(PM3A) Skin & Skin Diseases Flashcards
(298 cards)
1
Q
How does skin permeability vary between body sites?
A
Different between body sites
Palms not very permeable
Eyelids very permeable
2
Q
How much can skin permeability vary on the same body site between patients ?
A
Up to 40%
3
Q
Between what groups is there no difference in skin permeability?
(Based solely on the difference of group, not individual variation)
A
(1) Racial skin types
(2) Gender/ sex
(3) Ageing
4
Q
In which ethnicity is melanoma skin cancer most and least prevalent?
A
Most = White/ Caucasian
Least = Black
5
Q
Is melanoma skin cancer more common in men or women in the UK?
A
Women
But same incidence in Asians
6
Q
What are the different skin type classifications?
A
(1) Normal
(2) Dry
(3) Oily
(4) Combination
7
Q
How is a skin type of a ‘combination’ classified?
A
Oily in T-zone
Dry/ normal elsewhere
8
Q
How is dermatology/ skin type most commonly classified?
A
Fitzpatrick skin scale
9
Q
What is the Fitzpatrick skin scale?
A
A classification scale for dermatology/ skin type
10
Q
What is the Fitzpatrick skin scale based on?
A
Skin response to UV therapy for psoriasis
11
Q
How many types of skin are there in the Fitzpatrick skin scale?
A
6
12
Q
What are the different skin classifications in the Fitzpatrick skin scale?
A
(1) Ivory
(2) Beige
(3) Light Brown
(4) Medium Brown
(5) Dark Brown
(6) Very Dark Brown
13
Q
Despite most often being used for bruising (amongst other things), what has been observed to be a benefit of arnica?
A
Mental/ emotional symptoms
Forgetfulness/ memory loss
Severe headaches
14
Q
What is arnica applied topically for?
A
(1) Bruising
(2) Arthritis
(3) Oedema - due to fracture
(4) Inflammation - e.g. insect bites
15
Q
What is Arnica flos?
A
The flower of the herb Arnica montana
16
Q
How many phytochemicals have been identified in Arnica flos?
A
More than 150
17
Q
What is a phytochemical?
A
Any biologically active compound found in plants
18
Q
What are the main active constituents of arnica?
A
Sesquiterpene lactones
Other esters
19
Q
How do sesquiterpene lactones affect inflammatory processes?
A
Inhibit
NF-kappaB
NF-AT
20
Q
What is NF-kappaB?
A
A transcription factor affecting inflammatory responses
Inhibited by sesquiterpene lactones
Influence the release of cytokines
21
Q
What is NF-AT?
A
A transcription factor affecting inflammatory responses
Inhibited by sesquiterpene lactones
influence the release of cytokines
22
Q
Define moiety.
A
A part of a molecule
23
Q
What is the significance of unsaturated acetyl moieties of sesquiterpene lactones in arnica?
A
Exhibit increased activity
24
Q
What is the significance of acetate derivative moieties of sesquiterpene lactones in arnica?
A
Exhibit decreased activity
25
What is/ are the main permeant(s) of Arnica flos?
(1) 11-alpha, 13-dihydrohelenalin methacrylates ester
(2) 11-alpha, 13-dihydrohelenalin tiglinate esters
26
What effect does nicotinic acid have on the skin?
Produces reddening of the skin
Increases vasodilation
27
What effect does 0.1% betamethasone have on skin?
Blanching effect
Increase vasoconstriction
28
Do 0.1% betamethasone and nicotinic acid have the same effect on the skin?
No
Nicotinic acid causes vasoDILATION
0.1% betamethasone causes vasoCONSTRICTION
29
Describe the effect of nicotinic acid, in terms of concentration.
Concentration dependent
30
What effect does arnica have on blood vessels?
(vasodilation/ vasoconstriction)
Vasodilation
31
What thoughts to consider does the effect of arnica on blood vessels raise, for the indication of bruising?
Causes vasodilation
vasodilation would be expected for treatment of indication
32
How many of the phytochemicals in arnica have been observed to elicit a therapeutic effecft?
2/150
33
What should be considered when advising a patient on the use of a natural product?
(1) Will it cause harm? e.g. skin reaction
(2) Will it cause an interaction?
(3) Will it prevent patient's use of evidence-based therapy?
34
How many different skin disorders affect adults and children?
69
35
How many people, on average, suffer from a skin disorder?
1 in 3
36
What are some of the most common skin disorders?
- Acne
- Rosacea
- Psoriasis
- Eczema
- Cancers
- Fungal infections
37
Name some important cancers of the skin.
(1) Basal cell carcinoma (rodent ulcer)
(2) Squamous cell carcinoma
(3) Malignant melanoma
38
What is the most common form of skin cancer?
Basal cell carcinoma (rodent ulcer)
39
What is another name for basal cell carcinoma?
Rodent ulcer
40
Describe the malignancy of basal cell carcinoma.
Least malignant skin cancer
41
What percentage of Caucasians are expected to get basal cell carcinoma in their lifetime?
>30%
42
In what skin types is basal cell carcinoma most common?
(1) 1 - Ivory
(2) 2 - Beige
43
In what skin types is basal cell carcinoma least common?
(1) 4 - Medium brown skin
(2) 5 - Dark brown skin
(Does not occur in very dark brown skin)
44
Where does basal cell carcinoma (rodent ulcer) most commonly present?
The face
(Rarely the ears)
45
Describe the appearance of a rodent ulcer (basal cell carcinoma).
Shiny
Dome-shaped nodules
Later, develop central ulcer
46
What is telangiectasia?
Small visible blood vessels
47
What is the name given to small visible blood vessels?
Telangiectasia
48
How fast do basal cell carcinomas grow?
Relatively slow growing
49
What is the treatment for basal cell carcinoma (rodent ulcers)?
Surgical excision
50
What is the percentage of successful treatment of basal cell carcinoma?
>99%
51
When is radiotherapy used for basal cell carcinoma (rodent ulcers)?
For large superficial forms
52
When is cryotherapy used for basal cell carcinoma (rodent ulcers)?
has not spread elsewhere
53
What is the treatment for large superficial forms of basal cell carcinoma (rodent ulcers)?
Radiotherapy
54
What is the treatment for very large superficial forms of basal cell carcinoma (rodent ulcers)?
Cryotherapy
55
What drugs can be prescribed for basal cell carcinoma (rodent ulcers)?
(1) Fluorouracil
(2) Imiquimod
56
What is squamous cell carcinoma?
A type of skin cancer
57
Where does squamous cell carcinoma arise?
From keratinocytes
In stratified squamous epithelium
58
Describe the appearance of squamous cell carcinoma.
Lesions
Red + scaly papules
Can ulcerate + bleed
59
Where does squamous cell carcinoma most often present?
On the head
- Scalp/ ears/ lower lip
Also hands + legs
60
Describe the growth of squamous cell carcinoma.
Rapid growth
Metastasises if not removed
61
What effect can immunosuppression have on squamous cell carcinoma.
Can allow growth of multiple tumours
62
What is the most common form of skin cancer on black skin?
Squamous cell carcinoma
63
What is the treatment for squamous cell carcinoma?
(1) Surgical excision
(2) Radiation therapy
Must be caught early
64
What is essential when treating squamous cell carcinoma?
Must be caught early
65
What is malignant melanoma?
Most dangerous type of skin cancer
66
What is the most dangerous form of skin cancer?
Malignant melanoma
67
Which type of skin cancer can occur in the eye?
Malignant melanoma
68
Where can malignant melanoma present, that other skin cancers cannot?
Eye
69
What percentage of all skin cancers does malignant melanoma account for?
Approximately 5%
70
What are the most important risk factors for development of malignant melanoma?
(1) History of childhood sun exposure
(2) Positive family history
71
Which type of skin cancer is most resistant to chemotherapy?
Malignant melanoma
72
In which type of cell does malignant melanoma occur?
Melanocytes
(Wherever there is pigment)
73
What percentage of malignant melanoma comes from pre-existing moles?
Approximately 30%
74
What is the estimated 5 year survival rate for black patients with malignant melanoma?
70%
75
What is the estimated 5 years survival rate for white patients with malignant melanoma?
94%
76
Where does malignant melanoma most commonly present in black, asian, and native Hawaiian patients?
Non-exposed skin with less pigment
e.g. soles, palms, mucous membranes, nail regions
77
What is the most common site of malignant melanoma in non-white patients?
Plantar portion of the foot
30-40% of all cases
78
In which patient groups are late-stage melanomas more prevalent?
(1) Hispanic
(2) Black
79
What is the treatment of malignant melanoma?
Urgent + wide surgical excision + chemotherapy
Consider immunotherapy (IL-2)
80
What is the significance of a malignant melanoma lesion that is >4mm thick?
Chance of survival is poor
81
What is the advice given by pharmacists and healthcare professionals for prevention of development of skin cancer?
(1) Avoid sun exposure from 11am-3pm
(2) Wear a sun hat
(3) Application of a high protection suncream
(4) Reapply suncream regularly
82
What is the percentage increased risk of development of squamous cell carcinoma for those who have used tanning beds?
83%
83
What is the method used to recognise melanoma?
ABCD(E)
84
What does ABCD(E) stand for?
A = Asymmetry
B = Border irregularity - edges are ragged
C = Colour - pigmentation not uniform
D = Diameter - >6mm
(E) = Evolution + Elevation - mole changing size/ shape/ colour rapidly
85
In which country is ABCD(E) used to diagnose melanoma?
USA
86
In which country is the Glasgow 7-point checklist of melanoma used?
UK
87
What is the standardised method of melanoma diagnosis in the UK?
Glasgow 7-point checklist of melanoma
88
What are the subtypes of the Glasgow 7-point checklist of melanoma?
(1) Major criteria
(2) Minor criteria
89
How many major criteria are there in the Glasgow 7-point checklist of melanoma?
3
90
How many minor criteria are there in the Glasgow 7-point checklist of melanoma?
4
91
What are the major criteria in the Glasgow 7-point checklist of melanoma?
(1) Change in size
(2) Change in shape
(3) Change in colour
92
What are the minor criteria in the Glasgow 7-point checklist of melanoma?
(1) Diameter >6mm
(2) Inflammation
(3) Oozing/ bleeding
(4) Mild itch/ altered sensation
93
What is the role of a community pharmacist in skin cancers?
Recognition of suspicious lesions/ moles etc
94
What is a dermatophyte?
A pathogenic fungus that grows on skin
95
What is candidiasis?
A pathogenic fungus
Thrush
96
How are fungal organisms identified in suspected fungal infections?
Microscopy
Culture of skin/ hair/ nail samples
97
How are fungal infections spread between infected humans?
Direct contact
98
Define tinea.
Medical term for ringworm
Used to describe skin mycoses
99
How are superficial dermatophyte infections named?
According to body site affected
100
What is Tinea capitis?
Ringworm on the scalp
101
What is Tinea corporis?
Ringworm on the body
102
What is Tinea cruris?
Ringworm on the groin
103
What is Tinea pedis?
Ringworm on the feet
104
In which patient group is Tinea capitis most common?
Children
105
What causes Tinea capitis?
(1) Microsporum
(2) Trichophyton
106
How is Tinea capitis spread?
Close contact
107
What effect can hairdressers have on Tinea capitis?
Can spread indirectly accidentally
108
How can Tinea capitis be recognised?
Alopecia typically seen on head
Can be inflammatory
109
In which type of ringworm can alopecia be expected?
Tinea capitis
110
Where does Tinia pedis present?
In toe clefts
111
What is Tinia pedis also known as?
Athlete's foot
112
How does Tinia pedis present?
Red + scaly
Itchy
113
What can Tinia pedis lead to if not treated?
Fissures and maceration of the area
114
How can Tinea corporis be contracted?
From animals or humans
115
Which species of fungi is normally responsible for Tinea corporis?
Trichophyton
116
How does Tinea corporis present?
Scaly lesions
Clusters of round/ oval red patches
117
What is Tinea cruris also known as?
(1) Jock itch
(2) Gym itch
(3) Crotch rot
118
How does Tinea cruris usually present?
Itching in groin
Itching in anus
Itching in thigh skin folds
119
What is the first line treatment for Tinea cruris?
Self-care
(1) Keep skin clean + dry
(2) Wear loose clothing
(3) Prevent further irritation from friction
(4) Apply a topical OTC antifungal
120
What should be done if Tinea cruris does not respond to self-care after two weeks?
See GP
121
What is onchomyosis?
Fungal nail infection
122
What is the treatment for onchomyosis?
Lacquers + paints
123
What is Tinea manuum?
Ringworm of the hands
124
What is Tinea incognito?
A fungal skin infection which can be modified by a topical steroid treatment
Condition improves with steroid
Worsens again following treatment
125
What characterises Tinea incognito?
Condition improves with steroid but worsens after treatment cessation
126
What is the general treatment for tinea infections?
Topical
Broad-spectrum antifungals
e.g. imidazoles (clotrimazole or miconazole)
e.g. terbinafine
127
What is the treatment for Tinea pedis?
Terbinafine 1% cream/ spray
128
What is the treatment for Athlete's foot?
Terbinafine 1% cream/ spray
129
Why is terbinafine 1% cream/ spray used instead of imidazoles for Athlete's foot?
Cochrane review + trials support use
130
Why is terbinafine 1% cream/ spray used instead of imidazoles for Tinea pedis?
Cochrane review + trials support use
131
What is the treatment for Tinea capitis?
Usually systemic, due to risk of scarring from alopecia
Topical treatment, e.g. ketoconazole shampoo, recommended twice weekly for first 2 weeks of treatment
132
(1) When is ketoconazole shampoo recommended?
(2) Who should use it?
(1) Tinea capitis infection
(2) Infected individual + family for first 2 weeks
133
How are widespread fungal infections treated?
Oral antifungal therapy
e.g. terbinafine 250 mg OD
e.g. itraconazole 100 mg OD
Used for 1-2 months
134
What is the role of the pharmacist in fungal infections?
Advice on common Tinea infections
Referral to GP if oral therapy may be required, e.g. Tinea capitis
135
For which type of ringworm infection is GP referral likely?
Tinea capitis
Risk of scarring due to alopecia
136
What is epidermal differentiation?
Differentiation of basal cells to stratum corneum, regulated by enzymes
137
Which skin layer regulates water loss?
Stratum corneum
138
Which skin layer mediates hydrolytic enzymes?
Stratum corneum
139
What is Natural Moisturing Factor (NMF)?
Endogenous breakdown product from filaggrin hydrolysis
Hygroscopic mixture
Includes amino acids
140
What are the components of Natural Moisturing Factor (NMF)?
(1) Amino acids
(2) Pyrrolidone carboxylic acid - PCA
(3) Lactic acid
(4) Urea
141
What is the role of Natural Moisturing Factor (NMF)?
Maintains free water within the stratum corneum
142
Which processes are responsible for the maintenance of free water within the stratum corneum?
(1) Natural Moisturing Factor (NMF)
(2) Corneocyte maturation
(3) Desquamation
(4) Lipid biosynthesis
143
How does the stratum corneum exhibit biosensory function?
Responds to external humidity by regulating internal water content accordingly
144
How is Natural Moisturing Factor (NMF) produced?
(1) Profilaggrin is desphosphorylated to filaggrin
(2) Filaggrin is hydrolysed to Natural Moisturing Factor (NMF)
145
How is filaggrin produced?
Profilaggrin is dephosphorylated
146
What can be observed if too little Natural Moisturing Factor (NMF) is produced?
Dry skin
147
What is the role of Natural Moisturing Factor (NMF) in the stratum corneum?
(1) Flexibility
(2) Integrity
(3) Cohesion
(4) Hydration
(5) Buffers
148
How does Natural Moisturing Factor (NMF) act as a buffer?
When Natural Moisturing Factor (NMF) decreases, pH increases
149
What happens if insufficient filaggrin is produced?
(1) Corneocyte deformation
(2) Reduction in Natural Moisturing Factor - NMF
(3) Increase in skin pH
150
What is corneocyte deformation?
Flattening of surface skin cells
151
How can the activity of serine proteases be increased in the stratum corneum?
A reduction in filaggrin decreases Natural Moisturing Factor (NMF)
A reduction in Natural Moisturing Factor (NMF) increases the skin pH
Increased skin pH favours serine protease activity
152
What can be observed if serine proteases in the stratum corneum are overactive?
Inflammation
153
How do serine proteases cause inflammation?
Serine proteases produce cytokines
Cytokines promote inflammation
154
Which cytokines do serine proteases produce?
(1) Interleukin-1a
(2) Interleukin-1-beta
155
How common is loss-of-function in the filaggrin gene, as a percentage?
10% of the population
156
What are filaggrin mutations a risk factor for?
(1) Eczema
(2) Allergies - e.g. asthma, rhinitis, peanuts
157
What percentage of all eczema presence in the population is due to a mutation of at least 1 filaggrin gene?
50%
158
What difference does a 20% increase of filaggrin in skin make in reduction of eczema?
40% reduction in risk of getting eczema
159
What role does filaggrin have in eczema?
Deficiency increases risk of eczema
Sufficiency decreases risk of eczema
160
What percentage of the population are approximated to have eczema?
10%
161
What are the common features of eczema?
Dry + flaky skin
Oedematous
Crusty
Itchy
162
What are the common features present in chronic eczema, that are not usually seen in acute eczema?
- Thickened skin
- Lichenified skin
163
What percentage of childhood eczema clears up by adulthood, on average?
75%
164
What is meant by atopic march?
A typical sequence of immunoglobulin E (IgE) antibody responses
165
Which other medical conditions are associated with eczema?
Asthma (50% with atopic eczema get it)
Allergic rhinitis (75% with asthma get it)
166
What can trigger bouts of eczema?
(1) Internal inflammation
(2) Externally applied chemicals
(3) Humidity (environment)
167
How do the triggers for eczema cause eczema to arise?
Lead to an overproduction of proteases
Proteases break down corneodesmosomes
Breaks epidermal cohesion
Disrupts differentiation
168
What is a corneodesmosome?
Class of proteins
Hold corneocytes together
169
(1) What are the types of eczema?
(2) Give examples of each
(1) Irritant/ allergic contact eczema
(2)
- Irritant: soaps, cleansers, garlic
- Allergic: Allergens
170
What is the treatment for eczema?
Emollients - maintain hydration of stratum corneum
Topical corticosteroids, e.g. 1% hydrocortisone cream
Sedating oral antihistamines - e.g. chlorphenamine
Avoid soap + irritating fabrics
171
What is the reason for an emollient in the treatment of eczema?
Main hydration of the stratum corneum
172
What is the reason for a topical corticosteroid in the treatment of eczema?
Reduce inflammation + itchiness
173
What is the reason for sedating oral antihistamines in the treatment of eczema?
Reduce scratching at night
174
What is the reason for avoiding soap in the treatment of eczema?
Soap dries the skin
175
What is the reason for avoiding wool fabrics in the treatment of eczema?
Irritates the skin
176
What is the reason for avoiding synthetic materials in the treatment of eczema?
Irritates the skin
177
What is a researched drawback in the recommendation of aqueous cream in treatment of eczema?
Contains 1% sodium lauryl sulphate (SLS) A harsh anionic surfactant
178
What types of emollient are recommended in treatment of eczema?
Those without SLS - sodium lauryl sulphate
Recommend E45
179
How many finger tip units of topical corticosteroids should be recommended for eczema on the face?
2.5
180
How many finger tip units of topical corticosteroids should be recommended for eczema on the neck?
2.5
181
How many finger tip units of topical corticosteroids should be recommended for eczema on the entire arm?
4
182
How many finger tip units of topical corticosteroids should be recommended for eczema on the entire hand?
4
183
How many finger tip units of topical corticosteroids should be recommended for eczema on the entire leg?
8
184
How many finger tip units of topical corticosteroids should be recommended for eczema on the entire foot?
8
185
How many finger tip units of topical corticosteroids should be recommended for eczema on the front of chest and abdomen?
7
186
How many finger tip units of topical corticosteroids should be recommended for eczema on the back and buttocks?
7
187
How may applying multiple topical treatments together affect their absorption?
One could act as a permeation enhancer
OR act as another barrier to second drug
188
What is the current safest recommendation for order of application of a topical corticosteroid and an emollient, for the indication of eczema?
(1) Apply corticosteroid
(2) Wait an hour
(3) Apply emollient
189
What is seborrhoeic eczema?
Harmless scaling rash
Affects the scalp, eyebrows, ears, face, folds of underarms, groin
190
What is dandruff?
Seborrhoeic eczema of the scalp
191
What is pityriasis capitis?
Dandruff
Seborrhoeic eczema of the scalp
192
Is seborrhoeic eczema contagious?
No
193
Which patient groups are at increased risk of development of seborrhoeic eczema?
(1) Parkinson's - neurological disorders
(2) Stroke patients - neurological disorders
194
What is the self-care advice for seborrhoeic eczema?
(1) Reduce exposure to allergens
(2) Keep cool
(3) Loose clothing
(4) Soap-free cleansers
195
What is the general treatment for seborrhoeic eczema in adults?
(1) Regular use of antifungal agents
(2) Intermittent applications of topical steroids
196
What is the treatment for seborrhoeic eczema in infants?
Usually clears up within 6 months
Mild emollients
Hydrocortisone cream
Topical ketoconazole
197
How is seborrhoeic eczema on the scalp treated?
Medicated shampoos - containing ketoconazole - 2x/week for 4 weeks
198
Why are steroid scalp applications recommended for seborrhoeic eczema of the scalp?
Reduce symptoms
199
What are tar creams used for in seborrhoeic eczema of the scalp?
Applied to scaled areas
Removed with shampoo several hours later
200
What is the treatment of seborrhoeic eczema of the face, ears, chest or back?
(1) Cleanse affected areas 1-2x/day
(2) Ketoconazole cream OD for 2-4 weeks
(3) Hydrocortisone cream BD for 1-2 weeks
201
What is the treatment for severe seborrhoeic eczema of the face, ears, chest or back?
(1) Cleanse affected areas 1-2x/day
(2) Ketoconazole cream OD for 2-4 weeks
(3) Hydrocortisone cream BD for 1-2 weeks
(4) Course of UV radiation
202
What can eczema be mistaken for, as a serious mistake?
Systemic lupus erythematosus (SLE)
203
What is a classic symptoms of systemic lupus erythematosus (SLE)?
Butterfly rash on cheeks and nose
Can include trunk/ extremities
204
What can exacerbate the butterfly rashes seen systemic lupus erythematosus (SLE)?
Sunlight
Stresses that increase skin circulation
205
What are the symptoms of systemic lupus erythematosus (SLE)?
(1) Butterfly rash on cheeks + nose
(2) Non-specific joint pains (morning stiffness)
(3) Fatigue
(4) Rapid hair loss (regrows in remission)
206
How is systemic lupus erythematosus (SLE) contracted?
Genetic origin
207
What is psoriasis?
Chronic autoimmune disorder
208
How is psoriasis contracted?
Genetic predisposition
Other factors also required
209
In which ethnic group is psoriasis most common?
Caucasian
210
What is early onset psoriasis?
16-22 years old
211
What is late onset psoriasis?
55-60 years old
212
Is psoriasis more common in males or females?
No difference in incidence
Females tend to have early onset
213
How does psoriasis present?
Chronic
Scaling
Inflammation
Skin redness (skin types 1-4)
Skin greyness (skin types 4-5)
214
What factors can trigger psoriasis?
(1) Infection - can lower threshold for psoriasis
(2) Trauma
(3) Emotional stress/ anxiety
(4) Climatic factors - sunlight
(5) Certain drugs
215
Name some examples of drugs which can trigger psoriasis.
(1) ACE inhibitors
(2) NSAIDs
(3) Chloroquine
(4) B-blockers
(5) Lithium
(6) Alcohol abuse
216
What is the most common form of psoriasis?
Plaque psoriasis
>90% of all cases
217
How does plaque psoriasis present?
Scattered lesions
Raised + scaly
Often on knees, elbows, scalp
218
What is Guttate psoriasis?
Teardrop shaped
Numerous small + discrete patches
Commonly seen in the young
219
What percentage of patients with Guttate psoriasis spontaneously recover?
1/3
33%
220
What is flexural psoriasis?
Inverse psoriasis
Affects areas of skin-skin contact
Tends to occur later in life
221
Which type of psoriasis tends to occur in younger patients?
Guttate psoriasis
222
Which type of psoriasis tends to occur in older patients?
Flexural psoriasis
223
What is generalised pustular psoriasis?
Acute + severe eruption of superficial pustules
Reddening of the skin + high fever
Pustules do NOT contain bacteria, NOT caused by infection
224
When does generalised pustular psoriasis most commonly occur?
Following use of large quantities of steroid cream/ tablets
225
What is chronic pustular psoriasis?
Localised form of pustular psoriasis
Occurs on hands + feet
Reddening of skin + high fever
Severe eruption of superficial pustules
226
What is psoriatic arthritis?
Inflammatory joint disease
Usually affects small joints, e.g. hands/ feet
Skin changes before joint pain
227
What happens to the nails in psoriasis?
Pitting - small indentation
Onycholysis - lifting up of nails
Discolouration
Thickening
Crumbling
228
What percentage of patients with psoriasis experience nail changes?
25-50%
229
What is the purpose of psoriasis treatment?
Control + management
NOT cure
230
What are the potential options for treatment of psoriasis?
(1) Emollients: Hydrate skin + anti-proliferative effect
(2) Topical corticosteroids: Initial improvement
(3) Calcipotriol: Dovonex - synthetic D3 analogue, interferes with cell division and differentiation
231
Give an example of a synthetic D3 analogue.
Calcipotriol - Dovonex
232
What are some examples of emollients?
(1) E45
(2) Diprobase cream
233
What is the treatment for chronic psoriasis?
(1) Emollient
(2) Steroid + vitamin D analogue
234
What is the most appropriate treatment for mild/ onset psoriasis?
Corticosteroids > calcipotriol
235
What is coal tar used for in the treatment of psoriasis?
Anti-inflammatory + anti-scaling properties
Crude coal tar most effective
236
What is salicylic acid used for in the treatment of psoriasis?
Used as a keratolytic
237
What is dithranol used for in the treatment of psoriasis?
To induce remission
Especially effective for chronic plaque psoriasis
Not to be used on the skin/ flexures
238
When can dithranol not be used?
On the face/ flexures
239
What are retinoids used for in the treatment of psoriasis?
Used topically for mild-moderate plaque psoriasis
240
Give an example of a retinoid.
0.05% tazarotene
241
Give an example of a vitamin A analogue
0.05% tazarotene
242
Which skin condition can phototherapy be used to treat?
Psoriasis
243
What methods of phototherapy can be used for treatment of psoriasis?
(1) UVB light
(2) PUVA therapy
244
What types of psoriasis can UBV light be used for?
Method of treatment of chronic stable psoriasis
Method of treatment for guttate psoriasis
245
When should UVB light be recommended?
(1) Stable/ chronic psoriasis
(2) Guttate psoriasis
(3) When topical treatment has failed
246
When is UVB light contraindicated?
Inflammatory psoriasis
247
What is PUVA therapy?
Combination of long-wave UVA radiation with psoralen
248
Where can patients receive PUVA therapy?
Dermatology centres
249
What does psoralen do?
Enhances effect of UVA
Usually taken 2 hours before UVA exposure
250
What does PUVA therapy stand for?
P = Psoralen
UVA = Type of radiation
251
For which type of psoriasis is PUVA therapy normally used?
Effective in most types of psoriasis
252
What happens if patients receive high doses of PUVA therapy?
(1) Skin ageing
(2) Risk of cataracts
(3) Skin cancer
253
When is systemic treatment of psoriasis required?
(1) Severe psoriasis
(2) Resistant psoriasis
(3) Unstable psoriasis
(4) Complicated psoriasis
ONLY under specialist supervision
254
What drugs are available for systemic treatment of psoriasis?
(1) Acitretin
(2) Cyclosporin
(3) Methotrexate
255
What is acitretin?
Drug used for systemic treatment of psoriasis
Retinoid
Effect takes 2-4 weeks
Maximum effect at 4-6 weeks
Only available in hospital pharmacies
256
What is cyclosporin?
Drug used for systemic treatment of severe psoriasis AND severe eczema
Taken by mouth
257
What is methotrexate?
Drug used for systemic treatment of severe psoriasis
10-25 mg weekly
Taken by mouth
Folic acid often given to reduce risk of methotrexate toxicity
258
Which defining features are there of methotrexate toxicity?
(1) Bone marrow suppression
(2) Liver damage
259
What does the suffix 'man' on a drug name mean?
mab = monoclonal antibody
260
What is adalimumab?
First fully human monoclonal antibody approved
261
What is adalimumab used to treat?
(1) Rheumatoid arthritis
(2) Psoriatic arthritis
(3) Ankylosing spondylitis
(4) Crohn's disease
(5) Ulcerative colitis
(6) Chronic psoriasis
262
Which molecule does adalimumab inhibit?
TNF
263
What effect does adalimumab have on the body?
Anti-inflammatory
264
What is acne vulgaris?
(1) Cystic acne
(2) Pimples
(3) Zits
265
How is acne vulgaris characterised?
(1) Comedones - blackheads/ whiteheads
(2) Papules - pinheads
(3) Nodules - large than a papule
(4) Cysts - cavity containing a fluid
266
Where does acne vulgaris most commonly present?
(1) Face
(2) Shoulders
267
How is acne vulgaris caused?
Hair follicles and sebaceous glands become obstructed with sebum and dead keratinocytes
Become infected with skin anaerobe
268
What causes the formation of papule, nodules and cysts in acne vulgaris?
Rupturing of inflamed follicles
269
What is the most common trigger for acne vulgaris?
Puberty - from surges in androgen
Stimulates sebum production + hyper proliferation of keratinocytes
270
How does diet affect acne vulgaris?
It does not
271
What are the classifications of acne vulgaris?
(1) Mild
(2) Moderate
(3) Severe
272
What is the main aim of treatment for acne vulgaris?
Reduce sebum production
Reduce infection
Reduce inflammation
273
How is mild-moderate acne vulgaris usually treated?
Topically
274
How is moderate-severe acne vulgaris usually treated?
Systemic antibiotics
When topical has failed
275
How is severe acne vulgaris usually treated?
Referral to dermatologist
May require isotretinoin (more aggressive therapy)
276
What is azelaic acid?
Anti-microbial
Anti-comidonal (blackheads/ whiteheads)
277
Give two examples of retinoids.
(1) Tretinoin
(2) Adapalene
278
For which type of acne is systemic oral antibiotics used?
Give examples of the antibiotics used.
Moderate
Tetracycline/ doxycycline/ erythromycin
279
How is severe acne vulgaris treated?
Oral isotretinoin
280
What are some of the side effects of isotretinoin?
(1) Dryness of mucous membranes
(2) Depression
(3) Arthralgias
(4) Birth defects
(5) Hyperlipidaemia
281
What is rosacea?
Skin condition affecting the middle third of the face
282
What is rosacea most commonly mistaken for?
Acne
Due to pimples
283
What are the symptoms of rosacea?
Persistent redness of face
Dilation of blood vessels under skin (appears as thread veins)
284
How does rosacea compare in males and females?
More prevalent in women
Increased severity in men
285
If left untreated, what can rosacea cause?
Progressive development
Affects eyes, ears, and nose
Can cause the nose to significantly disfigure
286
What is rhinophyma?
Significant disfigurement of the nose
Often due to rosacea
287
What causes rosacea?
Unknown
Could be genetic/ environmental
288
Which medications have been linked with rosacea?
(1) Corticosteroids
(2) Vasodilators
289
Will rosacea resolve itself without treatment?
Unlikely
290
Will acne vulgaris resolve itself without treatment?
Most likely
291
Do the skin treatments for acne vulgaris treat rosacea also?
Not usually
Can make rosacea worse
292
What is the most common treatment for rosacea?
Topical metronidazole
293
What effect does topical metronidazole have on rosacea?
Reduces inflammatory papule and pustules
294
What effect does topical azelaic acid have on rosacea?
Reduces redness + inflammation
295
When is isotretinoin used for treatment of rosacea?
Severe cases of rosacea
296
What risk is there with isotretinoin treatment?
Teratogenic side-effects
297
What is the treatment for rhinophyma?
Surgery
Laser/ electro surgery
298
What is the advice for patients with rosacea?
(1) Wear protective suncream
(2) Protect face in winter
(3) Do not irritate face (mechanical/ chemical)
(4) Avoid alcohol
(5) Use products which are labelled as non-comedogenic
