Skin Flashcards

Question

Tinea Unguium (Onychomycosis – fungal nail infection)

Answer 1

- First Line: Terbinafine. Also: Amorolfine (available OTC to treat max. 2 nails) / Tioconazole

Answer 2

- Ketoconazole shampoo or alternatively Selenium sulphide shampoo OD for 7 days Second line: Topical Imidazole. If above treatment fails/infection widespread: Systemic Triazole

Answer 3

Topical imidazole e.g. clotrimazole or miconazole.

Answer 4

Miconazole (Daktarin oral gel)

Answer 5

- Aciclovir cream (Zovirax: available OTC) 5 times daily for 5-10 days. Applied early as possible in prodromal phase (tingling, irritation in the lip) & before vesicles appear. Mostly heal within 1 week. REFER if > 2weeks - Systemic for buccal or vaginal infections + for herpes zoster (shingles)

Answer 6

- Scabies: Permethrin or malathion - Head Lice: Dimeticone, Permethrin (risk of serious burns if treated hair is exposed to open flames or other sources of ignition) or malathion o Wet combing methods: (probably for at least 30 minutes each time) over the whole scalp at 4-day intervals for min. 2 weeks + continued until no lice are found on 3 consecutive sessions - Crab lice: Permethrin or malathion. An aqueous preparation should be applied, allowed to dry naturally + washed off after 12h; a second treatment is needed after 7 days to kill lice emerging from surviving eggs

Answer 7

```  Irritant  Allergic contact  Atopic (most common) (children <6 months - 5 years)  Venous  Discoid ```

Answer 8

- Skin dryness  Emollients (creams/ointments/bath) - Lichenification (repeated scratching)  Topical Corticosteroids (potent) - Prevent Flare ups (Pt with 2-3 flareups per month) Topical corticosteroids 2 consecutive days per week - Reduce Pruritus  Bandages (ichthammol with zinc oxide): Applied over emollient / topical corticosteroid - Reduce Pruritus  Anti-histamines (sedating if sleep disturbance) - Prevent scratching  Dry wrap dressings

Answer 9

 Hydrocortisone >10yrs+ Max 1 week use |  Clobetasone >12yrs+ Max 1 week use

Answer 10

* Short-course Antibiotics for 1 week * Widespread infection: Systemic Antibiotics * Anti-microbial-containing emollients

Answer 11

- Associated with species of yeast (Malassezia). Affects the scalp, paranasal areas & eyebrows - Cradle Cap: Infantile Seborrhoeic Dermatitis (Before 6 months old) - Treatment  Shampoo containing Ketoconazole or Coal Tar + combinations of mild-corticosteroid with suitable antimicrobias

Answer 12

- Characterised by epidermal thickening and scaling. Silvery-white scales with inflamed, red, patchy plaques Commonly affects extensor surfaces (elbow, knee, lower back) and the scalp - Exacerbating drugs inc. Lithium, Chloroquine, Hydroxychloroquine, B-blockers, NSAIDs & ACE inhibitors

Answer 13

- Mild Psoriasis  Emollients - Chronic stable plaque psoriasis  Vit D analogues (e.g. Calcipotriol), Coal tar, Dithranol + retinoid tazarotene (do not during inflammatory phase of psoriasis) - Scalp Psoriasis  Tar-based shampoo is 1st line / salicylic acid + coal tar/sulfur preparation - Facial, Flexural + Genital psoriasis  short-term mild (preferred for face) or moderate topical corticosteroid. Vit D analogues (e.g. Calcipotriol and tacalcitol) can be used for long-term treatment - Specialist  Topical Pimecrolimus / Tacrolimus

Answer 14

 Not recommended in routine treatment of urticaria; specialist use only. Do not use indiscriminately in pruritus (where they will only benefit if inflammation is causing itch). Do not use for acne vulgaris.  Systemic or very potent topical corticosteroids should be avoided in psoriasis. Specialist use only

Answer 15

Hydrocortisone 0.1-2.5% Dioderm Mildison Synalar 1 in 10 ``` With antimicrobials Canesten HC Daktacort Econacort Fucidin H Nystaform-HC Terra-Cortil Timodine ```

Answer 16

``` Betnovate-RD Eumovate Haelan Modrasone Synalar 1 in 4 Ultralanum Plain ``` With antimicrobials Trimovate With urea: Alphaderm

Answer 17

``` Beclometasone dipropionate 0.025% Betamethasone valerate 0.1% HC butyrate Locoid/ Locoid Crelo Betacap Metosyn Betesil Mometasone furoate 0.1% Bettamousse Nerisone Betnovate Synalar Cutivate Elocon Diprosone ``` ``` With antimicrobials: Lotriderm Betamethasone + clioquinol Betamethasone + neomycin Aureocort Synalar N Synalar C With salicylic acid: Fucibet Diprosalic ```

Answer 18

Clarelux Dermovate Etrivex Nerisone Forte With antimicrobials Clobetamol with neomycin + nystatin

Answer 19

* Females of child bearing potential should practice effective contraception 1 month before starting treatment, during treatment, and for at least 3 years after stopping treatment. Females should be advised to use at least 1 method of contraception, but ideally two methods should be used. * Barrier methods should not be used alone but can be used in conjunction with other contraceptive methods. Oral progestogen-only contraception is not effective. Females should seek immediate medical attention, if they become pregnant during treatment or within 3 years of stopping treatment * Advise patients to avoid alcohol during treatment and for 2 months after stopping treatment.

Answer 20

Discontinue if: Severe headache, nausea, vomiting or visual disturbances occur.

Answer 21

Side effects, further information: Risk of pancreatitis if triglycerides are above 9mmol/litre, discontinue if uncontrolled hypertriglyceridemia or pancreatitis. With oral use: Warn patient to avoid waxing (risk of epidermal stripping), dermabrasion + laser skin treatments during treatment + for at least 6 months after stopping; patient should avoid exposure to UV light (including sunlight) + use sunscreen and emollient (including lip balm) preparations for the start of treatment. Patients and carers should be told how to recognise signs and symptoms of psychiatric disorders such as depression, anxiety, and rarely suicidal thoughts. Psychiatric side-effects and visual disturbances could require expert referral and possible withdrawal. With topical use: Patients should be warned that some redness and skin peeling can occur initially but settle with time. If undue irritation occurs, the frequency of application should be reduced, or treatment suspended until the reaction subsides. If skin peeling is severe or haemorrhagic develops, treatment should be discontinued. Several months of treatment may be needed to achieve an optimal response + treatment should be continued until no new lesions develop. If sun exposure is unavoidable, appropriate sunscreen or protective clothing should be used.

Answer 22

• Salicylate toxicity may occur particularly if applied on large area of skin or neonatal skin.

Answer 23

Aluminium chloride hexahydrate is a potent antiperspirant used to treat hyperhidrosis. (Also available OTC)

Answer 24

 Pruritus may be caused by systemic disease (such as obstructive jaundice, endocrine disease, chronic renal disease, iron deficiency, and certain malignant diseases), skin disease (e.g. psoriasis, eczema, urticaria, and scabies), drug hypersensitivity, or as a side-effect of opioid analgesics.  Levomenthol cream can be used to relieve pruritus; it exerts a cooling effect on the skin. Local antipruritics have a role in the treatment of pruritus in palliative care.  Avoid topical antihistamines in eczema + are not recommended for longer than 3 days.

Answer 25

Mild to moderate acne is generally treated with topical preparations. Systemic treatment with oral antibacterials is generally used for moderate to severe acne or where topical preparations are not tolerated or ineffective or where application to the site is difficult. Another oral preparation used for acne is the hormone treatment co-cyprindiol (cyproterone acetate with ethinylestradiol); it is for women only.

Answer 26

There is an increased risk of venous thromboembolism in women during first year of use. Likelihood of VTE is 1.5-2 times higher in women taking co-cyprindiol than in women using COC containing Levonorgestrel. Women requiring Co-cyprindiol may have an increased risk of CVD.

Answer 27

is not comedonal (but may exist with acne which may be comedonal). Brimonidine tartrate is licensed to treat facial erythema in rosacea. The pustules + papules of rosacea respond to topical azelaic acid, topical ivermectin or topical metronidazole. Alternatively, oral administration of oxytetracycline, tetracycline or erythromycin can be used. Courses usually last 6–12 weeks and are repeated intermittently.

Answer 28

- RISK OF SYSTEMIC CARDIOVASCULAR EFFECTS: Systemic cardiovascular effects including bradycardia, hypotension + dizziness has been reported after application of gel. To minimise systemic absorption, avoid application to irritated/damaged skin, including after laser therapy. - RISK OF EXACERBATION OF ROSACEA: Symptom exacerbation has been reported very commonly in patients treated with brimonidine gel. Treatment should be initiated with a small amount of gel (less than the maximum dose) for at least 1 week, then increased gradually, based on tolerability and response. Patients should be counselled on the importance of not exceeding the maximum daily dose and advise to stop treatment + seek medical advice if symptoms worsen during treatment.

Answer 29

Dandruff - Shampoo with antimicrobial agents such as pyrithione zinc + selenium may be beneficial Alopecia - Finasteride in men/ Minoxidil Hirsutism - Eflornithine (antiprotozoal). Hirsutism may result from hormonal disorders or as a side-effect of drugs such as minoxidil, corticosteroids, anabolic steroids, androgens, danazol, and progestogens

Answer 30

Antiseptics e.g. chlorhexidine or povidone-iodine are used on intact skin before surgical procedures; their antiseptic effect is enhanced by an alcoholic solvent. Potassium permanganate sol. 1 in 10 000, a mild antiseptic with astringent properties, can be used for exudative eczematous areas; stop when skin gets dry. Desloughing agents: Alginate, hydrogel and hydrocolloid dressings are effective at wound debridement.