Sunburn

Question 1

What are the signs and symptoms of sunburn?

Answer 1

Painful erythema 2-6 hours after exposure, max severity in 24 hrs

Severe cases = malaise, nausea, vomiting

Resolution with peeling skin occurs over 4-7 days

Confused with photosensitive drug eruption = assess those who burn easily, esp children

Question 2

Summarise key features of basal cell carcinomas

Answer 2

Most on head & neck

Rarely metastasise –> cause extensive localised damage

Slow growing

Grows visible BV with time that can break open and scab

Diagnosed by biopsy

Question 3

What is the first line treatment of basal cell carcinoma?

Answer 3

Surgical removal (except superficial BCC)

Question 4

What is the treatment for superficial BCC?

Answer 4

Cryotherapy, PDT

topical imiquimod = at night 5x/wk for 6 weeks –> wash off in morning

Question 5

How is advanced BCC treated?

Answer 5

Vismodegib capsule = once daily

Pbs required

Question 6

Summarise the key features of SCC

Answer 6

Heavily sun exposed areas = head, neck, back of hand, limbs

Tender lesion, appear suddenly + grow rapidly (more than BCC) OR grow slowly over months to weeks

Characteristic thick irregular appearance –> raised and firm (like wart) over time

More likely in damaged skin

Question 7

What is the 1st line treatment for SCC?

Answer 7

Surgical treatment w/ 3-5 mm margin

Radiotherapy if surgery not appropriate

Question 8

Summarise the key features of Melanoma

Answer 8

Malignant tumour from melanocyte (can arise w//in mole or freckle)

early detection is vital

several types and classifications

surgical removal

Question 9

Outline the ABCDE rule of melanoma diagnosis

Answer 9

Asymmetry = one half different from the other

Border = usually irregular

Colour = varies within lesion, pigment may be largely or completely absent

Diameter = greater than 6 mm, can be diagnosed smaller (inc diameter is more important)

Evolution = changing or evolving

Question 10

What are some organic chemicals (Absorbing agents) in sunscreen?

Answer 10

octyl salicylate

Disodium phenyl dibenzimidazole tetrasulfonate

*risk of allergic dermatitis

Question 11

What are some inorganic substances (physical blockers) in sunscreen?

Answer 11

zinc oxide

titanium dioxide

Question 12

Outline some key tips for sunscreen application

Answer 12

Apply to exposed site 15-30 mins before sun exposure when UV index >3

Degree of cloud cover doesn’t change sunscreen option

Use generous amount

Reapply every 2 hours and after vigorous activity

Don’t used expired ones

Question 13

What drugs don’t really work to treat sunburn?

Answer 13

Anti-inflammatory drugs

oral and/or topical corticosteroids

Question 14

List the treatments for sunburn

Answer 14

cool compress, cool damp cloth to area

Inc water intake

anaesthetic spray to relieve pain

After sun cream or gels

Cooling gels = water based

Aloe vera - clinical evidence limited

Question 15

List the treatments (and their duration) for actinic keratosis

Answer 15

Fluorouracil = 1-2/day for 2-5 wks (face) or 3wks (arm/leg)

Imiquimod = 3x/week at night for 3-4wks OR apply 3x/week, for 16 weeks

Diclofenac 3% gel = apply bd for 60-90 days

Methylaminolevulinate/5-aminolevulinic acid = 1 session of photodynamic therapy, apply patch and then expose to PDT

Question 16

Summarise key facts about fluorouracil in skin cancer treatment

Answer 16

Interfere with DNA synth

Cont treatment until marked inflam response

Therapy 3-4 wks, can be longer, face responds quicker (trunk, lower limb, hands, forearms

Avoid excessive/prolonged sun exposure

Use metal applicator or gloves when applying

only RPBS

Question 17

Summarise key facts about imiquimod cream in skin cancer treatment

Answer 17

MOA = enhance immune response

Apply before bed (leave for 6-10 hrs) to clean area–> wash off w/ mild soap

2x dosing regimen

Avoid bathing/washing after application

Protect treated area from sun

Avoid contact with eyes, lips, nostrils

Question 18

Summarise the key facts about diclofenac + hyaluronic acid in skin cancer treatment

Answer 18

MOA = proposed blocking of COX-2 –> dec angiogenesis and cellular proliferation

avoid contact w/ eyes and mouth, do not cover with occlusive dressing

Protected area from sunlight

Can take 30 days after finishing for lesion to heal

Not interchangeable with diclofenac gels for pain

consider potential for systemic absorption

Question 19

Slip: What protective clothing should be worn in the sun?

Answer 19

Cover as much skin as possible = collared shirts w/ long sleeve

Some clothing may be poorer in ultraviolet protection

Question 20

Slop: When/how often should sunscreen be applied?

Answer 20

Apply generous amounts to clean, dry skin = 20 mins before going outside

Reapply every 2 hours or after swimming or excessive sweating

Sunscreen = does not provide 100% protection

Question 21

Slap: What kind of hat is best for sun safety?

Answer 21

Broad-brimmed, legionnaire or bucket style hat which shades face, nose, neck ears

Caps and visors are not enough

Question 22

What is the sun safety acronym?

Answer 22

Slip
Slop
Slap
seek
slide