Describe SCC and its associations
- Slow Growing
- Crusty
- In elderly
- Sun exposure
All Melanoma pts are on a 5-year watchlist.
How is a BCC referred?
Slow metastases, so 2wk wait referral doesn’t apply
How long can viral raises remain on body
7-10 days
When doing a skin exam, outline LOOK
- Hair, Nails, Mucous membranes, Lymph nodes
* Lesion Position, Size, Number, Symmetry, Colour, Border regularity
When doing a skin exam, outline TOUCH/ PALPATE
• Tenderness, Wam, Blanching or not, Scaling, Bleeding easily?
What are 2 structures of Describing Skin lesions ?
- Asymmetry, Border, Colour, Diameter
- Site of Distribution (Generalised, F, E, Photosensitive)
- Surface features (Scale, Crust, Exc, Erosion, Ulcer)
- Configuration (Discrete, Confluent, Linear, target)
- Colour (Red, Purpuric, Brown/Black, Hypopigment)
- Morphology (Annular, Wheal, Discoid, Comedone)
Outline the Non-pharmaceutical management of Eczema
Self care: Avoid scratching and triggers. May need dietary changes
List 6 aspects of Pharmaceutical Eczema Management
- Emollients
- Topical CSs
- Topical Pimecrolimus/ Tacrolimus in sensitive sites, and not responding to simple treatment
- Antihistamines
- Bandages/ Body suits to allow healing
- Stronger treatments from Dermatologist;
- Allergy testing, Phototherapy
- Topical Calcineurin Inhibitors, Immunosuppressant tablets
- Alitretinoin or Dupilumab
- Very potent Topical CS
Outline use of Topical CS in Eczema management
Oral CS tablets rarely used for 5-7day courses
- Use if inflammation
- Usually x1/day, 30mins after applying Emollient, Continue use upto 48hrs after flare-up cleared
Compare the 3 types of Emollients
Give 1 example for each
Lotions;
- Least oil, More frequent application
- Aveeno lotion
Creams;
- Middle
- E45 cream
Ointments;
- Most oil, most effective
- Hydromol
Outline use of Emollients in Eczema management
- Use all time, even if no symptoms
- Don’t rub, but stroke with grain
- Pat skin dry after shower and apply whilst moist
- Don’t scoop out with finger
List ADRs of Topical CSs
Increased risk if used for many mths/ In large amounts/ In sensitive areas
- Mild stinging for <1min
- Rare: Skin Thinning/ Colour changes, Acne, Hirsutism
List 4 Topical CS strengths and give examples of each
Mild: Hydrocortisone 0.1-2.5%
Moderate: Betamethasone Valerate 0.025% (Betnovate-RD)
Strong/ Potent: Betamethasone 0.1%
Very Strong/ Potent: Clobetasol propionate
How can Urticaria/ Hives present?
Can be Acute or Chronic, < or > 6wks
- Epidermal swelling
- Red, raised itchy/ stinging rash (can be spots)
List 3 important aspects oh history related to Urticaria
- Relation to menstrual cycle
- Previous treatment effectiveness
- Causes/ triggers (Stress, Allergies, Exercise, Foods etc)
How is Urticaria managed?
Acute is likely to be self-limiting
- Advice on trigger avoidance
- Non-sedating antihistamine daily for upto 6wks
- If severe, Oral CS for upto 7 days. If symptoms improve, consider daily antihistamines for 3-6mths
In Urticaria management, if treatment response is inadequate, what do you consider?
- Gradual dose increase of 1st line antihistamine upto x4 licensed dose
- Alternative non-sedating antihistamine
- Add sedating antihistamine for night use
- Adding topical anti-itch agent (Calamine)
- Refer if suspected Vasculitis Urticaria (Vessel inflammation)
Describe Pityriasis Rosea
How is it treated?
- Few wks after infection. Self-limiting (3-12wks)
- Emollients, Steroid creams, Antihistamines, UVB Light therapy
