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bnf > Skin > Flashcards

Skin Flashcards

1
Q

What are the advantages of different formulations for the skin?

A

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

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2
Q

How long after diluting a cream should it be used?

A

2 weeks

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3
Q

How can aqueous cream be used and not used?

A

Soap substitute for hand washing and in the bath. Not as leave on.

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4
Q

In dry skin conditions, soap should be avoided. True or false.

A

True

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5
Q

What advice should be given alongside a corticosteroid cream given for nappy rash?

A

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.

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6
Q

Should antifungal treatment be continued after disappearance of infection?

A

Yes for 1 to 2 weeks

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7
Q

Which ringworm infection generally requires systemic treatment?

A

Scalp

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8
Q

What preparations can be used in angular chelitis?

A

Fusidic acid if staph. Miconazole if candida.

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9
Q

What drug is used systemically if scabies does not respond to topical treatment?

A

Ivermectin

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10
Q

Should patients take a hot bath before applying permethrin cream?

A

No evidence of increased absorption into blood from skin

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11
Q

A patient has been treated for scabies but is still itching 2 weeks later, what should be done?

A

Can occur. Can use crotamiton, corticosteroids and sedating antihistamines. If persists, retreat

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12
Q

How long should headlice treatments be applied and with what formulations?

A

8 to 12 hours with Lotions and liquids. Shampoos diluted too much and 2 hour contact times not recommended.

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13
Q

What routine of wet combing can be adopted for headlice?

A

30 minutes each time at 4 day intervals for minimum 2 weeks. Continue until no lice found on 3 concecutive occasions.

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14
Q

What monitoring may be required with silver sulfadiazine?

A

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.

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15
Q

What advice should be given with oral terbinafine?

A

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.

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16
Q

When should alcoholic lotions not be used? What does this include?

A

In children with eczema or asthma, or in scabies or crab lice. Malathion.

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17
Q

Where are mild corticosteroids used in eczema?

A

Face and flexures

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18
Q

When are corticosteroids adopted for prevention of eczema flares?

A

If at least 2 to 3 flares per month. Applied for 2 concecutive days per week.

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19
Q

For what maximum duration are antibacterial drugs used in eczema?

A

1 week

20
Q

What can be used for lichenification associated with eczema?

A

Potent corticosteroid. Maybe bandages with ichtammol or zinc over top. Antihistamines.

21
Q

What can be used in exudative eczema?

A

Potent corticosteroid. Potassium permanganate until stops.

22
Q

What drugs can provoke or exacerbate psoriasis?

A

Lithium, chloroquine, hydroxychloroquine, beta blockers, nsaids, ACEIs

23
Q

Which drugs should be discontinued in the inflammatory phases of psoriasis? When should these drugs be reviewed?

A

Vitamin D analogues, coal tar, dithranol and tazarotene. Also assess these after 4 to 6 weeks.

24
Q

What disadvantages do tar and dithranol products pose?

A

Smell, messy. Irritant, stains skin/clothing.

25
Q

Is tazarotene irritant, staining or odoured?

A

Irritant

26
Q

How long should acitretin be trialled for?

A

4 months

27
Q

How long is acitretins teratogenicity risk valid for?

A

3 years after stopping.

28
Q

When can TNF alpha inhibitors be considered for psoriasis?

A

Severe plaque refractory to at least 2 standard systemic treatments and photochemotherapy or when they cannot be used.

29
Q

What decides between use of a corticosteroid cream or ointment?

A

Cream if moist/weeping. Ointment if dry, lichenified for more occlusion.

30
Q

Order the potency of these topical corticosteroids using the drugs and strengths; Betnovate, Betnovate RD, Dermovate, Elocon, Eumovate, Canesten HC, Locoid.

A

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)

31
Q

In what instance may moderate/potent corticosteroids be used in children?

A

Severe atopic eczema on the limbs for 1 to 2 weeks

32
Q

How much should a fingertip unit cover for corticosteroids?

A

2 palms

33
Q

What can be used in Hyperhidrosis?

A

Aluminium chloride hexahydrate - potent antiperspirant and incorporated with fungal infection preparations.

Oxybutynin - unlicensed
Glycopyrronium - severe cases
Botox

34
Q

What diseases cause pruritus? What drug class may be responsible?

A

Obstructive jaundice, endocrine, renal.
Iron deficiency, malignancy
Skin diseases
Opioids

35
Q

What can be used to treat prurititis?

A

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)

36
Q

After what time frame should oral antibacterials be swapped?

A

3 months

37
Q

Which antibiotics are used in acne?

A

Usually oxytetracycline or tetracycline. Alternatively doxycycline or lymecycline. Monocycline is associated with greater risk of lupus erythematsus like syndrome

38
Q

What side effects of Isotretinoin can occur?

A

Dryness of skin/mucous membranes, nose bleeds, joint pain.

Suicidal ideation not linked but considered

39
Q

What advice should be given with Isotretinoin?

A

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
40
Q

What can be used with cradle cap?

A

Coconut or olive oil then shampoo

41
Q

What can be given in hirsutism?

A 
Weight loss advised.
Local methods of hair removal.
Eflornithine antiprotazoal
Co cyprindiol
Metformin in POS
42
Q

What drugs can cause hirsutism?

A

Minoxidil, corticosteroids, anabolic steroids, androgens, danazol and progestogens

43
Q

What drug may be used for Androgenetic alopecia in men?

A

Finasteride

44
Q

What skin cleansers and antiseptics are available?

A 
Aqueous cream, emulsifying ointment
Chlorhexidine, povidone iodin
Cetrimide
Hydrogen peroxide
Sodium chloride
Potassium permanganate
45
Q

What risk is associated with povidone iodine?

A

Application to large wounds or severe burns may produce systemic side effects such as metabolic acidosis, hypernatreamia and impaired renal function

46
Q

What does spf mean in terms of length of skin protection

A

How much longer a person can remain in the sun without burning.

47
Q

What preparations are available for warts and calluses?

A

Salicylic acid, formaldehyde, glutaraldehyde and silver nitrate

Podophyllotoxin, camellia sinensis and imiquimod for anogenital

bnf (15 decks)

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