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Delivery Pharmaceutical care to patients > skin > Flashcards

skin Flashcards

1
Q

Layers of the skin, their cells and their functions

A

Hypodermis (fatty supportive tissue)

epidermis:
- Contains melanocytes to protect from UV light,
- Skin cancers at this level

Dermis
-Physical support and nutrients 
-Made elastin's, fibrillin and collagen
-Contain nerve ending, sweat glands, sebaceous glands, hair follicles, Blood vessels  
-
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2
Q

What questions are asked to diagnose skin conditions

A

History, PC, HPC, O/E, PMH, FH, SH and DH

  • Location of symptoms
  • Odour
  • In contact with irritant
  • Discharge
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3
Q

List of skin infections

A

Tinea Infections

Warts and verrucae (viral)

Cold sores

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4
Q

What are the anatomical classification of dermatophytes location

A 
athlete’s foot (tinea pedis), 
groin infection (tinea cruris) 
ringworm (tinea corporis)
Psoriasis 
Dermatitis
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5
Q

What is the aetiology of tinea infections?

A

Invade the stratum corneum, hair and nail

Fungus grows then begins to grow and proliferate in the non-living cornified layer of keratinised tissue of epidermis

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6
Q

Signs and symptoms of tineas pedis

A
  • Itching
  • Flaking and fissuring of the skin
  • Skin appears white and ‘soggy’ due to maceration of the skin
  • Feet often smell
  • Usual site is in the toe webs, especially the fourth web space
  • Infection can spread to the sole and instep of the foot
  • Nail involvement may be present
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7
Q

What specific questions should be asked in relation to tineas pedis

A

Age & Sex of patient- prevalent to in young adults especially men
>Nail involvement in older patient

Presence of itch, burning or irritation

Associated symptoms: flaky, smelly and nail involvement

Previous history- Usually have acute

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8
Q

What os the treatments for tinea pedis

A

First line: Imidazole for candidiasis for 10 days
> Canesten is licensed for 7 days BD
>Can be used with hydrocortisone
> Used in 10 y/o and older

Terbinafine for dermatophytes
>P Medicine
>More effective than imidazoles
> For 16 y/o and older

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9
Q

Self help advice for tineas pedis

A

Dry the skin thoroughly after showering or bathing

Keep personal towel and do not share it

Wear cotton socks and change them at least once a day

Avoid use of occlusive non-breathable shoes

Dusts shoes and socks with antifungal powder

Avoid scratching infected skin

Use flip-flops when using communal changing rooms

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10
Q

Describe the appearance of Tineas corporis (ring worm)

A

Itchy pink or red scaly slightly raised patches with WELL DEFINED INFLAMED BORDER

does not involve the face, hands, feet, groin or scalp

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11
Q

Differential diagnosis of tineas corporis and what question to ask to eliminate each

A

Psoriasis – take family history. Lesions tend not to itch, and exhibit more scaling and do not show central clearing

Eczema/dermatitis- take family history. Very itchy, particularly affects arms and legs- can be difficult to differentially diagnose.

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12
Q

Treatment for tineas corporis

A

Same ad Tineas Pedis

and refer when large areas become involved

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13
Q

What are warts and verrucae

A

Benign growths of the skin caused by the Human Papilloma Virus

Occurs in children up till 16 y/o

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14
Q

How do warts and verrucae occur

A

HPV enters the host by the epithelial defects in the epidermis

Transmitted by direct skin-to-skin contact (even shed skin)

Once in the epithelial cells, the virus stimulates basal cell division to produce the characteristic lesion

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15
Q

what conditions need to be eliminated

A

Corn/callus: lesion on toes caused by ill fitting shoes

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16
Q

signs and symptoms of verrucae

A
  • Found on sole of the foot, usually in weight bearing areas
  • Pressure on the nerves can cause considerable pain
  • Lesions normally reveal tiny black dots on surface
  • Rarely larger than 1cm in diameter
  • Occur singly or in crops
17
Q

Treatment options for Warts and Verrucae

A

Avoid treatment in diabetic people

Most self resove

  1. Salicylic aids products
    > The feet should be soaked and hard skin should be removed
    > Add few drops to lesion and surrounding skin daily
  2. Glutaraldehyde (Glutarol)
    TWICE daily
    S/E: Colours skin brown
  3. Formaldehyde (Veracur)
    TWICE daily
  4. Silver Nitrate (Avoca Pen)
    Moistened tip applied for 1-2 minutes
  5. Freezing products to kill viral particles
    > Up to 3 applications for warts and 6 application for verrucae
18
Q

Self-help advice for W and V

A
  • Do not to pick, bite, suck or scratch
  • Cover with waterproof plaster/sock when swimming
  • Wear flip-flops in communal showers
  • Avoid sharing shoes, socks & towels
19
Q

what are requirements for referral with warts and verrucae

A
  • Anogenital warts
  • Multiple & widespread warts
  • Diabetics/immunocompromised
  • Lesions to the face
  • Warts that have changed colour, grown, itch/bleed
20
Q

What is psoriasis

A

Chronic relapsing inflammatory disorder with lesions that present in a number of forms.

More prevalent in 40-50 years old
Rare in infants and uncommon in children

21
Q

What is the pathogenesis of psoriasis

A

Increased thickness of epidermis; increased turnover of cell and abnormal maturation

Dilated blood vessels; activated t-lymphocytes and neutrophils enter the skin

22
Q

Signs and symptoms of plaque psoriasis

A
  • Salmon pink lesions with silvery white scales and well defined boundaries.
  • Can be single or multiple lesions & vary in size
  • Pinpoint bleeding beneath the lesion (DIAGNOSTIC)
  • Not characteristically itchy
  • Often symmetrical in distribution & most commonly involves extensor aspects of elbows & knees.
23
Q

Signs and symptoms of scalp psoriasis

A

Can be mild, exhibiting slight redness of the scalp

Severe cases have marked inflammation and thick scaling

Redness often extends beyond the hair margin and is commonly seen behind the ears.

24
Q

What questions should be asked when diagnosing psoriasis

A

Onset: first occurs most commonly in adults

Distribution: often symmetrical involving scalp & extensor aspects

Other symptoms: itch not normally present

Look at rash: scaling is obvious feature

Previous history: psoriasis is chronic & remitting

25
Q

What are the treatment options for psoriasis

A

Emollients (Doublebase, Diprobase, Cetraben)
Help soften scaling and soothe the skin to reduce irritation, cracking and drying.
Applied regularly and liberally.

  1. Tar-based products (Alphosyl, Cocois, Pinetharsol)
    Anti-mitotic: slows down rate of cell production
    S/E: local skin/scalp reaction & stain skin/clothes. and possible increase in cancer
  2. Dithranol: for plaque
    Combines with DNA to reduce mitosis & inhibits proliferation
    Short contact-time is recommended because prolonged exposure can lead to irritation and burning skin.
    Suitable for face, flexures, acutely inflamed psoriasis
    E.g. Dithro-cream : apply for 20-60 minutes then wash off and apply emollient
  3. Topical steroids
    May be prescribed but NOT licensed for OTC psoriasis
26
Q

Self help advice for psoriasis

A

Remind patients that emollients should be used liberally and regularly
Some emollients will make bath slippery- so take care
Stress, alcohol, smoking can exacerbate the condition
Practice relaxation techniques, avoid alcohol & quit smoking

27
Q

When is referral in psoriasis required

A

Extensive lesions, follow recent infection or cause itching
No family history or past history
Pustular lesions

28
Q

What should never be used to treat psoriasis and why

A

Oral steroids: risk forsteroid-induced conversion to pustularpsoriasis, the long-term side effects ofsteroids, and deterioration ofpsoriasisafter withdrawal ofsteroids

29
Q

What are the characteristics of dermatitis

A

sore, red itching skin.

30
Q

What are the 2 main causes of psoriasis in primary care

A

Irritant contact

Allergic contact

31
Q

Difference between ICD and ACD

A

ICD: agent must penetrate the outer layer of skin to invoke physiological response.

ACD: first requires sensitisation to occur. Once skin sensitised to allergen, re-exposure triggers memory T-Cells to initiate inflammatory response 24-48hours after exposure

32
Q

Signs and symptoms of contact dermis’s

A

Acute phase: Lesions appear rapidly, within 6-12 hours of contactSkin appears red, itchy, inflamed & might show papules

Chronic Exposure: Skin becomes dry, scaly, and can crack/fissure

Both develop a rash

ICD rash tends to be well demarcated.
ACD tends to be less well defined

33
Q

Treatment options for contact dermatitis

A
  1. Emollients
    Apply regularly & liberally.
    a) Moisturisers e.g. Aveeno, Diprobase, Oilatum
    b) Bath additives e.g. Balneum, Oilatum
    c) Soap substitute e.g. Emulsifying Ointment, Aqueous cream, E45
    d) Humectants e.g. Urea, lactic acid (Calmurid, Aquadrate, Humiderm)
  2. Topical steroids
    OTC: Hydrocortisone 1% crm & Clobetason crm 0.05%
    BD for 7 days
    Not to be used on the face
    Anti-inflammatory. S/E: thinning of skin
34
Q

Self advice for dermatitis

A

Self-help advice:
AVOID soap/bubble bath  use soap substitute
Avoid contact with stimulus

35
Q

Referral requirements for dermatits

A

Children under 10 in need of corticosteroid
Lesions on the face unresponsive to emollients
OTC treatment failure
Widespread/severe dermatitis (signs of secondary infection

36
Q

What is Discoid eczema

A

Long-term condition that causes skin to become itchy, reddened, swollen and cracked in circular or oval patches

Mainly affects adults
The cause is unknown

37
Q

Signs and symptoms of discoid eczema

A

Distinctive circular/oval patch of eczema anywhere on body

First sign is usually group of small red spots/bumps. These join up to form large pink/red/brown patches.

Initially, patches are swollen & blistered. Tend to be itchy particularly at night

Over time, patches become dry, crusty, cracked & flaky

Can appear anywhere on the body except for face and scalp

38
Q

Skin cancers

A

Mole/Naevus/seborrheic, keratoses

Actinic keratoses

Basal cell carcinoma

Bowmen’s/ squamous cell carcinoma

Melanoma

Delivery Pharmaceutical care to patients (6 decks)

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