignancy
Skin diseases
Opioids
What can be used to treat prurititis?
Emollients
Levomenthol
Crotamiton
Calamine (little help in insect bites)
Doxepin topical (may cause drowsiness and sensitisation)
Cholestyramine if cholestasis/cirrhosis
Antihistamines, local anaesthetics (eg insects, <3 days, avoid in eczema)
After what time frame should oral antibacterials be swapped?
3 months
Which antibiotics are used in acne?
Usually oxytetracycline or tetracycline. Alternatively doxycycline or lymecycline. Monocycline is associated with greater risk of lupus erythematsus like syndrome
What side effects of Isotretinoin can occur?
Dryness of skin/mucous membranes, nose bleeds, joint pain.
Suicidal ideation not linked but considered
What advice should be given with Isotretinoin?
Pregnancy prevention programme
Avoid blood donation during and for 1 month after.
Avoid wax epilation, dermabrasion, laser skin treatment for at least 6 months.
Avoid exposure to sunlight
Recognise psychiatric symptoms and report
Allow peeling before using topical Redness/peeling will subside Several months may be needed Avoid exposure to UV light Effective contraception
What can be used with cradle cap?
Coconut or olive oil then shampoo
What can be given in hirsutism?
Weight loss advised. Local methods of hair removal. Eflornithine antiprotazoal Co cyprindiol Metformin in POS
What drugs can cause hirsutism?
Minoxidil, corticosteroids, anabolic steroids, androgens, danazol and progestogens
What drug may be used for Androgenetic alopecia in men?
Finasteride
What skin cleansers and antiseptics are available?
Aqueous cream, emulsifying ointment Chlorhexidine, povidone iodin Cetrimide Hydrogen peroxide Sodium chloride Potassium permanganate
What risk is associated with povidone iodine?
Application to large wounds or severe burns may produce systemic side effects such as metabolic acidosis, hypernatreamia and impaired renal function
What does spf mean in terms of length of skin protection
How much longer a person can remain in the sun without burning.
What preparations are available for warts and calluses?
Salicylic acid, formaldehyde, glutaraldehyde and silver nitrate
Podophyllotoxin, camellia sinensis and imiquimod for anogenital
