common aliment scheme: skin conditions

Common aliment scheme

• aims to improve patient access to consistent evidence based advice and treatment of management of common ailment s

CAS skin conditions

• Acne

• Athlete foot

• Chickenpox

• Cold sores

• Dry skins

• Igrown toenails

• Nappy rash

• Ringworm, tinea cruis and intertigo

• Scabies

• Warts and verrucae

Acne

• chronic, inflammatory skin conditions

• Blocked inflamed pilosebaceous unit

• Affect area with high amounts of ppilosebaceous units

  • Faced back chest

• Peaks in adolescence but can affect any age

• Non inflammatory comedones

  • Whiteheads (opens) and blackheads (closed)

• Inflammatory papules, pustules, nodules cysts

Treatment acne

• mild to moderate acne

  • Benzoyl peroxide 3 or 5% with clindamycin 1% gel

  • Benzoyl peroxide 5% gel- only if other options not suitable

ACNE counselling/ self care

• do not pick or squeeze spots

• Wash area max, twice a day with mild soap/ cleanser avoid hard scrubbing

• Avoid using heavy make up and cosmetics, avoid oil based products

• Clean skin with non alkaline skin cleansing product

• Shower after excerice and wash hair regularly

• Apply gel sparingly after washing and dryin affected area pat dry

Athlete foot

Tinea Pedis

•Fungal/dermatophyte infection affecting feet

•Overgrowth of fungus due to warm, humid, wet conditions in feet – sweaty feet

•Picked up by walking barefoot in areas where someone with athlete’s foot has been

 

•Itchy, white/red, scaly, blistering, cracking skin between toes

•Can spread to soles of foot and nails

 

•Treated with antifungal agents – Clotrimazole, Terbinafine, Miconazole

•Can treat with topical corticosteroid if there’s a lot of inflammation or dry skin

Athlete foot treatment

• clotrimazole 1% cream

  • Up to 3× 20g tubes, max 2 supplies per year

  • Apply 2-3 times daily and use for at leas 4 weeks

• Miconazole 2% cream

• Terbinafine 1% cream

• Hydrocortisone 1% cream

Athlete’s foot- GP referral

• severe or extensive symptoms

• Signs/ symptoms of bacterial symptoms

• Recurrent episode

• No improvement after 1 week

• Pain and discomfort

• Patient is immunocompromised

• Poorly controlled diabetes and not reviewed in last 3 month

Chicken pox

• acute viral disease

• Caused by varicella- zoster virus

• Common childhood illness but can also affect adults

• Rush- small, red, raised spots, itchy, blister/ vesicle present

• Commonly on face, scalp, trunk and limbs

• Also fever and malaise

• Very infectious- stay off school/ nursery until all blisters scabbed over

Chicken pox

• paracetamol 120mg/ 5ml (not for children under 3 months)

• Paracetamol 500mg tablets x32

• Chlorphenamine 2mg/ 5ml SF oral solution 150ml (not to be given to children under 1

• Chlorophenamine 4mg tablets x 28 (not for children under 6)

Chicken pox- ibuprofen

• do not advise or supply ibuprofen

• Cause increased risk of skin infection and necrotising fasciitis

• Increased pneumonia risk in children with respiratory problems

Chicken pox- GP referral

Unsure over diagnosis

• systemically unwell, deterioration, complication, no improvement in 6 days

• Baby less than 4 weeks old- disseminated

• Suspected bacterial infection

• Dehydration

• Associated respiratory symptoms

Cold sores

• small vesicles/ blisters around the mouth and on lips

• Herpes simplex virus

• Exists in a latent state and can ram in latent indefinitely, or reactive to cause clinical infection

• Tinging, itching burning around the month before blister appear

• Self limiting- can heal in 7- 10 days

• Poor evidence for topical antiviral treatment efficacy

Cold sores advice only under CAS

• minimising transmission

• Avoid touching lesions

• Avoid kissing until completely healted

  • Newborn

• Avoid oral sex until healed

• Do not share lipstick/ gloss, balm

• Drink adequate fluids

• Avoid acidic/ salty foods

• Eat, soft, cool foods

• Risk of recurrence

• Use of sunscreen

GP referral

• pregnancy

• Neonates

• Immunocomprosied

• Recurrences- 6+ year

• Deterioration- spreading lesions, fever dehydration

• No improvement after 5-7 day

Cold sores

• patient can purchase OTC aciclovir cream or cold sore patches

• Advice on:

  • Avoid touching lesion

  • Wash hands before and after use

  • Dab on rather than rub in

  • Do not share product with other

Dry skin/ dermatitis

• rough, scaly, flaky, cracked skin

• Sometimes red and itchy

Trigger

• hot/ cold/ windy condition

• Excess washing

• Soaps, detergents, chemical, alcohol

• Clothing and animal hair

• Food

Dry skin/ dermatitis- treatment

• emollients- liberal application and often avoid aqueous cream

• Topical corticosteroid- reduce itching and inflammation

• Hydrocortisone 1%/ 2.5% cream/ ointment

• Not to be supplied for children under 10 or pregnant

Dermatitis advice self management

• emollient use

• Avoid trigger

• Product contain paraffin

• Change/ wash bedding regularly

Ingrown toenail

• extremely common

• Part of toenail penetrates into the skin

• Pain redness heat tenderness, swelling, pus of nail fold

Ingrown toenail advice

• analgesia- paracetamol

• Prevention from getting worse

• Soak in water for 10 minutes to soften skin around nail

• Use cotton wool bud to push skin fold over ingrown nail and away

• Repeat daily for a few weeks

• As nail grown push a piece of cotton wool or dental floss under the nail to aid growth

Ingrown toenail causes

• trimming/ cutting nail too short

• Tearing off toenail

• Constricting footwear

• Sweaty feet

• Injury to the nail

Ingrown toenail GP referral

• diabetic

• Infection may need surgical intervention or draining

• Concurrent nail disease

• No improvement within 7 days or worsening

Intertrigo

• inflammation/ rash in body folds

• Under breast, armpits, groin

• Moist macerated skin, cracking, peeling

Inflammatory

• symmetrical

Infectious

• unilateral/ asymmetrical

• Bacteria, yeast, fungal growth

Intertrigo treatment

• clotrimazole 1% cream

• Micronazole 2% cream

• Terbinafine 1% cream

• Hydrocorticosone 1% cream

Intertigo- treatment

• wash affected area daily and dry thoroughly

• Wash clothes and bed linen frequently

• Do not share towels and wash frequently

• Wear loose- fitting clothing or material that take moisture away from the skin

Intertrigo GP referral

• severe/ extensive cases

• Signs/ symptoms of bacterial infections

• No improvement after 2 weeks treatment

• Recurrent episodes

• Immunocompromised

• Poorly controlled diabetes

Nappy rash

• mild rash to nappy area

• Redness over buttock, genitals, pubic region and upper thighs

• Can be scaly

Cause

• prolonged skin contact with urine and faces

Nappy rash advice

• use high absorbency nappies

• Keep nappies off for as long as possible

• Change and clean asap after wetting and soiling

• Use water based

• Dry gently

Nappy rash treatment

• signs of bacterial infection

• Severe inflammation

• Baby systemically unwell

• Fever

Ringworm

• common fungal infection

• Circular lesion/ patch, inside pale with exterior redness

• Gradually can become larger

Ringworm self care advice

• wash affected skin daily, dry throughly afterwards

• Wash clothes, towels and bed linen frequently

• Do not share towels

Ringworm treatment

• clotrimazole 1% cream 20g

• Miconazole 2% cream 30g

• Terbinafine 1% cream

Ringworm GP referral

• severe/ extensive case

• Suspected bacterial infection

• Treatment failure after 2 weeks

Scabies

• intense itching rash, worsen at night and in heat

• Burrows seen in webs between finger

• Raised rash or spots

• The spots may look red

Scabies advice

• wash clothes, bed sheets towels at high temp then dry in a hot air dryer

• Any clothes that can’t be washed should be sealed in plastic bag for 72 hours

• Treat all people within the household or anyone who has been a close contact

Scabies GP referral

• severe rash

• Suspected secondary bacterial infection

• Systemically unwell

• Child under 2

Scabies treatment

• permethrin 5% cream 30g

• Malathion 5% liquid

• Chlorphenamine

Warts and verrucae

• small rough growth in skin

• Caused by HPV

• Can appear anywhere on skin but most commonly on hands and feet

• Verruca= wart on sole of the foot

• Unsightly but not harmful

Warts and verrucae treatment

• salactol paint

• Salactac gel

• Apply at night for 12 weeks

• Debride surface with emery board/ soften in warm water for up to 10 mins before first application

Warts and verrucae GP referral

• wart on face, intertiginous or anogenital regions

• Uncertain diagnose

• Warts with hair growing out of them

• Bleeding warts

• Change in appearance

• Wart is associated with significant pain