Wk 30 - Dermatology OTC Flashcards
Give examples of the clinical variants of eczema
- Atopic
- Irritant contact
- Allergic contact
- Seborrheic gravitational
- Asteatotic
- Pompholyx
- Discoid
- Chronic hand
What are the common features of eczema?
Dry, red + itchy skin
What is eczema usually characterised by?
Acute:
- Erythema
- Vesiculation
Chronic:
- Dryness
- Lichenification
- Fissuring
What is atopic eczema?
State of hypersensitivity to common env allergens that may be inherited
Outline the features of atopic eczema
- Starts in childhood
- Improvement by adulthood
- Links w/: asthma, hay fever, fam history
What causes atopic eczema?
Barrier lipids in lower part of stratum corneum not formed normally = dysfunctional skin barrier + immune system dysregulation
What does atopic eczema lead to?
- 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
What are the symptoms of atopic eczema?
Itch
Under 2:
- Visible flexural dermatitis
- History of other atopic: asthma + hay fever
Adults:
Dryness + itching when exposed to irritants
What are the complications of atopic eczema?
- 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
What is contact dermatitis?
Inflammation of skin in response to external agents
What is the difference between allergic contact dermatitis + irritant contact dermatitis?
Allergic contact dermatitis involve T-cell mediated immunity
Give examples of common allergens of allergic contact dermatitis
- Nickel
- Topical antibiotics
- Preservative chemicals
- Fragrances
- Rubber accelerators
What are the typical features of irritant contact dermatitis?
- Burning, stinging + soreness
- Onset w/in 48 hrs/immediate
- Rash in areas exposed to irritant
- Resolution occurs quickly after removal of irritant (4 days)
What are the typical features of allergic contact dermatitis?
- Redness, itch + scaling
- Delayed onset
- Rash in areas which haven’t been in contact w. allergens
- Resolution takes longer than irritant
What is the management of irritant contact dermatitis?
- 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
Describe the process of the mainstay of treatment of emollients
Form oily layer over skin preventing water evap + mimic barrier effects of lipid
Describe the complete emollient therapy
- Frequent applications of creams/ointments
- Bath oil when bathing/showering
- Routine use of emollient soap subs
- Avoidance of reg soaps/detergents/bubble baths
Outline factors to consider when using emollients
- 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
Describe the application process of emollients
- 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
What is the recommended quantities of emollients in generalized eczema?
- 500g/wk adult
- 250g/wk child
Topical corticosteroids
- Treat: flares of eczema, psoriasis
- Inhibit prod + action of inflammatory mediators, red inflammation + itch
- Not for face/genitals
- OTC: hydrocortisone (10), clobetasone (12)
When should hydrocortisone cream, 1% be used?
- 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
When should clobetasone cream 0.05% be used?
- 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
Give counselling points for OTC corticosteroids
- 1 FTU
- Wait 10-30mins after applying emollient, to apply corticosteroid
Describe acne + what it is characterised by
- Chronic inflammatory disorder of sebaceous unit
- Inc sebum prod
- Hormone levels
- Drug induced: contraceptives, phenytoin + lithium
When should acne be referred?
- Drug induced
- Severe
- Failed treatment
- Extreme distress
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
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
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
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
What can be used after vesicles have erupted, as a treatment for cold sores?
- Local anaesthetic
- Antiseptics
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)
What can be considered when differentiating btw cold sores + impetigo?
- Age
- History of cold sore
- Presence of itch
- Absence of tingling
- Colour of scabs
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
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
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
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
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
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)
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
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
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
