Skin Conditions

Question 1

Non-Drug Treatments for Acne

-Acne vulgaris- skin care using non-alkaline, synthetic detergent cleansing product twice daily, removing make-up at the end of the day and avoiding oil-based skincare products, sun cream and make-up.
-Photodynamic therapy should be considered if acne vulgaris is severe and other treatments are ineffective or CI.

Answer 1

.

Question 2

Drug Treatment for Acne

-Patients with acne vulgaris should be offered a 12-week course of first-line treatment. May take 6-8 weeks for treatment to become noticeable.
-MUST COMPLETE COURSE

First line for ANY severity:
Topical adapalene with benzoyl peroxide or topical tretinoin with clindamycin

Mild-Moderate:
-Topical benzoyl peroxide with clindamycin

Moderate-Severe:
-Topical adapalene with benzoyl peroxide WITH oral lymecycline or doxycycline
-Topical azelaic acid WITH oral lymecycline or doxycycline

Answer 2

.

Question 3

What should be used for mild to moderate acne?

Answer 3

Topical benzoyl peroxide with clindamycin

Question 4

Reassessment and Further Treatment

-Review after 12 weeks- if cleared then continue topical treatment and stop oral antibacterial if it was being used.
-If improved but not cleared, consider treatment for a further 12 weeks
-If inadequate response, offer a different first-line treatment

Answer 4

.

Question 5

Isotretinoin

-A powerful teratogen, for severe acne that is resistent to other treatments.
-Risky in women of childbearing potential

Answer 5

.

Question 6

What are the main types of eczema?

Answer 6

Irritants
Allergic contact
Atopic (one of the most common)
Venous
Discoid

Question 7

Management of Eczema

-Removal of irritants
-Frequent use of emollients
-Topical corticosteroids

Answer 7

.

Question 8

Nappy Rash

-Change nappies frequently and avoid tightly fitting nappies
-Hydrocortisone 0.5% or 1% can be used, but avoid in neonates.
If there is a candidal infection, a topical antifungal such as clotrimazole can be used.

Question 9

What is psoriasis?

Answer 9

An inflammatory skin disease that usually follows a relapsing and remitting course and may have nail or joint involvement.

Question 10

What are the first-line treatment options for psoriasis?

Answer 10

Topical treatment:
-Emollients
-Corticosteroids
-Coal tar preparations
-Vitamin D

Question 11

Dandruff

-Mild form of seborrhoeic dermatitis
-Shampoos containing antimicrobial agents such as pyrithione zinc and selenium are useful. Also shampoos containing _ extracts.
-_ shampoos should be considered for more persistent or severe dandruff.

Answer 11

Tar
Ketoconazole

Question 12

What can be used to treat cradle cap in infants?

Answer 12

Coconut oil or olive oil, followed by shampooing

Question 13

What drug can be used to treat androgenic alopecia in men?

Answer 13

Finasteride- 3-6 months use required before benefit seen.

Question 14

Antibacterial Preparations for the Skin

-To minimise resistence, only use topical preparations that are not typically used systemically.
-Mupirocin and Fusidic Acid are effective- limit use to 10 days to avoid resistence developing

Answer 14

.

Question 15

Which antifungals can be used topically to treat ringworm and also Candidiasis?

Answer 15

Clotrimazole, Econazole, Ketoconazole and Miconazole

Question 16

Which antiviral cream should be used to treat initial and recurrent labial herpes simplex infections?

Answer 16

Aciclovir cream

Question 17

Head Lice Treatment

-Dimeticone
-Malathion is an alternative but resistence has been reported
-Benzyl benzoate is effective, but is more expensive and not suitable in children.
-Treat with lotion or liquid formulations if live lice are present: 8-12 contact time or overnight treatment is recommended.

Answer 17

.

Question 18

Which skin conditions are topical corticosteroids mostly used to treat?

Answer 18

Eczema
Contact dermatitis
Insect stings
Eczema of scabies

Question 19

Remember: Corticosteroids suppress the inflammatory reaction during use, and are not curative. Discontinuation may therefore cause a withdrawal reaction (rebound or flare).

Question 20

Topical Corticosteroid Potencies

Mild: Hydrocortisone, diodermn
Mild with antimicrobials: Canesten HC, Daktacort, Fucidin H, Timodine

Moderate: Betnovate-RD, Eumovate

Potent: Beclometasone dipropionate 0.025%, Betamethasone valerate 0.1%, Mometasone furoate 0.1%, Elocon
Potent with antimicrobials: Fucibet

Question 21

What are the symptoms of rosacea?

Answer 21

Persistent facial redness
Visible vessels
Sensitive skin- burning, itching etc
Facial swelling

Question 22

Remember: Isotretinoin is used to treat acne. It is teratogenic, and can also cause depression, psychosis and suicidal tendencies.

Question 23

What are some examples of drug treatments that can cause oral candidiasis infections?

Answer 23

Steroid asthma inhalers
Cytotoxic drugs
Broad spectrum antibacterials

Question 24

For miconazole/antifungal cream, what are the typical application instructions?

Answer 24

Apply twice a day, and for 10 days after lesions have healed.