D&M Dermatology Flashcards
(20 cards)
1
Q
Dermatitis: When to refer – 6
A
- Children under 10 needing steroids – consider competency
- Lesions on face unresponsive to emollients – consider competency
- Treatment failure
- Suspect pompholyx – ‘bubble on the skin’ – itchy vesicles & blister on the palms of hands & soles of feet
- Widespread & severe
- Secondary infection
2
Q
Eczema & Dermatitis treatment – 5
A
- No cure but can be treated successfully with skin care & lifestyle measures e.g. gently dry skin after washing, avoid soaps, detergents (use substitute)
- Irritant & allergic eczema – avoid irritants
- Emollients – Main eczema treatment as they rehydrate skin & replace damaged lipid barrier. Reduces flair ups so should be used all the time. Usable on skin, as soap or as additive for bath/shower (use with cream). Advise to use liberally, often whole body. Apply 3-4/day and after showering or bathing. Consider light creams in day & ointments at night. Fire hazard for emulsifying ointment of 50:50 (liable to ignition with naked flames, especially when clothes soaked)
- Topical steroids – Used only for flare ups (reduces inflammation & itching), short term use no local S/Es. OTC restrictions (patients must be >10 for hydrocortisone, >12 for clobetasone, max use 7 days & 15g sold at once. Apple 1/2 daily, not on face, anogenital region, broken or infected skin. Use as per fingertip units. Should be applied at different times to emollients.
- Seborrhoeic dermatitis – use ketoconazole for 3-5mins twice weekly for 2-4 weeks then use every 1-2 weeks to prevent symptoms returning.
3
Q
Corticosteroids OTC - 3
A
- Hydrocortisone – mild. Apply twice daily for a maximum of seven days. Only for >10’s
- Clobetasone – moderate. Apply twice daily for a maximum of seven days. Only for >12’s
- For both: maximum of 15g can be sold at a time & must not be applied to the face, anogenital areas, broken or infected skin.
4
Q
Dermatitis & Eczema advice – 8
A
- Decrease levels of house dust mite
- Avoid drying soaps
- Avoid perfumed toiletries
- Avoid abrasive clothing
- Stress management
- Wet-wrap technique
- Sunshine
- No evidence that dietary manipulation has an effect
5
Q
Acne referral – 4
A
- Moderate or severe acne, especially where there is a risk of scarring (pus or scarring)
- Occupational/drug-induced acne
- OTC treatment failure – after 12 weeks of acne treatment OTC
- Rosacea (many lifestyle triggers – alcohol, spicy foods, extremes of temperatures)
6
Q
Acne OTC Treatment – 2
A
- Benzoyl peroxide gel – Apply once/twice a day
- Freederm gel/Nicotinamide 4% gel & lotion - Use twice daily sparingly following skin cleansing
7
Q
Acne advice - 6
A
- Avoid over-cleaning the skin (causes dryness & irritation). Use anti-bacterial skin & wash off sweat.
- To use a non-alkaline (skin pH neutral or slightly acidic) synthetic detergent cleansing product twice daily on acne-prone skin.
- Avoid oil-based comedogenic skin care products, make-up (remove at end of day) & sunscreens
- That persistent picking or scratching of lesions can increase the risk of scarring.
- Treatments may irritate the skin, especially at the start of treatment.
- A start with alternate day or short contact (wash off after an hour) to reduce skin irritation
8
Q
Fungal infections: Ringworm/Athlete’s foot - 5
A
- Itchy pink or red scaly patch with a well-defined inflamed boarder.
- The lesion will often show a central clearing as the central area is relatively resistant to colonisation.
- Lesions occur singly, be numerous or even overlap to produce a single large lesion & appear polycyclic.
- Can also spread to the buttocks & has well defined edges
- Additional advice should include changing underwear daily & ensure the patient does not have athlete’s foot. Should treat this athlete’s foot to prevent reinfection.
9
Q
Ringworm & athlete’s foot treatment - 2
A
- Clotrimazole cream – apply two to three times daily – normally for at least 2 weeks to see an improvement then another 7-14 once lesion heals. If groin add tolnifate.
- Terbinafine cream (Lamisil) – over 16’s only – apply once daily for 7 days only
10
Q
Ringworm & Athlete’s foot management – 8
A
- Wash affected area daily & dry carefully
- Do not share towels
- Avoid scratching the area since this might spread the infection further
- Wear non-occlusive footwear to minimise foot perspiration & alternate footwear every 2 to 3 days
- Wear cotton socks
- Use flip-flops in communal areas
- Consider anti-fungal sprays to eliminate spores
- No need for children to miss school
11
Q
Nail fungal infections: Referral – 7
A
- Those with conditions which predispose them to fungal infections
- Pregnant or breastfeeding women
- Under 18’s
- Those with fungal nail infections other than DLSO
- Those with more than TWO infected nails
- Nail dystrophy or a destroyed nail
- Failed treatment or no improvement within 3 months
12
Q
Fungal nail infection: Treatment - 5
A
- Amorolfine 5% nail lacquer: Topical anti-fungal, works by causing ergosterol depletion & accumulation of ignosterol – cell wall thickening
- Because nail grows very slowly, treatment is long
- Apply once weekly – 6 months for fingernails & 9-12 months for toenails
- Nail preparation prior to weekly application – filed & cleansed
- Return in 3 months. Treatment may take 6 months
13
Q
Fungal nail infection: Advice - 9
A
- Wash & dry feet thoroughly everyday
- Try to prevent infection spreading to other toes
- Avoid tight fitting or occlusive shoes
- Alternate use of shoes
- Exercise good nail care
- Use anti-fungal sprays in shoes
- Visit podiatrist regularly
- Avoid going bare foot in communal areas
- Avoid nail varnish & artificial nails
14
Q
Warts & Verrucas: Referral - 7
A
- Anogenital warts
- Diabetics
- Lesions on the face
- Multiple & widespread warts
- Patients over 50 presenting with wart for first time
- Warts that itch or bleed without provocation
- Warts that have grown & changed in colour
15
Q
Warts & Verrucas: Treatment - 5
A
- 50% of all warts & verrucas will spontaneously resolve after 2 years
- Salicylic acid – destructive treatment which destroys the infected skin, showing success if used in 12 weeks
- OTC treatments contain between 12 or 26% salicylic acid applied daily. E.g. Bazuka or Bazuka extra strength
- Treatment not always needed, tell patient if they’re not willing to consistently treat them.
- No evidence that combining treatments increase efficacy
16
Q
Warts & Verrucas: Advice - 4
A
- Soak affected area prior to treatment
- The affected skin should then be lightly rubbed with pumice or emery board
- Application of product should only be made to the affected skin
- Allow product to dry – many products now form an occlusive layer to stop spread of HPV
17
Q
Cold sore (Itching, burning, tingling symptoms. Lesions): Treatment - 3
A
- Creams should be used ASAP once prodromal symptoms start (itching, burning pain).
- Apply aciclovir creams 4hrly for five days & penciclovir to people over 12 2hrly for 4 days.
- Ensure cream is not shared & is taped on to avoid trauma to the lesion
18
Q
Cellulitis (Pain, warmth, swelling & erythema, blisters often on lower limbs): Treatment – 5
A
- Risk factors: Lymphoedema, Leg oedema, Venous insufficiency & history of venous surgery, Obesity, Pregnancy
- Examine affected area (look for area of break in the skin):
- Acute rapidly spreading onset of red, painful, hot, swollen, & tender skin
- Analgesics & fluids whilst seeking GP appointment, elevate leg if appropriate
- Refer if confusion or present/systemic infection
19
Q
DVT: Referral Symptoms – 4
A
- Unilateral localised pain (usually throbbing) that occurs when walking or bearing weight, & calf swelling (possibly whole leg swells)
- Tenderness
- Skin changes, which include oedema, redness, & warmth
- Vein distension
20
Q
Skin cancer: Referral - 2
A
- Large black or brown marks on skin – possibly cancer
- Tell patient to immediately be in contact with their GP
