BMJ summaries from our GPSTs - keeping you up to date
2013 summary of BMJ key points (click)
2015 summary of BMJ key points (click)
2016 summary of BMJ key points (click)
2017 summary of BMJ key points (click)
2018 summary of BMJ key points (click)
Peri-0cular eczema – Rx with twice daily emollients, ointments preferable to creams. Use soap substitutes. Once daily 1% hydrocortisone, ointment preferable to creams, for 7 to 10 days. Consider topical tacrolimus in patients with recurrent periocular eczema or one resistant to treatment, If infected, swab and treat with a combination of topical and/or oral antibiotics depending upon severity.
Seborrheic dermatitis – Associated with the yeast Malasezzia.. If recurrent or recalcitrant consider screening for immune deficiency. Use ketoconazole shampoo. Leaving the suds in contact with the scalp for 5-10 mins and use the suds to wash the face. A topical antifungal with or without low potency steroid may be applied twice daily for 7 to 10 days.
Dual Anti-Platelet Therapy after high risk TIA or minor ischaemic stroke – TIA within 24 hours and ABCD2 score 6 to 7 (high risk) - consider a loading doe of clopidogrel of 300mg and then 75mg a day for 10 to 21 days and daily aspirin 75mg (no loading dose) in the long term. DAPT not to be used in major stroke due to risk of intracranial bleeding.
HIV Pre-exposure prophylaxis PreP – Recommended in patent at high risk of HIV e.g. HIV negative men who have condomless sec with men of unknown HIV status. Trans people who are HIV negative and have condomless sex and HIV negative individuals who have condomless sex with individuals known to have HIV (who do not have a suppressed viral load). Availability is increasing in the UK via sexual health clinics. Efficacy is dependant on adherence. It does not protect against other STDs. If affords a 70% risk reduction. An alternative to daily PreP is on demand PreP in which meds are taken in the 24 hours before intended sex and continued until 48 hours after sex.
Dysfunctional breathing in adolescents with asthma – this may cause symptoms which can be confused with poor asthma control and ‘resistant asthma’. Consider it in patients with inspiratory difficulties, tightness in the throat, resistant wheeze and anxiety symptoms. Often patient have psycho-social stressors. They may have increased agitation or tremor after beta agonist use. Breathing re-training exercises may be helpful http://www.uhs.nhs.uk/Media/Controlleddocuments/Patientinformation/Respiratory/Breathing-pattern-disorders-patient-information.pdf or www.breathestudy.co.uk.
Vulval itch – Is common. Frequent causes include eczema, contact dermatitis, seborrheic dermatitis, genital psoriasis, lichen planus and lichen sclerosis. Common skin irritants which may matters worse; latex condoms, lubricants, spermicides, toiletries including bubble baths, soaps etc and urine leakage.
General advice – avoid scratching, avoid tight fitting clothes, use loose cotton underwear, avoid irritants as detailed above. Use simple emollients and soap substitutes, consider an antihistamine for itch-scratch suppression. Treat urinary incontinence.
Dermatitis – general measures + moderate potency topical steroid dialy for 7 to 10 days
Seborrhoeic dermatitis – Antifungal/mild steroid for 1 to 2 weeks
Genital psoriasis – moderate potency steroid followed by low potency steroid. Once daily for up to 4 weeks and then step down to twice weekly maintenance.
Lichen planus – High potency steroid daily for 4 to 8 weeks then tapered according to response followed by maintenance Rx with lower potency steroid.
Lichen sclerosis – Very potent steroid once a day for 1 month, alternate days for 1 month, twice weekly for 1 month and follow up after 3 months