Oral Antibiotics No 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.
Case 2 17 year old 6th Former 2 year history of worsening acne. On 250mg bd oxytetracycline.
Case 3 6 year old girl Itchy face, neck, arms. Worsening over past 3 months. Not responding to hydrocortisone. Mum asks about allergy tests.
Atopic eczema - top tips Emollients - trial then large quanitities. Soap substitutes - simplify Topical steroids - appropriate to severity Short bursts of moderate / potent steroids to achieve control Topical tacrolimus 0.1% - equivalent strength to mod potent top steroid. Maintenance. Allergy: consider to be relevant if Instant urticaria/itching after eating/ contact Severe/ resistant eczema especially if bowel sx +/- FTT
Case 4 51 year old school teacher. Worsening facial rash. Uncomfotable, especially in hot weather.
Rosacea Subtypes: Erythematotelangectatic Papulopustular Phymatous Treatment Depends on subtype Avoid triggers Sun protection Topical azaleic acid/metronidazole Oral antibiotics
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 months Moderate or severe papulopustular rosacea Oxytetracycline Tablets 500mg twice daily for 3-6 months £5.68 Lymecycline (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.
Case 5 55 year old art teacher. Worsening facial rash over 2 weeks. Sore, weeping.
Case 6 38 year old IT worker Persistent lesion R cheek
Case 7 35 year old nurse Irritating rash past 2 years central face
Joint Formulary For moderate and severe disease affecting the scalp Ketoconazole shampoo £3.02 (120mL) Use twice a week For more severe erythema and flaking on the scalp add Betamethasone scalp application £3.81 (100mL) Apply to dry hair morning and evening and allow to dry Disease affecting face and body Ketoconazole cream £3.40 (30g) Apply once or twice a day until resolution then reduce frequency to daily or alternate daily use. For inflamed skin Daktacort® cream………………..…………………………………...……….£1.83 Apply once or twice a day until resolved.
Case 8 75 year old man Rough patches on forehead. Sore in strong sunlight.