Skin conditions

Question 1

Topical skin formulations: ointment

Answer 1

Greasy + forms occlusive barrier, chronic dry skin

Question 2

Topical skin formulations: creams

Answer 2

Cosmetically more acceptable + easier to apply
Dries out quicker + applied more frequently

Question 3

Topical skin formulations: lotions

Answer 3

Cooling effect
Hairy area
Alcohol base sting broken skin

Question 4

Topical skin formulations: gels

Answer 4

Higher water content
Scalp + face

Question 5

Topical skin formulations: paste

Answer 5

Stiff prep w powdered solids

Question 6

Topical skin formulations: dusting powder

Answer 6

Rare use
Red friction
Do not apply to moist areas = caking, abrade skin

Question 7

Topical skin formulations: excipients

Answer 7

Salicylate: toxicity in neonates if applied to large areas
Benzyl alcohol in neonates: fatal toxicity

Question 8

Eczema: treatment

Answer 8

Emollient (lotion, creams, ointment) AND topical corticosteroids
- Often as required
- Direction of hair growth
- Damp skin to maximise hydration
- Bath emollient - slipping hazard + Soak for 10-20 mins to hydrate

MHRA: emollients: fatal burns w paraffin based + paraffin free products
- Counsel: do not smoke or go near naked flames, wash material at high temp to reduce build up

Question 9

Steroid potency ladder: very potent

Answer 9

Clobetasol

Question 10

Steroid potency ladder: potent

Answer 10

• Betamethasone 0.1%
• Hydrocortisone butyrate
• Mometasone

Question 11

Steroid potency ladder: moderate

Answer 11

Betamethasone 0.025%
Clobetasone

Question 12

Steroid potency ladder: mild

Answer 12

Hydrocortisone <2.5%

Question 13

Topical corticosteroids: application

Answer 13

Apply thinly to affected area, max twice daily

Apply emollients first + wait 30 min before steroid

FTU Area
0.5 Genitals
1 Hands, elbow + knees
1.5 Feet inc soles
2.5 Face + neck
3 Scalp
4 One hand + arm or buttocks
8 One leg and foot, and chest or back

Question 14

Topical corticosteroids: CI

Answer 14

• Acne
• Rosacea
• Skin infections

Question 15

Topical corticosteroids: side effect

Answer 15

Skin thinning, discolouration

Topical steroid withdrawal

MHRA: topical corticosteroid: long term use esp w mod-high potency = rebound flares, use lowest potency, frequency, duration

Counsel:
- Seek advice before using on a new body area, if skin condition worsens, + advise when it would be appropriate to re-treat without a consultation
- If skin worsens <2 weeks of stopping, do not start again unless doctor says
- Report via yellow card scheme

Question 16

Acne: treatment

Answer 16

• Retinoid (isotretinoin)
• Abx (erythromycin, tetracyclines)
• Azelaic acid
• Benzoyl peroxide
• Oral combined contraception

Question 17

Isotretinoin: pregnancy

Answer 17

Teratogenic

MHRA: females of child bearing potential: PPP

Negative pregnancy test:

• Every month + 1 month after stopping
• Same day prescribing + dispensing (30 day supply)

Effective contraception:

• 1 month before, during + after
• IUD or progestogen implant

Pregnant within 1M of stopping? see doctor

Question 18

Isotretinoin: side effects

Answer 18

Neuropsychiatric reactions
- MHRA: monitor for depression + suicidal ideation
- Counsel: report any changes in mood or behaviour

Skin reactions (dry, red, photosensitive, fragile)
- Counsel: avoid wax, epilation, dermabrasion/laser for 6 months after: avoid UV light (high SPF sunscreen + emollient)
- Severe peeling: STOP

Erectile dysfunction
- MHRA: isotretinoin: ED + Red libido

Vision disorders

Haemorrhagic diarrhoea + pancreatitis
- Risk if high triglycerides - STOP