Skin Conditions Flashcards
9.1 fungal infections
symptoms:
1. tinea pedis - athletes foot: white, itchy,
flaky skin between toes - looks soggy,
smelly
2. tinea corporas - body ringworm: flat,
slightly raised circular rings with a distinctive red scaly border and can have a central clearing
3. tinea captain - scalp ringworm: distinctive ring-shaped rash with associated hair loss - refer requires oral anti fungal
4. tinea cruris - jock itch: fungal groin infection, red-brown rash with well defined edge on inner thighs and buttocks
referral:
• facial or scalp involvement
• toenails also affected
• large area affected
• broken skin
• secondary bacterial infection
• diabetic/immunocompromised
• OTC failure after 2 weeks
• pregnant or breastfeeding
OTC product:
topical imidazoles
• all ages = clotrimazole
• adults = ketoconazole
• all ages = miconazole, daktacort = 10+,
7 days use only, BD thinly
Terbinafine - lamisil 16+, lamisil once 18+ OTC licensing - spray, cream, gel
Powders - mycota, myci - can be used
prophylactically for athletes foot
Advice:
• continue for at least 7 days after
symptoms disappear
• contagious - easily transferred from pets and animals
• avoid sharing towels
• athletes foot: change socks regularly,
dry skin thoroughly, wear flip-flops in communal areas
9.2 acne vulgaris - propionibacterium acnes
symptoms:
• whiteheads
• blackheads
• spots
• pustules
Commonly affected areas = face, neck, upper back, shoulders and centre of chest
referral:
• children under 12
• adults over 24 for first time
• acne rosacea
• anywhere but face
• medicines adr - lithium. Phenytoin,
progestogens
• OTC failure > 8 weeks
• moderate-severe acne
OTC products:
• benzoyl peroxide - first line
(acnecide, panoxyl)
start with low strength 2.5/5% from
once to twice daily then after a few weeks increase up to 10%
Application:
• wash skin before applying
• takes about 8 weeks for
improvement
• apply to whole area affected at
night
side effects:
• bleaches clothes, avoid direct
sunlight; photosensitivity
• stinging, dry, burning skin - stop for
1-2 days then restart
Advice:
• no evidence to suggest food or poor
hygiene causes acne
• use milk antibacterial soap - BD fine
• do not overscrub
• do not squeeze spots
• avoid greasy oil-based cosmetics
9.3 corns and calluses
symptoms:
• yellow hyperkeratinsed skin
• can be painful
referral:
• diabetics
• impaired circulation
• treatment failure
• soft corns
OTC product:
• padding or shielding
advice:
• wear appropriate well-fitting
shoes
• use a pumice stone to remove
hard skin
• dry feet thoroughly after washing
9.4 eczema and dermatitis
symptoms:
atopic dermatitis (eczema)
• sore and inflamed rash
• very dry and flaky skin
• irritated and itchy skin commonly affected areas are face, hands and limb flexures
contact dermatitis - caused by irritants or allergic substances
• infected skin
• severe rash
• broken skin
• face
• anogenital areas
Referral:
• OTC failure >7 days
• undiagnosed eczema or unknown
cause
• symptoms >2 weeks
OTC product:
emollients: hydrates and soothes
• lotion (dermol 500)
• cream (aveeno, cetraben, E45)
• ointment - most lipid content and
most hydrating
• soap substitutes
• bath additives
Steroids: reduce inflammation for mild to moderate eczema
Apply thinly once or twice a day
• 10+ hydrocortisone (mild)
• 12+ clobetasone (moderate) licensing
• 15g max
• 7 days max
• not for broken or infected skin
• not for face or anogenital
• not for pregnancy Contraindications:
• acne, rosacea, skin infections
Itch relief - calamine/crotamiton
advice:
• apply steroid sparingly
• apply emollient first (30 mins)
• use soap substitutes
• eliminate aggravating factors
9.5 fungal nail infections
symptoms:
• dull, yellow opaque
• nail thickens and distorts
• brittle and crumbles away
referral:
• other fungal nail infections
• nail breaking away
• immunocompromised, peripheral
circulatory disease
• diabetes
OTC product:
• amorolfine 18+ (curanail 5% nial
lacquer) For mild DLSO
Distal - beneath the nail top Lateral - side of nail Subungal - under nail plate Onchomycosis
OTC licensing: 18+, no more than 2 nails affected
only beneath tips or sides of nails affected NOT FOR PREGNANCY OR BREASTFEEDING
advice:
• keep using until all of the affected nail
tissues grows out - one pack gives 3
month supply
• apply once a week to affected nail
• file down nail surface
• Clean
• apply and leave to dry
9.6 psoriasis
symptoms:
• plaque psoriasis
• red plaques
• well-defined edges
• silvery scales - elbows, knees and scalp
referral:
• undiagnosed
• moderate to severe
OTC product:
• emollient
• 12+ coal tar solution - can stain
clothes and has an unpleasant smell side effects: photosensitivity and skin irritation
advice:
• • •
limit stress
not contagious
sun exposure can improve psoriasis
9.7 cold sores - HSV-1
symptoms:
• tingling sensation or irritation (6-24
hours before blister)
• blisters on lips/around mouth -
filled with white matter on top of sore inflamed skin
referral:
• painless
• babies/young children
• immunocompromised
• uncertain diagnosis
• eyes affected
• cold sores inside mouth
• >2 weeks
• patients with atopic eczema
OTC product:
at blister or tingle
• aciclovir - apply 5 times a day for
at least 4 days - max 10 days
• penciclovir 12+ - apply 8 times a
day for 4 days (2hrly)
• hydro colloid patch - apply for 24
hours a day until it completely
heals
• bland creams - soothes and
moistens skin
advice:
• contagious until crusts form
• wash hands after applying cream
• avoid eyes
• avoid kissing/oral sex
• loifelong
9.8 warts and verrucae
symptoms:
• warts - flesh-colour, raised
“cauliflower” surface
• verrucae - flat, occur on sole of feet
with black dots
referral:
• facial warts
• multiple warts
• anogenital warts
• diabetic patients
• immunocompromised patients
• itchy/bleeding
• change in appearance
• OTC failure >3 months
OTC product:
• salicylic acid - treatment of choice
• cryotherapy - freezes: comes off in 1-
days
• glutaraldehyde - more for resistant
verrucae
advice:
• takes up to 12 weeks to disappear
• take steps to prevent spreading applying salicylic acid:
• soak affected area with warm water for
5 minutes
• apply daily, protect healthy skin
• remove dead skin every week
