5 Oral AntibioticsNo benefit in concomitant oral and topical antibiotics.Intermittent benzoyl peroxide recommended during oral antibiotics to eliminate resistant strains.Dose: evidence to support erythromycin at 1g/day rather than 500mg/day. No evidence regarding dose of other oral antibiotics.Treatment should be at least 3 months, maximal effect by 6 months – then if relapse, change drug.
6 Case 2 17 year old 6th Former 2 year history of worsening acne. On 250mg bd oxytetracycline.
7 Case 3 6 year old girl Itchy face, neck, arms. Worsening over past 3 months.Not responding to hydrocortisone.Mum asks about allergy tests.
8 Atopic eczema - top tips Emollients - trial then large quanitities.Soap substitutes - simplifyTopical steroids - appropriate to severityShort bursts of moderate / potent steroids to achieve controlTopical tacrolimus 0.1% - equivalent strength to mod potent top steroid. Maintenance.Allergy: consider to be relevant ifInstant urticaria/itching after eating/ contactSevere/ resistant eczema especially if bowel sx +/- FTT
12 Rosacea Subtypes: Treatment Depends on subtype Avoid triggers ErythematotelangectaticPapulopustularPhymatousTreatmentDepends on subtypeAvoid triggersSun protectionTopical azaleic acid/metronidazoleOral antibiotics
13 Rosacea Mild or moderate papulopustular rosacea Metronidazole Gel (Metrogel®) 0.75% £9.95 (40g)Cream (Rozex®) 0.75% £15.28 (40g)Apply twice daily for 3-4 monthsModerate or severe papulopustular rosaceaOxytetracyclineTablets 500mg twice daily for 3-6 months £5.68Lymecycline (unlicensed)Capsules 408mg once daily ………………………………..….£22.45 (3 months)Review at 2 months and continue for a total of 3 months if responding well.Repeat 3 monthly course when rosacea flares.
14 Case 5 55 year old art teacher. Worsening facial rash over 2 weeks. Sore, weeping.
16 Case 638 year old IT workerPersistent lesion R cheek
17 Case 735 year old nurseIrritating rash past 2 years central face
18 Joint Formulary For moderate and severe disease affecting the scalp Ketoconazole shampoo £3.02 (120mL)Use twice a weekFor more severe erythema and flaking on the scalp addBetamethasone scalp application £3.81 (100mL)Apply to dry hair morning and evening and allow to dryDisease affecting face and bodyKetoconazole cream £3.40 (30g)Apply once or twice a day until resolution then reduce frequency to daily oralternate daily use.For inflamed skinDaktacort® cream………………..…………………………………...……….£1.83Apply once or twice a day until resolved.
19 Case 8 75 year old man Rough patches on forehead. Sore in strong sunlight.
20 Solar (actinic) keratosis: Treamtent Treatment:Diclofenac5FUPhotodynamic TherapyCryotherapyCurettage