W25 CAS Skin Conditions Flashcards
1
Q
What are the skin related CAS conditions?
A
- Acne
- Athlete’s foot
- Chickenpox
- Cold sores
- Dry skin
- Ingrowing toenail
- Nappy rash
- Ringworm, tinea cruris & intertrigo
- Scabies
- Warts & Verrucae
2
Q
What is Acne?
A
- Chronic, inflammatory skin condition
- Blocked, inflamed pilosebaceous unit
- Affects areas with high amounts of pilosebaceous units
- Face, back, chest
- Peaks in adolescence but can affect any age
- Non-inflammatory comedones
- Whiteheads (open) & blackheads (closed)
- Inflammatory papules, pustules, nodules cysts
3
Q
Treatment of Acne? (Offered by CAS)
A
- Mild to moderate acne
1. Benzoyl Peroxide 3 or 5% with clindamycin 1% gel (DUAC Once daily gel)
2. Benzoyl Peroxide 5% gel – only if other options not suitable - 12 week course of 1st line treatment applied once daily in the evening
- 30 or 60g packs
- Products supplied under PGD
4
Q
What is the Counselling/Self care advice for acne?
A
- Do not pick or squeeze spots
- Wash area max. twice a day with mild soap/cleanser, avoid hard scrubbing
- Avoid using heavy make –up & cosmetics, avoid oil based products, remove make up at end of day
- Clean skin with non-alkaline skin cleansing product
- Shower after exercise, wash hair regularly
- Apply gel sparingly after washing and drying affected area – pat dry
- Apply to whole affected area (e.g. whole face) OD/BD
- Advise on skin irritation, bleaching effect & light sensitivity – start with alt. days & short contact application
- Benzoyl Peroxide can bleach clothes and hair
- Can take up to 6 weeks to notice effect
5
Q
When is a GP Referral required for acne?
A
- Moderate/Severe Acne
- No improvement or worsening within 6 weeks
6
Q
What is ATHLETE’S FOOT?
A
- AKA Tinea Pedis
- Fungal/dermatophyte infection affecting feet
- Overgrowth of fungus due to warm, humid, wet conditions in feet –sweaty feet
- Picked up by walking barefoot in areas where someone with athlete’s foot has been
- Itchy, white/red, scaly, blistering, cracking skin between toes
- Can spread to soles of foot and nails
=Can treat with topical corticosteroid if there’s a lot of inflammation or dry skin
7
Q
What is athlete’s foot treated with? (general)
A
- Treated with antifungal agents – Clotrimazole, Terbinafine, Miconazole
- Can treat with topical corticosteroid if there’s a lot of inflammation or dry skin
8
Q
What are 4 treatments for Athlete’s foot?
A
- Clotrimazole 1% Cream (Canesten)
* up to 3x 20g tubes, max. 2 supplies per year
* Apply 2-3 times daily & use for at least 4 weeks - Miconazole 2% Cream (Daktarin)
* up to 2x30g tubes, max. 2 supplies per year
* Apply BD, continue for 10 days after healing
* Avoid in patient taking Warfarin - Terbinafine 1% Cream
* up to 1x30g tubes, max. 2 supplies per year
* Apply OD-BD for 1 week - Hydrocortisone 1% cream
* 1 x 15g tube, max. 2 supplies per year
* Max 7 days treatment
9
Q
Athletes foot- what is advice for patients? (From PIL)
A
- Wash and dry the affected skin before applying treatment and clean your hands afterwards
- Antifungal treatment should be applied to the affected skin and surrounding area
- Do not scratch affected skin as this can spread the infection to other parts of your body
- Seek medical advice if the condition does not improve within a week of treatment
- Wear footwear that keeps the feet cool and dry, leaving shoes and socks off as much as possible when at home
- Change to a different pair of shoes every 2-3 days
Wash the feet daily, then dry them thoroughly, especially between the toes - Avoid using moisturisers between the toes because this may help fungi to multiply
- Antifungal dusting powders may help prevent re-infection
- Do not share towels and wash them frequently
- Avoid going barefoot in public places
10
Q
ATHLETE’S FOOT - GP referral
A
Severe or extensive symptoms
* Signs/symptoms of bacterial symptoms – what are these?
* Recurrent episodes – Why?
* No improvement after 1 week
* Pain & discomfort
* Patient is immunocompromised
* Poorly controlled diabetes and not reviewed in last 3 months
11
Q
What is Chicken pox?
A
- Acute viral disease
- Caused by varicella-zoster virus
- Common childhood illness but can also affect adults
- Rash – small, red, raised spots, itchy, blisters/vesicles present
- Commonly on face, scalp, trunk and limbs
- Also fever & malaise
- Very infectious – stay off school/nursery until all blisters scabbed over
- Children under 14 under CAS
12
Q
What are the treatments for chicken pox?
A
- Paracetamol 120mg/5ml (100ml) or 250mg/5ml SF oral suspension (200ml)
-Not for children under 3 months - Paracetamol 500mg tablets x 32
- Chlorphenamine 2mg/5ml SF oral solution 150ml
-Not to be given to children under 1 - Chlorphenamine 4mg tablets x 28
-Not for children under 6
13
Q
What is the self management advice for chicken pox?
A
- Adequate fluid intake
- Appropriate clothing to avoid overheating or shivering – smooth, cotton fabrics
- Keep nails short and clean to minimise skin damage from scratching – mittens for younger children
- Lukewarm/cool bath - dab/pat dry
- Calamine lotion/cream, emollients, cooling gels
- Advise on signs of bacterial infection
14
Q
Chicken pox
What must you NOT ADVISE OR SUPPLY?
Why-complications?(2)
A
IBUPROFEN
* increased risks of skin infection & necrotising fasciitis
* Increased pneumonia risk in children with respiratory problems
15
Q
CHICKEN POX – GP REFERRAL
When to refer?
A
- Unsure over diagnosis
- Systemically unwell, deterioration, complications, no improvement in 6 days
- Baby less than 4 weeks old – Disseminated/haemorrhagic varicella risk
- Suspected bacterial infection
- Dehydration
- Associated respiratory symptoms – cough, SOB, chest pain/tightness
16
Q
What are COLD SORES?
A
- Small vesicles/blisters around the mouth and on lips
- Herpes simplex virus (HSV)
- Exists in a latent state and can remain latent indefinitely, or reactivate to cause clinical infection
- Tingling, itching burning around the mouth before blisters appear
- Self-limiting – can heal in 7-10 days
- Poor evidence for topical antiviral treatment efficacy
17
Q
What are the triggers for cold sores?
A
- Illness/infection
- Strong sunlight
- Fatigue
- Stress/upset
- Injury to area
- Periods
18
Q
Cold sores
Advice only under CAS
What advice to give?
A
- Minimising transmission
- Avoid touching lesions
- Avoid kissing until completely healed
-newborn babies/immunocompromised - Avoid oral sex until healed
- Do not share lipstick/gloss/balm
- Drink adequate fluids
- Avoid acidic/salty foods
- Eat soft, cool foods
- Risk of recurrence
- Use of sunscreen/sunblock lip balm
19
Q
Cold sores- When to refer to GP?
A
- Pregnancy
- Neonates
- Immunocompromised
- Recurrences – 6+/year
- Deterioration – spreading lesions, fever,
dehydration - No improvement after 5-7 days
