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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
Q

Describe acne + what it is characterised by

A
  • Chronic inflammatory disorder of sebaceous unit
  • Inc sebum prod
  • Hormone levels
  • Drug induced: contraceptives, phenytoin + lithium
26
Q

When should acne be referred?

A
  • Drug induced
  • Severe
  • Failed treatment
  • Extreme distress
27
Q

What is the OTC treatment of acne?

A

Benzoyl peroxide:

  • Causes: dryness, irritation + peeling
  • Sun beneficial but avoid strong sun
  • Takes upto 4 weeks, refer if no response after 8 wks
28
Q

Outline the causes, symptoms + triggers of cold sores

A
  • 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
Q

What are the stages of cold sores?

A
  • Prodromal phase - tingling
  • Eruption of vesicles w/in 24hrs
  • Rupture of vesicles - painful, weeping
  • Crusting/scab
  • 10-14 days to heal
30
Q

What OTC treatment is used for cold sores?

A

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
Q

What can be used after vesicles have erupted, as a treatment for cold sores?

A
  • Local anaesthetic

- Antiseptics

32
Q

When should cold sores be referred?

A
  • Affecting eye
  • Frequent severe attacks
  • Pregnant
  • Genital lesions
  • Lesions in mouth
  • Patient on immunosuppressive therapy
  • Infants
  • Painless lesions (cancer)
33
Q

What can be considered when differentiating btw cold sores + impetigo?

A
  • Age
  • History of cold sore
  • Presence of itch
  • Absence of tingling
  • Colour of scabs
34
Q

What is impetigo?

A
  • 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
Q

What is chickenpox?

A
  • 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
Q

What is the treatment for chickenpox?

A
  • 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
Q

Why should NSAIDs be avoided in children w/ chickenpox?

A
  • Inc risk of necrotizing soft tissue infections + secondary infections caused by invasive streptococci
  • Inc risk of skin reactions
38
Q

What is shingles caused by what what are the symptoms?

A
  • Reactivation of herpes zoster
  • Pain before rash appears
  • Unilateral rash of red papules
  • Change to vesicles then scabs
  • Pain persist
39
Q

Outline the treatment for shingles?

A
  • 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
Q

What is tinea pedis?

A
  • 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
Q

What is the treatment of athletes foot?

A

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
Q

Give counselling points for someone w/ athlete’s foot

A
  • 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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