skin CS

What are the functions of healthy skin?

• Barrier function

• Homeostasis

• Sensation

• Excretion

• Immunity

• Vitamin D production

In acne vulgaris, what are the superficial lesions?

• Open comedones (blackheads)

• Closed comedones (whiteheads)

• Papules (small, tender, red bumps)

• Pustules (white/yellow spots)

: In acne vulgaris, what are the deeper lesions?

• Nodules (large, red, painful lumps)

• Pseudocysts (cyst-like swelling)

In acne vulgaris, what are the secondary lesions?

• Excoriation (scratched spots)

• Erythematous macules

• Pigmented macules

• Scars

In acne vulgaris, what defines mild acne?

Predominantly non-inflamed lesions (open/closed comedones) with few inflammatory lesions

In acne vulgaris, what defines moderate acne?

More widespread lesions with increased number of inflammatory papules and pustules

In acne vulgaris, what defines severe acne?

Widespread inflammatory papules, pustules, nodules or cysts. Scarring may be present.

In acne vulgaris, what lifestyle advice is recommended?

• Avoid excessive cleaning and extreme water temperatures

• Avoid squeezing spots (can cause scarring)

• Avoid oil-based makeup, skincare, suncare

• Remove makeup before bed

• Use fragrance-free water-based emollient if dry skin problematic

• Wash hair regularly and avoid letting it fall across face

In acne vulgaris, what is first-line cleansing treatment?

Non-alkaline synthetic detergent cleansing product twice daily.

In acne vulgaris, what OTC topical treatment is used?

Benzoyl peroxide gel/cream.

In acne vulgaris, what topical prescription options exist for mild–moderate acne?

• 12-week course of topical benzoyl peroxide + adapalene

• Clindamycin

• Topical tretinoin + clindamycin

In acne vulgaris, what are treatment options for moderate–severe acne?

• Topical treatment

• Systemic antibiotics (e.g., lymecycline)

• Combined oral contraceptive

In acne vulgaris, what is used for severe or unresponsive acne?

Consultant dermatologist-led oral isotretinoin.

In acne vulgaris, what are the red flag symptoms?

• Moderate/severe acne

• Scarring/persistent pigment changes

• Age <10 or >40

• Symptoms of depression

• Acne fulminans/conglobata

• Unresponsive to treatment

• Females with acne + menstrual irregularities

In allergic rash (urticaria), what are the key features?

• Raised bumps/patches anywhere on body

• Itchy/sting/burn

• May appear pink/red on fair skin

What causes allergic rash (urticaria)?

Histamine release triggered by foods, pollen, animals, etc.

What is the first-line management of allergic rash (urticaria)?

Wash affected area with water.

What oral medication is used for allergic rash (urticaria)?

Non-sedating antihistamines (e.g., loratadine, cetirizine).

What topical treatment is used for allergic rash (urticaria)?

Hydrocortisone 1% cream.

What long-term advice is given for allergic rash (urticaria)?

Identify and avoid triggers.

What are the red flag signs for allergic rash (urticaria)?

• No improvement after 2 days

• Rash spreading

• Recurrence (consider allergies)

• High temperature or feeling unwell

• Simultaneous swelling under skin

• Signs of anaphylaxis

In atopic eczema, which areas are commonly affected?
.

Flexures

Who is commonly affected by atopic eczema?

People of all ages, common in children.

What are the symptoms of atopic eczema?
.

Itchy, dry/cracked/scaly skin, discolouration, blistering/bleeding (if severe)

What causes atopic eczema?

Multifactorial — genetic predisposition, family history of eczema, asthma, hayfever.

What worsens atopic eczema?

Allergens, irritants, heat, infection, stress, hormonal changes.

What is the treatment for mild atopic eczema?

• Frequent, liberal emollients (cetraben, dermol, aproderm)

• Mild topical corticosteroid (1% hydrocortisone)

• Emollients as soap substitute

• Creams for inflamed skin, ointments for dry skin

What is the treatment for moderate atopic eczema?

• Continue emollients

• Moderately potent steroid (betamethasone valerate 0.025% or clobetasone butyrate 0.05%)

What is the treatment for severe atopic eczema?

• Continue emollients

• Potent steroid (betamethasone valerate 0.1%)

• May require antihistamine for itchiness

What advice is given for atopic eczema?

• Avoid irritants

• Apply emollient frequently, even if improved

• Wash with emollient instead of soap

• Keep cool, loose clothing

• Keep nails short/use mittens

• Avoid aqueous cream

What are the red flag signs of atopic eczema?

• No improvement

• Blistered/crusty/leaking fluid/pus

• Painful, swollen, warm skin

• Sudden worsening/spreading

• Accompanied by high temperature

What is contact dermatitis?

A type of eczema caused by irritants or allergens.

What is irritant contact dermatitis?

Skin damage after exposure to substances (soaps, perfumes, powders, cement, plants).

What is allergic contact dermatitis?

Immune reaction to triggers like cosmetics, metals, rubber, textiles

How is contact dermatitis managed?

• Clean skin with warm water

• Use gloves

• Avoid irritating products

• Apply emollients generously

• Identify and avoid cause

• Topical/oral steroids if necessary

What are the red flags in contact dermatitis?

• Signs of infection

• Chronic, severe, or recurrent dermatitis

• Worsening of stable dermatitis

• Associated with recent medications

What is the treatment for blisters?

• Clean and pat dry

• Cover with soft/padded plaster

• If burst, allow fluid to drain before covering

What preventative measures are recommended for blisters?

• Wear well-fitting shoes

• Thick socks/protective gloves during exercise

• Change socks frequently if sweaty

What are red flag signs for blisters?

• Recurring

• Infection signs

• Surrounding redness

• Unusual location

• Multiple blisters without cause

• Burns/scalds/sunburn/allergic reaction

What is a burn?

Dry heat injury.

What is a scald?

Wet heat injury (e.g., steam).

What are symptoms of burns/scalds?

Red/peeling skin, blisters, swelling, white/charred skin.

What immediate actions are recommended for burns/scalds?

• Remove from heat

• Remove clothing/jewellery if not stuck

• Cool under water 20–30 mins

• Keep patient warm

• Cover with clingfilm

• Raise affected area

• Pain relief (paracetamol/ibuprofen)

What are the types of burns/scalds?

• 1st degree: superficial epidermal, red/swollen/painful

• Superficial dermal: epidermis + part dermis, pale pink, painful, small blisters

• 2nd degree/partial thickness: epidermis + dermis, red/blotchy, moist/dry, swollen, blistered

• 4th degree/full thickness: all layers destroyed, white/black, leathery/waxy, may be painless

What are red flag signs for burns/scalds?

• Chemical or electrical burns

• Children

• Large/deep burns

• White/charred skin

• Face/neck/hands/feet/joints/genitals

What is sunburn?

Red, painful, peeling skin caused by UV exposure; usually self-resolves in 7 days.

What advice is given for sunburn?

• Stay out of sun, cover burnt areas

• Cool compress or water

• Use aftersun

• Drink fluids

• Pain relief (paracetamol/ibuprofen)

• Don’t use petroleum jelly or ice

• Don’t burst blisters

• Don’t scratch peeling skin

What are red flag signs for sunburn?

• Blistered/swollen

• High temp, shivering

• Dizzy, sick

• Headache/muscle cramps

• Young children/babies affected

What is heat rash (prickly heat)?

Small, raised, itchy spots from blocked sweat glands.

What advice is given for heat rash?

• Loose cotton clothing

• Cool showers

• Drink fluids

• Cold compress 20 mins

• Avoid scratching

• Avoid perfumed products

What OTC options exist for heat rash?

Calamine, antihistamine, hydrocortisone cream.

What are red flag signs for heat rash?

Not resolving; unclear cause in babies.

What are moles and how do they behave?

Normal throughout life; can appear or disappear at any stage. Some may indicate melanoma.

How should moles be monitored/prevented?

• Avoid strong sun 11am–3pm

• Cover up

• Sunscreen SPF 30+

• Avoid sun beds

What are red flag signs for moles?

• Changes in shape, size, or color

• Painful or itchy

• Inflamed, bleeding, or crusty

• New/unusual marks not healing after weeks, >5mm, irregular border

• Unusual lesions in patients >70yrs

What is ringworm?

Fungal infection causing red/darker, scaly, itchy patches; can occur anywhere.

How is ringworm treated topically?

Topical imidazoles (clotrimazole 1%, miconazole 2%, econazole 1%) for 12 weeks.

What advice is given for ringworm?

• Wash towels/bed sheets regularly

• Avoid scratching (prevent spread)

• Wash hands and pets if suspected

• Take precautions with contaminated objects/soil

When is oral treatment for ringworm needed?

Severe cases, scalp involvement: oral antifungals may be required.

What are red flag signs for ringworm?

• Unresponsive to treatment

• Large/scalp areas

• Immunocompromised

• Reinfection from contacts

What are warts/verrucae?

Viral skin growths, often self-limiting.

What is first-line treatment for warts/verrucae (non-facial)?

• Topical salicylic acid daily for 12 weeks

• Cryotherapy (liquid nitrogen) every 2–4 weeks, up to 6 sessions

• Combination therapy: salicylic acid + cryotherapy

How should salicylic acid be applied for warts/verrucae?

• Soak skin in warm water

• File thickened skin (avoid healthy skin)

• Apply daily up to 3 months

• Avoid face

• Keep away from fire

What are red flag signs for warts/verrucae?

• Unresponsive to treatment

• Extensive areas

• Painful warts

• Warts that bleed, itch, or change

• Patients >50yrs with first-time wart

• Immunocompromised

What are key features of insect bites/stings?

Painful lump; sometimes left stinger/hair embedded.

How should insect bites/stings be managed?

• Wash with soap and water

• Remove foreign object

• Ice pack to reduce swelling

• Avoid scratching

• Topical/oral antihistamine

• Hydrocortisone 1% cream

What are red flag signs for insect bites/stings?

• Signs of infection (pus, hot to touch)

• Painful

• Considerable swelling/itching

• Children <1yr

• Tick bite symptoms (flu-like, circular rash)

• Signs of anaphylaxis

What are key features of scabies?

• Intense itching (worse at night)

• Rash/spots across body

• Burrows on fingers, wrists, hands

How is scabies treated?

• Wash clothing/bedding at 60°C

• Put non-washable items in sealed bag 3 days

• Permethrin 5% w/v cream (children >2 months)

• Single oral ivermectin 200 µg/kg for severe cases

• Malathion also licensed

What precautions are required for scabies?

Avoid close contact with others for 24h after treatment; children <5yrs avoid nursery/school 24h after first treatment

What are red flag signs for scabies?

• Infection

• Severe/extensive rash

• Institutional outbreaks

• Symmetrical pattern; may indicate differential diagnosis

How should wounds be initially managed?

Administer first aid, remove debris, raise affected limb above heart if heavy bleeding.

How should wounds be cleaned?

Use bottled/tap water or sterile wipes; surrounding skin with soap/antiseptic.

How are wounds dressed?

Apply plaster or dressing as needed.

What are red flag signs for wounds?

• Signs of infection

• Animal/human bites

• Large wounds >5cm

• Persistent bleeding

• Blood spurting, bright red

• Loss of sensation or movement

• Foreign body present