SKIN SYMPTOMS

Question 1

What skin conditions are covered by the CAS?

Answer 1

Acne
Nappy rash
Athletes foot
Cold sores
Intertrigo/ringworm
Verruca
Dermatitis (acute)
Scabies

Question 2

What is Atopic Eczema?

Answer 2

Chronic and itchy skin condition - common in children
Often accompanies other atopic conditions
Rash is dry, flaky and inflamed
Aetiology unclear - unclear trigger factors

Question 3

What is contact dermatitis?

Answer 3

Type of eczema triggered by contact with a particular substance
Commonly on the hands
Consider the patients history and occupation
Nappy rash is a type of contact dermatitis

Question 4

What are treatments of eczema and dermatitis?

Question 5

What is psoriasis?

Answer 5

A skin condition often confused with eczema
Characterised by inflamed skin topped with silver or white “plaques”
Cause is unclear but immune system is believed to be involved

Question 6

Treatment of psoriasis?

Answer 6

Mild psoriasis typically treated with topical agents:
- Emollients
- Coal tar preparations
- Dithranol and salicylic acid
- Topical corticosteroids

Phototherapy is also a treatment

Question 7

What are examples of fungal skin infections?

Answer 7

Ring worm
Ringworm of the scalp
Fungal nail infections
Athletes foot

Question 8

What is ringworm?

Answer 8

A fungal infection that presents as a circular rash
Spread by person-person/person-animal contact

Question 9

What is ringworm of the scalp?

Answer 9

Rare and should be referred

Question 10

What are fungal nail infections?

Answer 10

Should be referred as system antibiotics usually required

Question 11

What is athletes foot?

Answer 11

Is a fungal foot infection usually spread by person-person contact or from shared towels, changing rooms etc.

Question 12

What is the treatment of ring worm?

Answer 12

Can be treated OTC with topical anti fungals
Imidazoles i.e. miconazole cream (daktarin) are usually first line treatment - can also be use for athletes foot

Question 13

What is the treatment of athletes foot?

Question 14

When would you refer a fungal infection such as ring worm, athletes foot, or nail infections?

Answer 14

Treatment failure > 2 weeks
Bacterial infection
Diabetic patients
Involvement of the nails

Question 15

What are cold sores (herpes simplex labialis)?

Answer 15

Usually found around the lips/nose
Triggered by factors such as:
- Sunlight
- Other infections (cold/flu due to weakened immune system)
- Menstrual cycle

Question 16

Treatment of cold sores?

Answer 16

Aciclovir cream 5%

Question 17

When would you refer cold sores?

Answer 17

If eyes/genital regions affected
Age of patient?
Painless
If in the mouth
Last longer than 2 weeks
Immunocompromised

Question 18

What are warts and verrucas?

Answer 18

Small growths on the skin caused by human papillomavirus (HPV)
Peak incidence in secondary school children
A verruca (plantar wart) is just a wart on the plantar region i.e. sole of foot
Warts/verrucae contain a network of capillaries
Warts and verruca will eventually resolve on their own, but appearance can be distressing to patients

Question 19

Treatments for warts and verrucas?

Answer 19

Treatment options typically use keratolytics
Salicylic acid based products are commonly used. This active ingredient gradually destroys the affected area
Care to ensure that the formulation is only applied to the wart / verruca (protect surrounding skin with white soft paraffin)
Emphasise that successful treatment may take >3 months
Cryotherapy used to freeze off wart (10-14 days) – home kits available

Question 20

When should you refer warts and verrucas?

Answer 20

Suspicious changes in shape or colour +/- bleeding and itching
(A) Asymmetrical – melanomas usually irregular shape
(B) Border – melanoma border often “ragged”
(C) Colours – at least 2 colours
(D) Diameter – most melanomas >6mm in diameter
(E) Evolving – moles that change in size may be a melanoma
Diabetic and immunocompromised patients
Anogenital warts in children
Failed treatment