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Clinical Pharmacy 1 - Term 1 > 3 - Scaly Dermatitis > Flashcards

3 - Scaly Dermatitis Flashcards

1
Q

What is coal tar?

A

A keratolytic, antiseptic that reduces local swelling & inflammation

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2
Q

What does keratolytic mean?

A

Breaks down skin cells

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3
Q

Does coal tar have any antifungal properties?

A

Minimal

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4
Q

What are side effects to coal tar?

A
  • Acne
  • Folliculitis (infection of hair follicles)
  • Stains to skin and air
  • Photosensitization
  • Irritant contact dermatitis
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5
Q

What is zinc pyrithione generally found in?

A

Anything to treat dandruff or itchy scalp

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6
Q

What is zinc pyrithione?

A

Cytostatic and keratolytic agent

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7
Q

What does cytostatic mean?

A

Decreases rate of epidermal cell replication

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8
Q

Zinc pyrithione has ____ and ____ properties

A

Bacteriostatic and fungistatic

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9
Q

Is zinc pyrithione or selenium sulfide slower acting?

A

Zinc pyrithione

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10
Q

What is one side effect of zinc pyrithione?

A

Rare cases of contact dermatitis if used on broken or abraded skin

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11
Q

What is selenium sulfide?

A

A keratolytic that slows down scale production and epidermal proliferation

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12
Q

Does selenium sulfide have some fungicidal or fungistatic effects?

A

Both

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13
Q

Why must selenium sulfide be washed through hair thoroughly?

A

Hair discolouration may result

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14
Q

What does frequent use of selenium sulfide typically cause?

A

Residual odour, oily scalp, and hair loss

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15
Q

Does selenium sulfide cause irritation when used topically?

A

Minimal

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16
Q

Ketoconazole is an _____

A

Antifungal

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17
Q

What is ketoconazole available as OTC?

A

2% shampoo

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18
Q

What schedule is ketoconazole?

A
  • Schedule 1 in everything except for topical use in a shampoo
  • Unscheduled as a shampoo
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19
Q

What are some side effects to ketoconazole?

A
  • Minimal scalp and skin irritation
  • Greasy or dry hair/scalp
  • Itching or stinging
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20
Q

Salicylic acid is ______

A

Keratolytic

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21
Q

What is the mechanism of action for salicylic acid?

A

Decreases skin pH, which increases hydration of keratin, facilitating loosening and removal

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22
Q

When should salicylic acid NOT be used and why?

A
  • In patients with greater than 20% BSA involvement

- May cause salicylate toxicity

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23
Q

What is the characterizing symptom of salicylate toxicity?

A

Tynitis (ringing in the ear)

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24
Q

Is psoriasis contagious?

A

No

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25
Q

What is psoriasis?

A

Life-long chronic inflammatory disease of the skin

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26
Q

What is the typical onset of psoriasis?

A

16-22 (more severe) and 57-60 (less severe)

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27
Q

What is the most common form of psoriasis?

A

Plaque psoriasis

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28
Q

What are the common sites of psoriasis?

A

Scalp, buttocks, arms, legs, elbows, knees, ears, palms, and soles

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29
Q

What are the risk/aggravating factors of psoriasis?

A
  • Genetic predisposition
  • Skin trauma
  • Environmental (alcohol ingestion, obesity, stress, pregnancy)
  • Medications (beta-blockers, NSAIDs, anti-malarial, lithium)
  • Infections (respiratory, HIV, streptococcal)
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30
Q

What are the signs and symptoms of psoriasis?

A
  • Thickened red plaque with silvery-white scales
  • Bleed easily (if plaque is removed)
  • Most have symmetrical lesions
  • Minimal itching
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31
Q

What questions should be asked during assessment for psoriasis?

A
  • How severe are the symptoms?
  • Duration of irritation?
  • Area of involvement?
  • How often do symptoms occur?
  • Medical history?
  • Has anything been tried yet?
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32
Q

When should you refer for psoriasis?

A
  • Under 2 years of age
  • If diagnosis has not been made
  • No improvement of symptoms after 2 weeks
  • Over 3% of BSA involved
  • Severity and type of psoriasis
  • Location of lesions - hands, nails, forearms, and face (b/c may impact patients quality of life)
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33
Q

What are the treatment goals of psoriasis?

A
  • Control or eliminate the signs and symptoms

- Prevent or minimize the likelihood of flares

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34
Q

Only ____ cases of psoriasis may be self-treated

A

Mild

35
Q

What determines the choice of treatment for psoriasis?

A
  • Severity
  • Location of plaques
  • Convenience
  • Patient compliance
  • Financial considerations
  • Physical accessibility to treatment
36
Q

What are some non-pharms for psoriasis?

A
  • Do not rub, scratch, or pick skin
  • Dab (don’t rub) medication onto area
  • Mild cleansers and warm water used for cleaning
  • Moisturize skin
  • Avoid triggers (dry skin)
  • Reduce risk for infections (avoid smoking, alcohol, stress)
  • Moisturize air in home
37
Q

What are the types of treatment for psoriasis?

A
  • Topical therapy (first line therapy for mild to moderate psoriasis)
  • Phototherapy
  • Systemic therapy
  • Biologic therapy
  • Combination therapy
38
Q

What are common topical prescription products for psoriasis?

A
  • Corticosteroids (medium - high potency)
  • Compounds w/ coal tar or salicylic acid
  • Tazarotene
  • Calcipotriol (alone or combined w/ corticosteroid)
39
Q

What is a common oral therapy prescription for psoriasis?

A

Various immunosuppression medications

40
Q

When is biological therapy used for psoriasis?

A

For chronic moderate to severe plaque psoriasis

41
Q

What types of corticosteroids are used for psoriasis?

A
  • Hydrocortisone 0.5% and 1% (OTC, used for mild cases)

- Clobetasone 0.05% cream (schedule 2, moderate potency)

42
Q

When is coal tar used for psoriasis treatment?

A
  • Mild to moderate psoriasis

- In combination w/ other topical treatments

43
Q

When are keratolytic agents used for psoriasis treatment?

A
  • Mild to moderate psoriasis

- In combination w/ other topical treatments

44
Q

What are the most effective moisturizers for psoriasis?

A

Ointments

45
Q

What are the monitoring parameters for psoriasis?

A
  • Thickness of scales should decrease 50% in 6-8 weeks
  • Scaling should decrease 50% in 7-10 days
  • Itching should go away in 1-2 weeks
  • Redness should decrease 50% in 8-12 weeks
  • Side effects of treatment
46
Q

Can pharmacists prescribe for psoriasis?

A

No

47
Q

Can pharmacists prescribe for seborrhea dermatitis?

A

Yes

48
Q

What is seborrhea dermatitis?

A
  • Sub-acute or chronic inflammatory disorder

- Accelerated cell turnover (9-10 days; normal is 30)

49
Q

Where is seborrhea dermatitis primarily found?

A

Scalp, face, and trunk

50
Q

Does seborrhea dermatitis affect men or women more often?

A

Men

51
Q

What are 2 possible causes of seborrhea dermatitis?

A
  • Yeast infection (Malassezia furfur)

- Abnormality of oil glands and hair follicles

52
Q

When completing the differential diagnosis of seborrhea dermatitis, what other conditions should you consider?

A

Psoriasis

53
Q

What are the risk/aggravating factors of seborrhea dermatitis?

A
  • Increased incidence in HIV or AIDS patients
  • Genetics (maybe)
  • Medical conditions (Parkinson’s, depression, mood disorders)
  • Environmental (low humidity and temp, stress)
  • Medications (lithium, cimetidine, haloperidol, methyldopa)
54
Q

What are the signs and symptoms of seborrhea dermatitis?

A
  • Mild, greasy scaling of scalp area
  • Starts as small patches and spreads
  • Dull, yellowish, oily, scaly areas on red skin
  • Itching
  • Groin area and axillae show lesions that are bright red w/o scaling
  • Cradle cap in infants
55
Q

What are the symptoms of cradle cap?

A

Thick, dry, yellowish-brown scales on the face, forehead, ears, or entire scalp

56
Q

When should you refer for seborrhea dermatitis?

A
  • Under 2 years of age
  • No improvement w/ OTC treatment after 2 weeks
  • Symptoms are severe or spread to other parts of body
  • Signs of infection
57
Q

What are the treatment goals for seborrhea dermatitis?

A
  • Reduce inflammation and epidermal turnover rate of scalp skin
  • Minimize or eliminate visible erythema and scaling
58
Q

What are some non-pharms for seborrhea dermatitis and dandruff?

A
  • Remove triggers/aggravating factors
  • Avoid irritating soaps, greasy creams
  • Avoid excessive hot water
  • Decrease exposure to cold, dry air
  • Wash hair w/ general, non-medicated shampoo every 1-2 days
  • Control stress
59
Q

What should treatment include for seborrhea dermatitis?

A
  • Loosening and removal of scale and crust
  • Inhibit yeast
  • Decrease redness and itching
60
Q

What should be the initial OTC treatment for seborrhea dermatitis and dandruff?

A

Agent that reduces Malassezia (zinc pyrithione, selenium sulfide, or ketoconazole shampoo)

61
Q

What should be the second line OTC treatment for seborrhea dermatitis and dandruff?

A

Agent that reduces scaling by decreasing epidermal turnover (keratolytic agent, antiproliferative agent, hydrocortisone cream)

62
Q

What are the dosing instructions for hydrocortisone cream in the treatment of seborrhea dermatitis

A
  • Once or twice daily until symptoms clear for 1-2 weeks

- Apply after shampooing to enhance absorption

63
Q

How often should medicated shampoos be used?

A

2-4 times/week for approx. 4-5 weeks then reduce to once a week to prevent relapse

64
Q

What medications can pharmacists provide for seborrhea dermatitis under the laws?

A
  • Salicylic acid (available OTC so no use prescribing)
  • Ciclopirox*
  • Terbinafine*
  • Tolnaftate (not appropriate)
  • Combinations (not available)
65
Q

What is ciclopirox?

A
  • Broad spectrum agent

- Effective against dermatophytes, yeast, and some bacteria

66
Q

What strengths is ciclopirox available as?

A
  • 1% cream or lotion (Loprox)

- 1.5% shampoo (Stieprox)

67
Q

What is the recommended use for Stieprox?

A

2-3 times/week for treatment of fungal infections associated w/ seborrheic dermatitis until remission, then once/week to prevent relapse

68
Q

What are recommended treatments for non-scalp seborrhea dermatitis?

A
  • Avoid harsh soaps
  • Remove scales
  • Warm (not hot) water to decrease dryness
  • May want to apply medicated shampoo onto face and wash off in the shower (*don’t leave on too long or will irritate)
69
Q

What are the monitoring parameters for seborrhea dermatitis and dandruff?

A
  • Scaling should improve w/in 7-10 days
  • Redness should improve w/in 8-12 weeks
  • Thickness of plaques should decrease w/in 6-8 weeks
  • Itching should improve w/in 1-2 weeks
70
Q

Can pharmacists prescribe for seborrhea dermatitis in pediatrics (cradle cap)?

A

No, but the treatment is non-pharms only anyway

71
Q

Does cradle cap make a child more prone to seborrhea dermatitis or dandruff in the future?

A

No

72
Q

When does cradle cap usually start?

A

In infants first month

73
Q

When does cradle cap usually resolve?

A

By age 3-4 months

74
Q

What is the presentation of cradle cap?

A

Yellowish, greasy scale on scalp

75
Q

What is the treatment for cradle cap?

A
  • Wash hair daily w/ mild baby shampoo
  • Loosen scales w/ soft brush before rinsing
  • Gently massage in mineral oil or baby oil to loosen scales, then wash w/ baby shampoo
  • If on face, use mild soap and moisturizer
76
Q

Dandruff is a mild form of _____

A

Seborrhea dermatitis

77
Q

What is dandruff?

A
  • Chronic, non-inflammatory scalp condition

- Excessive scaling of scalp, characterized by accelerated epidermal cell turnover (13-15 days)

78
Q

Is dandruff common in children?

A

No

79
Q

When does dandruff usually appear?

A

During puberty (10-20 years old)

80
Q

What are the risk/aggravating factors of dandruff?

A
  • Environmental (dry climate, extremes in weather)
  • Increased stress
  • Obesity
  • Inadequate hair washing (?)
  • Possibly caused by Malassezia furfur
81
Q

What are the signs and symptoms of dandruff?

A
  • Dry, white or silver-gray flakes
  • Scaling w/ accumulation of flakes
  • Detached by combing of hair
  • Some itching
  • Usually symmetrical
  • May be in patches, but most often not
82
Q

What are the treatment goals for dandruff?

A
  • Reduce of eliminate flaking and associated symptoms
  • Minimize cosmetic embarrassment of visible flakes
  • Prevent recurrences
83
Q

What is important to tell a patient who is using a medicated shampoo to treat dandruff?

A
  • Contact time is vitally important for effectiveness of medicated shampoos
  • Used only 2-4 times/week until controlled (about 2-3 weeks) then reduce to once per week or 2 weeks to maintain control
84
Q

Can you prescribe Cicloprix for dandruff?

A

No, only seborrhea dermatitis

Clinical Pharmacy 1 - Term 1 (18 decks)

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