Week 23 - skin Flashcards
Eczema and dermatitis
These two terms are often used interchangeably;
->Eczema often reserved for atopic eczema and dermatitis for
contact dermatitis
Atopic eczema
->Chronic, itchy skin condition – common in children
->Often accompanies other “atopic” conditions
->Rash is dry, flaky and inflamed
->Aetiology unclear – trigger factors
Contact dermatitis
-Commonly on the hands
-Consider patient history and occupation
-Nappy rash is a type of contact dermatitis
Eczema and dermatitis - treatments
Although different aetiology the treatments for atopic eczema and contact dermatitis can be similar
Emollients
They soothe the skin and can form a waterproof barrier to prevent drying
->May be applied to soothe the skin or used as soaps or bath
additives
Topical corticosteroids
w/v, are available as P medicines
More potent corticosteroids are also available
Antipruritics
To prevent itching are also available but generally not
recommended (Doxepin Cream is POM)
Seborrhoeic dermatitis
Affects the sebaceous gland-rich regions of the skin, e.g. scalp
->Can also occur at other hairy sites, e.g. under arms, chest
Dandruff is an (uninflamed) form of seborrhoeic dermatitis
-Presents as scaly patches which typically do not itch
->May be referred to as “cradle cap” in babies
-Treatment may involve the use of keratolytics such as salicylic acid
-Antifungals may also be required
-For infants: mild shampoos +/- baby oil
When to refer (eczema and dermatitis)
-Infected rashes, e.g. weeping from the rash
-Suspected ADR or unidentifiable cause
-Failed medication, e.g. >1 week of topical corticosteroid use
-Always consider meningitis / septicaemia
Psoriasis
A skin condition sometimes confused with eczema
Characterised by inflamed skin topped with silver or white “plaques”
Cause unclear but immune system believed to be involved
Mild psoriasis typically treated with topical agents:
-Emollients
-Coal tar preparations
-Dithranol and salicylic acid
-Topical corticosteroids
Phototherapy is an option for treatment
Skin infections (Fungal)
-Ringworm
-Ringworm of the scalp
-Fungal nail infections
-Athletes foot
Ringworm
A fungal infection that
presents as a circular rash
->Spread by person-person / person-animal contact
Ringworm of the scalp
Rare and should be referred
Fungal nail infections
Should be referred as system antibiotics usually required
Athlete’s foot
A fungal foot infection usually spread by person-person
contact or from shared towels,
changing rooms etc…
Skin infections (fungal) – treatment
-Ringworm and athlete’s foot can be treated OTC with topical antifungals
-Imidazoles, e.g. miconazole cream (Daktarin®), are the
usual first line treatment for ringworm and are also used for
athlete’s foot
-Itraconazole and terbinafine (an allylamine) are also used OTC in athlete’s foot treatment
-Powder and spray formulations are commonly used for athlete’s foot
When to refer (fungal)
-Treatment failure (>2 weeks)
-Bacterial infection
-Diabetic patients
-Involvement of the nail
Skin infections (herpes)
Herpes simplex labialis or cold sores can usually be managed OTC
->Skin infection – usually around lips / nose caused by the herpes simplex virus (HSV-1 in most cases)
Triggered by various factors;
-Sunlight
-Other infections (colds / flu)
-Menstrual cycle
->Treatment OTC with aciclovir 5% cream (apply 5 × 5 + 5)
When to refer (herpes)
-Eyes / genital regions affected
-Age of patient? (Zovirax® cream has no age restrictions)
-Painless, in the mouth or lasting >2 weeks
-Immunocompromised
Warts and verrucae
Small growths on the skin caused by human papillomavirus (HPV)
->Peak incidence in secondary school children
-A verruca (plantar wart) is just a wart on the plantar region, i.e. sole of foot
-Warts / verrucae contain a network of capillaries
->Warts and verruca will eventually resolve without treatment, but the appearance can be distressing for patients
Warts and verruca (treatment)
Treatment options typically use keratolytics:
-Salicylic acid based products are commonly used -> this active ingredient gradually destroys the affected area
-Care to ensure that the formulation is only applied to the wart / verruca (protect surrounding skin with white soft paraffin)
->Emphasise that successful treatment may take >3 months
-Cryotherapy used to freeze off wart (10-14 days) – home kits available
When to refer (warts and verrucae)
->Suspicious changes in shape or colour +/- bleeding and itching
(A) Asymmetrical – melanomas usually irregular shape
(B) Border – melanoma border often “ragged”
(C) Colours – at least 2 colours
(D) Diameter – most melanomas >6mm in diameter
(E) Evolving – moles that change in size may be a melanoma
->Diabetic and immunocompromised patients
->Anogenital warts in children
->Failed treatment
Acne
Acne vulgaris = common acne
Hair follicles and sebaceous glands become blocked
High incidence in teenagers and
largely affects the face, but back and chest are other common sites
Classified as mild / moderate / severe
Acne – treatments
Mild to moderate acne can be managed without referral
-Many OTC products are available
-Benzoyl peroxide is usually the first line treatment
-2.5%, 5% and 10% strengths available – start with lowest
-Treatment required for at least 6-8 weeks
-Antibiotics and retinoids are POMs and require referral
-Sunlight may help, avoid greasy foundation
When to refer (acne)
-Severe acne
-Treatment failure
-Suspected ADR
-ABCDE concerns
-Causing mental health issues
Scabies
-Scabies is an intensely itchy skin condition caused by a mite that burrows through the skin causing a rash
-Burrows are often seen on the palms of the hands but rash and itching can be at other sites
-Passed on through close personal contact – common in schools, universities, care homes ->Can be up to 2 months before symptoms start to appear
Scabies - treatments
-Two applications of a topical acaricide required 7 days apart
-Must be left on for 12-24 hours depending on the acaricide used
->Other household members should be treated at the same time
-Treatment can worsen the itch initially
When to refer (scabies)
-Age: young children and elderly
-Outbreaks suspected, e.g. in a school
-Crusted scabies (hyper-infection with mites)
-Infected rash
-Treatment failure
-Acquired through sexual activity
Communicable diseases
Many (typically childhood) communicable diseases present with skin rashes
E.g., shingles more likely in elderly individuals
If fever and/or malaise then unlikely to be a simple skin condition ->consider communicable diseases
Referral required if suspected bacterial skin infection (particularly in diabetic patients, respiratory symptoms
E.g., measles, chickenpox, rubella, shingles
Red flags
-Skin cancer (ABCDE)
-Meningitis – petechial rash
-Erythroderma (>90% of skin affected)
-Bullous disorders
-Suspected ADR
