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PHA333 > Wk 30 - Dermatology OTC > Flashcards

Wk 30 - Dermatology OTC Flashcards

1
Q

Give examples of the clinical variants of eczema

A
  • Atopic
  • Irritant contact
  • Allergic contact
  • Seborrheic gravitational
  • Asteatotic
  • Pompholyx
  • Discoid
  • Chronic hand
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2
Q

What are the common features of eczema?

A

Dry, red + itchy skin

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3
Q

What is eczema usually characterised by?

A

Acute:
- Erythema

  • Vesiculation

Chronic:
- Dryness

  • Lichenification
  • Fissuring
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4
Q

What is atopic eczema?

A

State of hypersensitivity to common env allergens that may be inherited

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5
Q

Outline the features of atopic eczema

A
  • Starts in childhood
  • Improvement by adulthood
  • Links w/: asthma, hay fever, fam history
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6
Q

What causes atopic eczema?

A

Barrier lipids in lower part of stratum corneum not formed normally = dysfunctional skin barrier + immune system dysregulation

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7
Q

What does atopic eczema lead to?

A
  • Inc water loss from stratum corneum - dryness + itching
  • Skin susceptible to allergens + hyperreactive
  • Predisposed to infection by stap. a
  • Soap removes more lipid + red barrier function
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8
Q

What are the symptoms of atopic eczema?

A

Itch

Under 2:
- Visible flexural dermatitis

  • History of other atopic: asthma + hay fever

Adults:
Dryness + itching when exposed to irritants

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9
Q

What are the complications of atopic eczema?

A
  • Bacterial infection: scratching + excoriation of skin causing secondary infection (crusting, weeping, fever, malaise)
  • Folliculitis crusting: treat w/ potassium permanganate/antiseptic bath prods eg. dermol
  • If severe: oral antibiotics
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10
Q

What is contact dermatitis?

A

Inflammation of skin in response to external agents

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11
Q

What is the difference between allergic contact dermatitis + irritant contact dermatitis?

A

Allergic contact dermatitis involve T-cell mediated immunity

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12
Q

Give examples of common allergens of allergic contact dermatitis

A
  • Nickel
  • Topical antibiotics
  • Preservative chemicals
  • Fragrances
  • Rubber accelerators
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13
Q

What are the typical features of irritant contact dermatitis?

A
  • Burning, stinging + soreness
  • Onset w/in 48 hrs/immediate
  • Rash in areas exposed to irritant
  • Resolution occurs quickly after removal of irritant (4 days)
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14
Q

What are the typical features of allergic contact dermatitis?

A
  • Redness, itch + scaling
  • Delayed onset
  • Rash in areas which haven’t been in contact w. allergens
  • Resolution takes longer than irritant
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15
Q

What is the management of irritant contact dermatitis?

A
  • Avoid irritant
  • Use gloves w/ cotton liner , take off gloves regularly as sweating may aggravate dermatitis
  • Heavy emollients: improve barrier function
  • Topical corticosteroids also used
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16
Q

Describe the process of the mainstay of treatment of emollients

A

Form oily layer over skin preventing water evap + mimic barrier effects of lipid

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17
Q

Describe the complete emollient therapy

A
  • Frequent applications of creams/ointments
  • Bath oil when bathing/showering
  • Routine use of emollient soap subs
  • Avoidance of reg soaps/detergents/bubble baths
18
Q

Outline factors to consider when using emollients

A
  • Cream less effective than ointment + sting more but less greasy + light on skin
  • Creams: skin infected/oozing
  • Ointment: dry scaly thick areas
  • Aqueous cream unsuitable as leave on emollient as contains sodium lauryl sulphate
  • Fire hazard w/ paraffin
  • Slipping hazard
19
Q

Describe the application process of emollients

A
  • Apply 30-60 mins before topical steroid to avoid dilution
  • Apply direction of hair growth to red risk of folliculitis
  • Emollient should outweigh steroid by 10:1
20
Q

What is the recommended quantities of emollients in generalized eczema?

A
  • 500g/wk adult

- 250g/wk child

21
Q

Topical corticosteroids

A
  • Treat: flares of eczema, psoriasis
  • Inhibit prod + action of inflammatory mediators, red inflammation + itch
  • Not for face/genitals
  • OTC: hydrocortisone (10), clobetasone (12)
22
Q

When should hydrocortisone cream, 1% be used?

A
  • Mild/mod eczema, contact dermatitis + insect bites
  • Apply upto bd, no more than 7 days
  • Not on broken/infected skin
  • Not on face/neck except earlobes
  • Not for <10
  • Not for pregnant
  • Not for ano-genital area
23
Q

When should clobetasone cream 0.05% be used?

A
  • Mild/mod eczema + contact dermatitis
  • Apply upto bd, no more than 7 days
  • Not on broken/infected skin
  • Not on face/neck except earlobes
  • Not for <12
  • Not for pregnant
  • Not for ano-genital area
24
Q

Give counselling points for OTC corticosteroids

A
  • 1 FTU

- Wait 10-30mins after applying emollient, to apply corticosteroid

25
Describe acne + what it is characterised by
- Chronic inflammatory disorder of sebaceous unit - Inc sebum prod - Hormone levels - Drug induced: contraceptives, phenytoin + lithium
26
When should acne be referred?
- Drug induced - Severe - Failed treatment - Extreme distress
27
What is the OTC treatment of acne?
Benzoyl peroxide: - Causes: dryness, irritation + peeling - Sun beneficial but avoid strong sun - Takes upto 4 weeks, refer if no response after 8 wks
28
Outline the causes, symptoms + triggers of cold sores
- Cause: reactivation of herpes simplex virus - Symptoms: Painful crops of small blisters + lesions inside mouth or eye (refer) - Triggers: sun, trauma, emotional upset, menstruation + illness
29
What are the stages of cold sores?
- Prodromal phase - tingling - Eruption of vesicles w/in 24hrs - Rupture of vesicles - painful, weeping - Crusting/scab - 10-14 days to heal
30
What OTC treatment is used for cold sores?
Aciclovir cream 5% - Best sued in tingling stage for max effect - Can dec length of time of attack - Apply to face only - Apply 5x daily - Apply sunblock to lips - TRed spread of infection - avoid kissing newborns
31
What can be used after vesicles have erupted, as a treatment for cold sores?
- Local anaesthetic | - Antiseptics
32
When should cold sores be referred?
- Affecting eye - Frequent severe attacks - Pregnant - Genital lesions - Lesions in mouth - Patient on immunosuppressive therapy - Infants - Painless lesions (cancer)
33
What can be considered when differentiating btw cold sores + impetigo?
- Age - History of cold sore - Presence of itch - Absence of tingling - Colour of scabs
34
What is impetigo?
- Highly contagious spreading via touch - Due to staphcoc or streptcoc pyogenes - Develops on face as small red lesions which weep + form yellow crust - Treatment: hydrogen peroxide 1% cream (apply 2-3x day for 5 days) - Or refer antibiotics flucloxacillin or topical fusidic acid - Use own towels + children kept away from school til rash clears
35
What is chickenpox?
- Caused by varicella zoster, virus resides in dorsal route ganglia of CNS - Transmitted via airborne inhalation/exudate from lesions/lesion infected clothing - Incubation: 11-21days + infectious 1-2 days before + around 6 days after 1st crop of vesicles appear - Prodromal phase: 3 days of fever, headache + ore throat - Lesions develop on head, neck + trunk
36
What is the treatment for chickenpox?
- Oral = rarely - Fluids - 1st line paracetamol, NSAIDS avoided - Antihistamines - Frequent cool washes w/ sodium bicarbonate - Topical application of calamine lotion/cream - Oral aciclovir for adults/immunocompromised patients - Antibiotics in secondary infections
37
Why should NSAIDs be avoided in children w/ chickenpox?
- Inc risk of necrotizing soft tissue infections + secondary infections caused by invasive streptococci - Inc risk of skin reactions
38
What is shingles caused by what what are the symptoms?
- Reactivation of herpes zoster - Pain before rash appears - Unilateral rash of red papules - Change to vesicles then scabs - Pain persist
39
Outline the treatment for shingles?
- Painkillers - Emollients - Calamine lotion - If POM treatment required, start promptly - Try not to scratch lesions (apply antipruritic) - Highly contagious esp before rash - Antiviral treatment - Eye involvement (refer)
40
What is tinea pedis?
- Athletes foot - Fungus likes soft moist conditions - Presents as: red + itchy btw toes then white, soggy + sore - Can spread over sides + sole of feet + small vesicles on instep
41
What is the treatment of athletes foot?
Imidazole anti-fungals: - Clotrimazole 1% (Canesten) - Clotrimazole + hydrocortisone - Miconazole (Daktarin range) - Ketoconazole (Daktarin Gold) - Bifonazole(Canesten) Terbinafine (Lamisil AT; Lamisil Once) - Lamisil AT not for <16 - Lamisil once for >18
42
Give counselling points for someone w/ athlete's foot
- Hygiene - Wash feet twice daily + dry thoroughly - Apply cream widely to include infected area + 2 inches around to treat spores - Don't share towels - Avoid wearing same pair of shoes everyday - Wash socks/tights at high temp - Refer if area is hot/red - Nail infected: treat w/ amorolfine

PHA333 (35 decks)

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