Common Dermatological Problems
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How much of the UK population is affected by skin diseases?
1/3rd - 25% consult for advice/treatment
What is dermatitis also known as?
Eczema - itchy skin condition
What other conditions does atopic eczema usually accompany?
• Allergic rhinitis (hay fever) • Asthma (atopic tendency)
What consists of the initial treatment for atopic eczema?
• Trigger avoidance + break itch-scratch-itch cycle • Moisturisers (lotion, cream, ointment) • Soap substitutes - aqueous cream, Dermol 500 • Bath preparations (Oliatum, Balneum, Dermol 600) • Topical steroids (next card) • Other - topical calcineurin inhibitors, oral antibiotics, antihistamines
What intermittent topical steroids can be used for atopic eczema?
• 1% hydrocortisone (mild) • Eumovate (moderate) • Betnovate, Elocon (potent) • Dermovate (very potent)
If there is very severe eczema or poor response to topical therapy, what can be done?
• UV phototherapy • Systemic treatment - Ciclosporin, methotrexate, axathioprine
What are complications of atopic eczema?
• Bacterial co-infection - impetiginisation • Viral co-infection - eczema herpecticum • Post-inflammatory hypo/hyper pigmentation • Scarring • Striae/skin atrophy from steroid use • Depression / psychosocial impact
In which areas of the body is psoriasis most common?
• Extensor surfaces • Sacrum, scalp, ears, palms, soles • Nails
What is the topical treatment of psoriasis?
• Emollients • Topical steroids • Coal tar • Salicyclic acid • Vitamin D analogues (Calcipotriol - dovonex) • Combo of above - Diprosalic, dovobet • Dithranol
Sometimes a dermatologist may prescribe biologics such as monoclonal antibodies against TNF, what are some anti-TNFs?
• Etanercept (Enbrel) • Infliximab (Remicade) • Adalimumab (Humira)
Where does acne vulgaris affect?
Areas of skin w/ densest population of sebacous follicles - face, upper chest, back.
How is acne vulgaris graded?
I - IV • I - multiple open comedones (blackheads) • II - closed comedones (whiteheads) (mild acne) • III - extensive inflammatory papules/postules (moderate acne) • IV - large nodules, cysts, scarring (nodulocystic acne)
What are the topical treatments of acne vulgaris?
• Topical retinoids (Adapalene, Tretinoin) • Topical antibiotics (Dalacin-T, Zineryt) • Benzoyl peroxide (duac)
What oral medications can treat acne vulgaris?
• Oral antibiotics - erythromycin, oxytetracycline, lymecycline • Oral contraceptive pill - dianette
What is Isotretinoin (Roaccutane) and when is it used? Side effects?
• Systemic retinoid • For severe cystic acne • Teratogenic (so can’t get pregnant) • Side effects - dry lips/skin, myalgias, hair thinning, depression • Baseline FBC, LFTs, lipids
Impetigo is the most common bacterial skin infection in children. What is mild/localised impetigo treated with?
Topical Fucidin
What is extensive impetigo treated with?
Oral Flucloxacillin
Which virus causes viral warts?
Human Papilloma Virus
How are viral warts spread?
Direct or indirect contact - swimming pools, biting fingernails, shaving
What is treatment of viral warts?
• Nil - self-resolving • Duct tape • Salicyclic acid • Cryotherapy
What is the treatment for tinea?
• Topical azole (eg. clotrimazole) or allylamine (eg. terbinafine) for 2 weeks • Nails - Terbinafine for 6 weeks (fingernails) or 3-4 months (toenails) • Systemic therapy may be indicated if extensive, immunosuppression, resistance to topical therapy
What is acitinic keratosis?
• Common sun-indued scaly or hyperkeratotic lesion -> potential to become malignant • affects 23% Uk pop >60 years
What creams and gels can be used to treat actinic keratosis?
• 5-fluorouracil cream - Efudix • Imiquimod cream - Aldara • Diclofenac gel - Solaraze
What is squamous cell carcinoma?
• Result of cumulative sun exposure (incidence inc w age) • Dorsum of hands, forearms, ears, upper face, lower lip • Arise de-novo OR from AK/Bowmen’s • Refer immediately under 2ww for surgical intervention