Skin Flashcards
What is the difference between cream and ointment?
Ointment = more greasy Cream = less greasy
Ointment = more hydrating for chronic dry skin Cream = dries out quicker and applied more frequently than ointment
When would you usually use gels?
- for scalp and face
- have a high water content
When would you usually use lotions?
- have a cooling effect, for large hairy areas
- alcoholic base so can sting broken skin
When should you be cautious of preparations containing salicylate?
- in neonates - toxicity
- when applied to large areas - toxicity
Which patient group should you avoid benzyl alcohol in?
- neonates - fatal toxicity syndrome
How do you apply emollients?
- as often as required
- in the direction of hair growth to reduce folliculitis
- after washing/bathing to maximise hydration
What is the MHRA warning with emollients?
- fire risk
- clothes/dressings easily ignite by naked flame
What is used to treat eczema?
- steroids
- reduce inflammation
CI - acne, rosacea, skin inf
Which eczema treatment is classified as VERY potent?
- clobetasol (dermovate)
Which eczema treatment is classified as just potent?
- betamethasone 0.1% (betnovate)
- hydrocortisone
- mometasone
Which eczema cream is moderately potent?
- clobetasone (eumovate)
- betamethasone 0.025% (betnovate RD)
Which eczema creams are mildly potent)?
- hydrocortisone < 2.5%
How often should you apply eczema cream?
- NO MORE THAN TWICE DAILY
Why should you avoid prolonged use of eczema products on the face?
- thinning skin and hyperpigmentation
In what order should you apply the emollient and the steroid?
- emollient first
- wait half an hour and then apply steroid for max absorption
How do you treat rosacea?
- 6 to 12 week course repeated intermittently
- facial erythema = brimonidine
- MHRA = risk of systeic CV effects and risk of exacerbation of rosacea
How do you treat pustules and papules associated with rosacea?
- Topical - metronidazole, azelaic acid, ivermectin
OR
- Oral - oxytetracycline, tetracycline, erythromycin
How do you treat acne?
- isotretanoin
- under specialist supervision
- all retinoids or vit A derivatives are teratogenic
What would you advise about pregnancy when a pt is starting isotretonoin?
- contraception 1 month before and after treatment (2 methods ideally)
- pregnancy test must be negative in first 3 days of menstrual cycle up to 3 days before treatment - repeat every month and for 5 weeks after stopping
- start treatment on 2nd or 3rd day of menstrual cycle
- seek urgent advice if you fall pregnant during or up to 1 month after
What is the PPP?
- pregnancy prevention programme
- exclude pregnancy - at least 2 negative tests
How long is a prescription under the PPP valid for?
- 7 days - max 30 day supply
- repeats and faxes not accepted
Can you give emergency supply for PPP?
- only on specialist request with negative pregnancy test
What are the other side effects of isotretonoin?
- hyperglycaemia, hypertriglyceridaemia, high cholesterol, pancreatotos, hepatotoxicity, visual distrubance
- skin peeling, redness, severe dry skin
How would you manage a side effect of pancreatitis with isotret?
- high risk of it is triglycerides above 9mmol/L
- discontinue it if hypertriglyceridaemia is uncontrolled
What would you do if your skin was peeling with isotret?
discontinue
what would you do if you had visual distrubances with isotret?
- expert referral and posisble withdrawal
What should patients avoid during and 6 months after isotretonoin treatment?
- wax epilation, dermabrasion, laser treatment - scarring
- photosensitivity - avoid UV light, Use high factor SPF sunscreen and emollient inducing lip balm
- stop immediately if psychiatric reactions occur
