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PHARM 213 Dermatology > 5. Common Skin Conditions > Flashcards

5. Common Skin Conditions Flashcards

1
Q

Dermatitis/eczema:

Acute vs Chronic

A
  • “Inflammation of the dermis”
  • Acute: erythema (redness), itching, oedema, vesicles, weeping
  • Chronic: Skin thickening (‘lichenification’)
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2
Q

Types (3) of Dermatitis:

A
  1. Atopic Dermatitis:
    - Caused by genetic (filaggrin mutation) & environmental factors
    - Atopic eczema linked to asthma & hay fever etc
    - Affects 15-20% of children, with 80-90% resolved by teens, while 10% continue into adulthood
    - Scalp -> Face -> Flextures as child ages
  2. Irritant Contact Dermatitis:
    - Due to contact with irritant e.g. detergents, solvents, workplace products, water, saliva etc
    - Amount & strength of irritant is important
    - Need to pass a threshold of exposure to occur
  3. Allergic Contact Dermatitis:
    - Due to an allergic reaction to allergen in contact with the skin (Type 4 hypersensitivity)
    - Substances that can cause dermatitis include nickel, hair dyes, topical medications etc
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3
Q

Treatments: Emollients

A
  • Prevents water loss from skin & allergen development
  • Repairs epidermal barrier
  • Greasy: “Emulsifying ointment & Fatty cream”
  • Lighter: Cetomacrogol with glycerol
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4
Q 
Treatments: Steroids
Mild: 1x
Moderate: 2-25x
Potent: 100-150x
Ultrapotent: 600x
A
  • Mild: 1% hydrocortisone
  • Moderate: Clobetasone butyrate
  • Potent: Betamethasone valerate
  • Ultrapotent: Clobetasol propionate
  • Apply once daily using fingertip unit for hand (0.5g)
  • Diluting a steroid by half does not alter its efficacy or potency
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5
Q

Treatments: Topical immunomodulators

A
  • Calcineurin inhibitors (Pimecrolimus & Tacrolimus) are non-steroids so can be used around eyes & eyelids
  • Do not have problems associated with topical steroids
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6
Q

Treatments: Other (for dermatitis)

A
  • Systemic steroids
  • Phototherapy
  • Second line agents e.g. Methotrexate, Ciclosporin, Azathioprine
  • Biological agents
  • Janus kinase inhibitors
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7
Q

Psoriasis:

A
  • Affects 1-2% of population
  • Genetics & environment important (post strep throat, medication)
  • Any age but peaks at 15-25 & 50-60 years
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8
Q

Types (5) of Psoraisis:

Sites of involvement

A
  1. Chronic Plaque Psoriasis: Red scaly plaques often on elbows/knees
  2. Guttate Psoriasis: “Rain drops”, can occur after strep sore throat
  3. Generalised Pustular Psoraisis
  4. Localised Pustular Psoriasis: Palms & Soles
  5. Erythrodermic Psoriasis: Skin failure

Found at scalp, nails, umbilicus, axilla

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9
Q

What worsens Psoriasis?

A
  • Stress
  • Streptococci infection leads to guttate psoriasis
  • Drugs such as systemic & potent topical steroids, lithium
  • HIV/AIDS
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10
Q

Psoriasis associated conditions

A
  • Psoriatic arthritis
  • Coronary artery
  • Mortality, vascular disease
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11
Q

Treatments for Psoriasis

A
  1. Topical therapy:
    - Salicylic Acid
    - Steroids
    - Coal tar
    - (Dirthanol)
    - Calcipotriol
    - Combination - beta + calcipotriol
  2. Phototherapy
  3. Systemic therapy:
    - Methotrexate
    - Ciclosporin
    - Acitretin (requires contraceptive for 3 years after use)
    - Biologics: TNF-α (adalimumab)
    - Interleukin 17 (secukinumab)
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12
Q

Acne

  • Pathogenesis (3)
  • Aetiolgy (3)
A

Chronic inflammatory skin condition affecting face, neck, shoulders, chest & back

  • Disorder of the pilosebaceous gland
  • Blockage & rupture of the pilosebaceous duct
  • Rupture of comedones involves inflammatory response & scarring
  • Androgen-induced seborrhoea - excess grease
  • Comedone formation - blackheads & whiteheads
  • Cutibacterium acnes - colonisation of pilosebaceous duct
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13
Q

Factors that may modify (aggravate) acne

A
  • Hormones
  • Medicines: Corticosteroids, anabolic steroids, lithium, cyclosporin
  • Diet (weak evidence)
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14
Q

Acne vs Rosacea

A
  • Rosacea is indicated with redness, flushing, papule & pustules but NO comedones
  • Gritty eyes
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15
Q

Treatments for Mild Acne

A

Topical treatments:

  • Benzoyl peroxide
  • Azelaic acid
  • Antibiotics (clindamycin) in conjunction with other topical agent
  • Retinoids (adapalene, tretinoin)
  • Apply to all of the face for 3 months (minimum)
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16
Q

Treatments for Moderate Acne

A

Topical treatment + Oral treatment:

  • Antibiotics e.g. doxycycline, erythromycin
  • Hormones e.g. cyproterone + ethinyloestradiol
  • Treat for at least 3 months
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17
Q

Treatment for Severe Acne

A

Isotretinoin

  • Effective but has major adverse effects e.g. teratogenic, dry skin, photosensitivity, depression - Requires ~6-9 months treatment
  • Consider in mild acne as psychological distress can be severe
18
Q

Bacterial skin infections - impetigo

A
  • Acute superficial skin infection that affects mainly children
  • Golden crusted lesions
  • Caused by S. aureus
  • Associated with atopic dermatitis, scabies & skin trauma
  • Clinically diagnosed with swab (microscopy, culture & sensitivities)
19
Q

Treatment of impetigo

A
  • Topical antiseptic agents - hydrogen peroxide cream
  • Never use topical antibiotics - encourages resistance
  • Use oral antibiotics if extensive
20
Q

Fungal infections (4)

  • Diagnosis?
  • Differential diagnosis
A
  1. Tinea capitis: Can arise from animal fungus e.g Trichophyton verrucosum
  2. Tinea corporis (ringworm): itchy, red, scaly with a sharp edge
  3. Tinea pedis (athletes foot): well demarcated, red, itchy peeling skin caused usually by Trichophyton rubrum
  4. Onychomycosis (nail): clinically white/yellow, thickened, crumbly with source of tinea infection elsewhere

Diagnosis is usually done via skin scrapings/nail clippings before treatment

Differential diagnosis:

  • Dermatitis
  • Psoriasis
  • Mixed infection (macerated web spaces)
  • Bacterial infection - nail
21
Q

Treatment of fungal infections

A

Topical:

  • Miconazole, clotrimazole,
  • Terbinafine
  • Apply for once/twice daily until rash has resolved then for 3-5 days after

Systemic:

  • Terbinafine
  • Itraconazole (many drug interactions)
22
Q

Fungal infections: Pityriasis versicolor

  • Basic info
  • Treatments
A
  • Due to yeast Malassezia furfur
  • Seen in young adults (trunk)
  • Red, brown, plate patches
  • Causes dyspigmentation of the skin

Treatments:

  • Ketaconazole shampoo: Body scrub
  • Creams: Terbinafine, clotrimazole/miconazole
  • Oral: Itraconazole
23
Q

Fungal infections: Pityriasis capitis /Seborrhoeic dermatitis (dandruff)

  • Basic info
  • Treatments
A
  • Caused by Malassezia furfural yeast
  • Babies: Cradle cap
  • Adults: Scalp, eyebrows, behind ears, upper chest
  • Do not requires skin scraping

Treatments:

  • Topical: Miconazole-hydrocortisone cream, Ketaconazole shampoo
  • Systemic: Itraconazole
24
Q

Viral infections - Herpes simplex (cold sores)

A
  • Type I usually causes oral & facial infections
  • Type II usually causes genital & rectal infections (anogenital herpes)
  • Primary infection in infants & young children with virus becoming dominant in nerves (recurrence)
  • Recurrence can be triggered by trauma, infection, sun exposure, hormones, stress etc
  • Diagnosis: history of discomfort & itch with no rash then vesicles appear
  • Examination: Vesicles on red base & enlarged local lymph nodes
  • Normally heals in 7 - 10 days
25
Q

Treatments for Cold Sores

A
  • Oral antiviral agents: Acyclovir, Valaciclovir

- Topical antivirals

26
Q

Arthropod infections - Head lice (Pediculosis humanis capitis)

A
  • Small insects that infect human scalp, feed on human blood, cling to hair & rapidly moves
  • Common problem for children aged 4-14 years
  • Itchy scalp which may take several weeks to develop
  • Heavy infestation can lead to dermatitis, impetigo & swollen lymph nodes
27
Q

Treatment for head lice

A
  • Phenothrin shampoo

- Dimeticone (suffocants)

28
Q

Arthropod infections - Scabies (Sarcoptes scabiei)

A
  • Mites burrow underneath top layer of skin & breed, lay eggs, poo & die
  • Very itchy
  • Most patients only have ~10 mites - carefully examine finger webs, hands & wrists
  • Rash due to hypersensitivity to dead mites, faeces
  • Secondary infection common
29
Q

Treatment of Scabies

A
  • Topical: Permethrin cream
  • Oral: Ivermectin
  • Apply to all of the skin inc face in elderly & young
  • Treat all household contacts at once
30
Q

Arthropod infections - Others

A
  • Public lice
  • Ticks
  • Insects
  • Bed bugs
31
Q

Papular Urticaria

A
  • Grouped papule that are very itchy & last for days

- Caused by: Fleas, mosquitoes, mites etc

32
Q

Sunlight: UV radiation damages?

A
  • Damages melanocytes & keratinocyte nuclei

- Leads to DNA damage

33
Q

Acute effects of UV radiation

A

Sunburn:

  • 2-6 hours of exposure & peak at 12-24 hours
  • Pain swelling
  • Blistering (Severe)
  • Erythema
34
Q

Chronic effects of UV radiation

A
  • Photoageing
  • Dyspigmentation
  • Actinic keratoses
  • Skin cancer
35
Q

Skin cancer - 3 types

A

UV damage to epidermis:

  • Keratinocytes: Squamous cell carcinoma (1)
  • Melanocytes: Melanoma (2)
  • Basal cell carcinoma (3)
36
Q

Melanoma

  • Basic info
  • Common sites (NZ)
  • Tell tale signs
A
  • NZ has highest rate in the world
  • Maori & pacific peoples have lower chance of getting melanoma - often have more serious melanomas
  • Men: Back ~40%
  • Women: Legs ~35%
  • Change in pigmented lesion is most important clue
37
Q

Squamous cell carcinoma

- Basic info

A
  • Malignant proliferation of keratinocytes

- Can spread

38
Q

Basal cell carcinoma

- Basic info

A
  • Most common
  • Slow growing
  • Spread locally
  • Curable
39
Q

Pharmacists role in skin cancer

A
  • Advise patients on the correct use of sunscreen

- Nicotinamide 500 mg bd

40
Q

Nicotinamide in cancer prevention

A
  • Reduces UV induced immunosupression

PHARM 213 Dermatology (8 decks)

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