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PDAT1 > 6 - Dermatology: Hair Loss & Warts > Flashcards

6 - Dermatology: Hair Loss & Warts Flashcards

1
Q

What is Epidermis and what type of cells does it condain?

A
  • *EXTERNAL** layer composed of
  • *layers of KERATINOCYTES**

but also containing MELANOCYTE + other cells
(produce melanin)

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2
Q

What is the DERMIS and what does it contain?

A

Area of supportive connective tissue
underneath the epidermis

contains:

Sweat Glands / Hair Roots / Nerve Cells

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3
Q

Melanocyte

A

Cell found in the Epidermis

that produces MELANIN

eumelanin / pheomelanin = biopolymer agent

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4
Q

Melanosome vs Melanophage

A

MelanoSOME = VESICLE that transports melanin

MelanoPHAGE = melanin phagocytized by dermal macrophages

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5
Q

Hyperpigmentation Pathophysiology

A

INCREASE in synthesis or desposition of MELANIN

EPIdermal –> Increased Melanin production

Dermal -> does NOT usually have melanin
Transfer / accumalation within melanophages
production by ectopic melanocytes
exogenous pigments

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6
Q

Associated Disorders of HYPERpigmentation

A

Solar Lentigines
age spots, tan-dark-brown macules on sun exposed areas

Maturational Hyperpigmentation
dyschromia, darkening on lateral aspects of face due to sun

Post-inflammatory** **HYPERpigmentation
darkening of skin after injury / inflammation

  • *Melasma**
  • *facial** HYPERpigmentation on sun-exposed areas often associatioed w/ hormonal changes
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7
Q

Medications that cause HYPERpigmentation

A

Amiodarone / Anticonvulsants
Antimalarial Agents / Antineoplastic agents

HRT / Oral Contraceptives

Heavy Metals

Minocycline / Phenothiazines / TCA’s

Zidovudine

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8
Q

Tyrosinase Inhibitors

MoA / Treatments

for HYPERpigmentation

A

Act on Melanocytes @ cytoplasm

  • *Tyrosinase is the enzyme that oxidates this reaction**
  • *Tyrosine -/-> DOPA -/-> Dopaquinone** -> MELANIN

Treatments:
Hydroquinone / Mequinol

Azelaic/Kojic/Glycolic ACID

Alpha-Arbutin / Licorice Extract

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9
Q

Copper Interaction

MoA / Treatments for HYPERpigmentation

A

In Melanocyte @ cyto, copper interacts
Tyrosine –> DOPA –> Dopaquinone -> MELANIN

KOJIC ACID

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10
Q

Reduction in Melanosome Transfer

MoA / Treatment for HYPERpigmentation

A

IN Keratinocyte & melanocyte interface:
Melanosome –/–> Protease activated receptor-2

RETINOIDS

NIACINAMIDE

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11
Q

INCREASED Keratinocyte TURNOVER

MoA / Treatment for HYPERpigmentation

A

more keratinocytes turnover / new skin

Retinoids

GLYCOLIC Acid

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12
Q

RX-treatment for HYPERpigmentation

A

Retinoids
Tretinoin / Tazarotene

Hydroquinone 3% or 4%

Azelaic Acid 20%

Mequinol/tretinoin = Solage

Fluocinolone/hydroquinone/tretinoin = Tri-Luma

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13
Q

Non-Rx Treatment for HYPERpigmentation

A

SUNSCREEN

Hydroquinone 1.5 / 2%

Azelaid Acid 10%

Glycolic / Kojic Acid

Niacinamide

Botanical combinations = Meladerm

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14
Q

Basic treatment ideas for HYPERpigmentation

A

DAILY SUNSCREEN USE is CRUICIAL

more DIFFICULT to treat DERMAL H-P

Better to use multiple medications for melasma/PIH
beware of use of _LASERS_ –> PIH

some OTC cosmeceuticals contain MERCURY

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15
Q

ADR’s of HYPERpigmentation Treatments

A

Generally:
skin Irritation / HYPERsensitivity / SUN sensitivity

BOTH HYPER/hypoPigmentation

Hydroquinone: OCHRONOSIS
yellow -> blue/black discoloring

Retinoids: Inflammatory response

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16
Q

EX-ST

for HYPERpigmentation

A

Treatment + Sunscreen with NO improvement in 3 MONTHS

<12 years old

HYPERpigmentation of large BSA

Disease / Drug -induced

Lesions CHANGING
in size/shape/color

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17
Q

Suggested treatment for HYPERpigmentation

A

As long as NO EX-ST
>12 yo / large BSA / lesions changing / disease-drug-induced

HYDROQUINONE 2%** +/- **AHA _(_acid product)
with SUNSCREEN

after 3 months
improvement-> continuesunscreen+QD/BID treatment prn

no improvement –> SEE MD

18
Q

Pathophysiology of WARTS

A

Caused by HPV = human papilloma virus
various strains are common

Various warts caused by different strains
HPV-1 = plantar

HPV stays on the epidermal layer
proliferation -> WART in about 4-Weeks after infaction

19
Q

Types of cutaneous WARTs that can be SELF TREATED

A

Common = Hands
often in children/adolescents, skin colored / DOME/ rough surface

Plantar / Mosaic = FEET
adolescents & Young Adults

20
Q

Types of Cutaneous WARTS that we can NOT treat

A

SEE MD

Flat / Filiform on FACE

Periungual on NAILS

21
Q

Basic Treatment ideas for WARTS

A

Non-treatment
Most can resolve on OWN (70% in 2years)
less likely if ADULT or IMMUNE compromised

SELF TREATMENT
1) Salicylic Acid = chemical destruction/keratolytic
2) Cryotherapy = physical destruction
Complementary = DUCT TAPE

  • *Micellaneous**
  • *Prevention of transmission** = important
  • *SEEMD for Physical removal**
22
Q

Efficacy & Duration
Salicylic Acid

for WARTS

A

with NO treatment = 70% resolve, 46% will remain wart free

TAKES WEEKS
Greater efficacy for HANDS > feet

Equally effective vs Cryotherapy

23
Q

Efficacy & Duration
CRYOTHERAPY

for WARTS

A

with NO treatment = 70% resolve, 46% will remain wart free

  • *wart removal after 10 DAYS**
  • *single use** that will produce a BLISTER –> can be repeated

Equally effective vs Salicylic Acid

maybe more effective on hands?

24
Q

Salicylic Acid

ADR

A

used for WARTS, generally well tolerated

Skin irritation

see MD if > 12 weeks

  • AVOID* use in patients with
  • *PERIPHERAL NEUROPATHY**
25
**Cryotherapy** **ADR**
treatment for **WARTS**, generally **well tolerated** **Erythema / Blistering / Pain-Tendernes** SEE MD after \>3 treatments Applicator ***can NOT be used MORE THAN ONCE*** *to **_avoid spreading the virus_***
26
**EX-ST** for treating **WARTS**
Ensure that it is **_actually a wart_** *not CORNS / CALLUSES / Malignant growth,* these show **_PAIN_** * *\<4 years old** * *Pregnancy / Breast Feeding** * *\>12 weeks** SA treatment or **\>3** Cryotherapy Treatments Debilitating conditions that affect **sensitivity / circulation (blood)** **LARGE or MULTIPLE warts** or located on **face / breast / armpits / nails / anus / genitalia** **_Immunosuppressive medications_**
27
**Salicylic Acid 40%** Type of Dosage form / Dosage & Direction Treatment of **WARTS**
**Plasters / Pad / Strip** typically used for the **FEET** **Apply** & **Remove** after **_48 HOURS_** repeat PRN for **_12 weeks_**, *if no improvement --\> SEE MD*
28
**Salicylic Acid 17%** Type of Dosage form / Dosage & Direction Treatment of WARTS
**Liquid / Gel** in a collodion vehicle **_apply QD / BID_** for up to **_12 weeks_** *if no improvement --\> SEE MD*
29
**Salicylic Acid 15%** Type of Dosage form / Dosage & Direction Treatment of WARTS
**PATCH** (Trans-Ver-Sal), in a Kg-g vehicle Apply for **_8 hours_**, _repeat **QD**_ for up to **12 weeks**, *if no improvement --\> SEE MD*
30
**Cryotherapy** Type of Dosage form / Dosage & Direction Treatment of WARTS
**Freeze Away** / **Freeze Off** **repeat** after **_10 DAYS PRN_** for up to **_\<3 Treatments_,** *if no improval --\> SEE MD*
31
**Hair Growth Cycle** **ACT**
* *_Anagen_** * *active** GROWTH phase, **2-6 years** * *_Catagen_** * *transitio****n**phase,**1-2 weeks** * *_Telogen_** * *resting** phase, **2-4 months** ***_return to anagen_***
32
What **type of Hair loss** should we **NOT TREAT**
* *_Scarring Alopecia_** * *inflammatory disorder** --\> leads to PERMENANT hair loss **_ABRUPT_** hair loss effluviums / cosmetic **_AUTOIMMUNE_** hair loss alopecia AREATA **_FUNGAL_** tinea captis
33
**Medications that cause HAIR LOSS**
**Beta-Blockers / ACE-Inhibitors** Allopurinol / Anticoags / Gemfibrozile **Anticonvulsants / Anti-depressants** * *_ANDROGENIC ACTION_** * *HRT** / **Contraception** / Testosterone / Steroids **Chemotherapeutic agents**
34
**General Causes for HAIR LOSS**
**Medication** **HORMONAL CHANGES** **Physical STRESS / TRAUMA** Chronic illness / **Diet change or deficiency** **GENETICS**
35
**Finasteride** (Propecia) ## Footnote **MoA / Dose / Indication / ADR**
* *_5-Alpha-Reductase Inhibitor_** * *Testosterone --/--\> *dihydrotestorone*** -\> androgen receptor for **male AGA** (androgenetic allopecia) **_1mg QD_** used for ***_at LEAST 12 MONTHS_*** *ADR: ED / decreased libido / ejaculation / decreased sperm count*
36
**Minoxidil** MoA / Dose / Indication / ADR | (Rogaine)
**Increases ANAGEN duration** & **ENLARGES Vellus** Terminal Hair --\> Vellus (live active hair) * *5%** suggested for **males** (AGA) * *2%** \> **5%** for females (FPHL) need to use for ***_AT LEAST 4 MONTHS_*** ***_does NOT reduce blood pressure_*** = NO systemic absorption ADR: *itching / irritation / dryness / contact dermatitis (FOAM decreased)*
37
**Complementary Treatment for HAIR LOSS**
**_BIOTIN_** **_IRON_** **_ZINC_** Specialty shampoos
38
**Efficacy of** **Minoxidil vs Finasteride**
**5%** \> **2%** for AGA & FPHL * no **high quality studies*** in comparing **finasteride vs minoxidil** * finasteride may be more efficacious \> minoxidil for MALE AGA* Some data SUPPORT **_DUAL USE_** of both for MALE AGA
39
**EX-ST** for **Self care of HAIR LOSS**
* *\<18 years old** * no NEW HAIR appearing after **4 MONTHS** --\> SEE MD* * *Pregnancy / BF** / postpartum * *recent D/C of oral contraceptives** **_SUDDEN / PATCHY hair loss_** Patients with **_no FMH_** of hair loss or **_Positive Hair-pull Test_** loss of **eyebrows / eyelashes** / **nail change** scalp **scaling / sunburn** / other damage **AUTOimmune disease** / **FEVER** of inflamation **Endocrine dysfuntion** / medical treatments
40
**Self-Care assessment for HAIR LOSS**
*after assuring NO EX-ST* \>18 y/o + no SUDDEN loss / pregnancy / d/c HRT **STOP use of** **Hair/grooming** that can cause ``` **Male** = **Minoxidil 5%** Female = Minoxidil **2%** -\> 5% ``` **New hair after _4 months_?** Yes -\> continue treatment **_INDEFINITELY_** *NO --\> SEE MD*
41
**Compound W** Active Ingredients / Dosage Forms / Indication
**_SALICYLIC ACID_** (a Keratolytic) for **WARTS** * *17%** = **Liquid / Gel** * *40% = Pads / Strips** * *Freeze-Off** ***_DNU for \>12 weeks_*** --\> see MD **_\<4 years old_**
42
**DUOFILM** Active Ingredients / Dosage Forms / Indication
**_SALICYLIC ACID_** **17%** **LIQUID** flexible collodion + alcohol + castor oil **Wart Removal soak for 5 minutes**, then thoroughly wash can use a protective cover after **_QD - BID_** _*DNU **\>12 weeks***_ **\<4 y/o**

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