Unit 2 - Dermatology 1

Question 1

What type of acne can be managed by the pharmacist?

Answer 1

Mild acne

Question 2

What type of acne should be referred to the GP?

Answer 2

Moderate to severe acne

Question 3

What will the treatment of acne be dictated by?

Answer 3

The type of lesions

• inflammatory
• non-inflammatory

Question 4

What are the BNF treatments for acne?

Answer 4

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

Question 5

What are the BNF treatments for eczema?

Answer 5

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))

Question 6

How is clear eczema treated?

Answer 6

Emollients

Question 7

How is mild eczema treated?

Answer 7

Emollients

Mild topical corticosteroids

Question 8

How is moderate eczema treated?

Answer 8

Emollients
Topical corticosteroids
- moderate body vs mild face/neck
Topical calcineurin inhibitors (pimecrolimus)
- body vs face/neck
Bandages

Question 9

How is severe eczema treated?

Answer 9

Emollients
Topical corticosteroids
- potent body vs moderate face/neck
Topical tacrolimus
Bandages
Phototherapy
Systemic therapy

Question 10

What can be used to treat concurrent skin infections?

Answer 10

Topical antibacterials
Topical antibacterias in emollients
Topical antibiotics?
Oral antibiotics?

Question 11

What is seborrhoeic eczema?

Answer 11

Common pattern of scaly eruption on scalp and around eyebrows, nose and ears

Question 12

Which sex has a higher incidence of seborrhoeic eczema?

Answer 12

Adult form more common in males

Question 13

When does seborrhoeic eczema usually first appear?

Answer 13

Puberty

Question 14

What can seborrhoeic eczema resemble?

Answer 14

Dandruff

Question 15

What can cause seborrhoeic eczema?

Answer 15

Pityrosporum ovale (yeast)

Question 16

What should a pharmacist do with a patient if they suspect seborrhoeic eczema?

Answer 16

Refer to the GP

Question 17

What can be used to treat seborrhoeic eczema?

Answer 17

Antifungal creams/shampoos

Mild corticosteroids

Question 18

Describe discoid eczema

Answer 18

Well defined coin-like lesions
Scaly plaques
Very itchy

Question 19

Who is more likely to suffer from discoid eczema?

Answer 19

Middle aged men

Question 20

What should a pharmacist do with a patient if they suspect discoid eczema?

Answer 20

Refer to GP

Question 21

What can be used to treat discoid eczema?

Answer 21

Topical corticosteroids

Question 22

Describe pompholyx

Answer 22

Localised to palms of hands and soles of feet
Vesicles and blisters
Symmetrical presentation

Question 23

What should a pharmacist do with a patient if they suspect pompholyx?

Answer 23

Refer to GP

Question 24

What can be used to treat pompholyx?

Answer 24

Topical corticosteroids (moderate potency)

Question 25

Describe psoriasis

Answer 25

``` 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 ```

Question 26

What are the six different types of psoriasis?

Answer 26

1. Chronic plaque psoriasis (most common - > 80%) 2. Guttate psoriasis - acute form 3. Pustular psoriasis 4. Erythrodermic psoriasis 5. Flexural psoriasis 6. Palmoplantar pustular psoriasis

Question 27

Describe chronic plaque psoriasis

Answer 27

- 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

Question 28

What are the major concerns with psoriasis?

Answer 28

``` Disfigurement and psychological morbidity Significant social implications - quality of life - jobs - social life - hobbies Infection risk Risk of co-morbidities - skin cancer - cardiovascular complications ```

Question 29

What are the BNF treatments for psoriasis?

Answer 29

``` 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 ```

Question 30

What is the mainstay of psoriasis treatment on the trunk and limbs?

Answer 30

Vitamin D analogues Potent corticosteroids Initial treatment is both treatments - one in morning - one in evening

Question 31

What is the first line treatment of psoriasis on the face, flexures, scalp and genitals?

Answer 31

Mild/moderate corticosteroid

Question 32

What is the second line treatment of psoriasis on the face, flexures, scalp and genitals?

Answer 32

Vitamin D analogues | Coal tar preparations

Question 33

What is the role of pharmacists in the treatment of psoriasis and eczema?

Answer 33

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

Question 34

What is hyperhidrosis?

Answer 34

Excessive sweating from the eccrine sweat gland

Question 35

What are the issues with hyperhidrosis?

Answer 35

Significant impact on quality of life | Limited simple treatment options

Question 36

What are the treatment options for hyperhidrosis?

Answer 36

``` 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 ```

Question 37

Which drugs are frequently indicated in drug induced rashes?

Answer 37

- antibiotics - sulphonamides - thiazides - barbiturates - anticonvulsants - salicylates - gold

Question 38

What types of rashes can be produced by taking medicines?

Answer 38

Toxic erythema Urticaria (hives) Eczematous lesions Acneiform eruptions

Question 39

Which drugs can produce photosensitivity?

Answer 39

``` Amiodorone Tetracyclines NSAIDs Sulphonamides Quinolones Thiazides Tricyclic antidepressants ```