Unit 2 - Dermatology 1 Flashcards
What type of acne can be managed by the pharmacist?
Mild acne
What type of acne should be referred to the GP?
Moderate to severe acne
What will the treatment of acne be dictated by?
The type of lesions
- inflammatory
- non-inflammatory
What are the BNF treatments for acne?
Topical benzoyl peroxide / azelaic acid Topical antibacterials - clindamycin - erythromycin Topical retinoids - adapalene - tretinoin - isotretinoin Oral antibiotics - oxytetracycline Oral anti-androgens - co-cyprindiol Oral retinoids - isotretoin
What are the BNF treatments for eczema?
Emollients - mainstay of treatment Topical corticosteroids Topical calcineurin inhibitors - pimecrolimus cream - tacrolimus ointment Oral immunomodulation - ciclosporin - azathioprine (unlicensed) - systemic corticosteroids Miscellaneous - wrapping - sometimes coal tar - alitretinoin (severe chronic hand eczema (NICE))
How is clear eczema treated?
Emollients
How is mild eczema treated?
Emollients
Mild topical corticosteroids
How is moderate eczema treated?
Emollients Topical corticosteroids - moderate body vs mild face/neck Topical calcineurin inhibitors (pimecrolimus) - body vs face/neck Bandages
How is severe eczema treated?
Emollients Topical corticosteroids - potent body vs moderate face/neck Topical tacrolimus Bandages Phototherapy Systemic therapy
What can be used to treat concurrent skin infections?
Topical antibacterials
Topical antibacterias in emollients
Topical antibiotics?
Oral antibiotics?
What is seborrhoeic eczema?
Common pattern of scaly eruption on scalp and around eyebrows, nose and ears
Which sex has a higher incidence of seborrhoeic eczema?
Adult form more common in males
When does seborrhoeic eczema usually first appear?
Puberty
What can seborrhoeic eczema resemble?
Dandruff
What can cause seborrhoeic eczema?
Pityrosporum ovale (yeast)
What should a pharmacist do with a patient if they suspect seborrhoeic eczema?
Refer to the GP
What can be used to treat seborrhoeic eczema?
Antifungal creams/shampoos
Mild corticosteroids
Describe discoid eczema
Well defined coin-like lesions
Scaly plaques
Very itchy
Who is more likely to suffer from discoid eczema?
Middle aged men
What should a pharmacist do with a patient if they suspect discoid eczema?
Refer to GP
What can be used to treat discoid eczema?
Topical corticosteroids
Describe pompholyx
Localised to palms of hands and soles of feet
Vesicles and blisters
Symmetrical presentation
What should a pharmacist do with a patient if they suspect pompholyx?
Refer to GP
What can be used to treat pompholyx?
Topical corticosteroids (moderate potency)
Describe psoriasis
Chronic inflammatory skin condition Affects 2-3% of the population 80 million sufferers worldwide Occurs commonly in second and sixth decades of life May be a lifelong condition Spontaneous exacerbations and remissions
What are the six different types of psoriasis?
- Chronic plaque psoriasis (most common - > 80%)
- Guttate psoriasis - acute form
- Pustular psoriasis
- Erythrodermic psoriasis
- Flexural psoriasis
- Palmoplantar pustular psoriasis
Describe chronic plaque psoriasis
- well defined, thickened red, symmetrical plaques ( > 2cm)
- silvery scales (hyperproliferation)
- scalp, extensor of limbs (elbows, knees, shins)
- flexures
- hands and feet
- itching can occur in up to 50%
- scalp involved in 80% of cases
- nails involved in 50% of cases
What are the major concerns with psoriasis?
Disfigurement and psychological morbidity Significant social implications - quality of life - jobs - social life - hobbies Infection risk Risk of co-morbidities - skin cancer - cardiovascular complications
What are the BNF treatments for psoriasis?
Topical - emollients including olive oil - topical corticosteroids - topical Vitamin D analogues - coal tar - tazarotene - salicylic acid (scalp) often combined with coal tar - dithranol Phototherapy Chemotherapy Systemic - methotrexate - ciclosporin
What is the mainstay of psoriasis treatment on the trunk and limbs?
Vitamin D analogues
Potent corticosteroids
Initial treatment is both treatments
- one in morning
- one in evening
What is the first line treatment of psoriasis on the face, flexures, scalp and genitals?
Mild/moderate corticosteroid
What is the second line treatment of psoriasis on the face, flexures, scalp and genitals?
Vitamin D analogues
Coal tar preparations
What is the role of pharmacists in the treatment of psoriasis and eczema?
Patients are disappointed in prescribed treatments for psoriasis and eczema
- educate on use of creams
- be aware of side effects
- offer practical advice
- look out for drugs that may induce eczema/psoriasis
- look out for drugs that may cause photosensitivity in phototherapy patients
What is hyperhidrosis?
Excessive sweating from the eccrine sweat gland
What are the issues with hyperhidrosis?
Significant impact on quality of life
Limited simple treatment options
What are the treatment options for hyperhidrosis?
Aluminium chloride hexhydrate - can be purchased from the pharmacy Glycopyrronium bromide - outpatient appointment in combination with iontophoresis Botulinum toxin - outpatient appointment - Botox only licenced brand in the UK
Which drugs are frequently indicated in drug induced rashes?
- antibiotics
- sulphonamides
- thiazides
- barbiturates
- anticonvulsants
- salicylates
- gold
What types of rashes can be produced by taking medicines?
Toxic erythema
Urticaria (hives)
Eczematous lesions
Acneiform eruptions
Which drugs can produce photosensitivity?
Amiodorone Tetracyclines NSAIDs Sulphonamides Quinolones Thiazides Tricyclic antidepressants
