75: Dermatology Flashcards by Brooke Thornburg

When to refer skin

-multiple/extensive burns, cuts, abrasions
-human/animal bites
-bad rash
-tumors/growths
-yellow skin
-deep infection (cellulitis)
-large blisters of unknown origins
-exposed deep tissue, muscle, bone

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Choosing a base for skin tx

desired effect
area of application
patient acceptability
nature of incorporated medication (stability, compatibility)

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Basic vehicles for most skin rx

-ointment
-cream
-lotion gel
-solution/foam/spray

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Ointments

-best for hydration and drug delivery
-removes scales
-greasy, low acceptance, no good for hairy areas

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Creams

-good for hydration and drug delivery
-can apply to most areas
-high acceptance

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Lotions

-watered down creams
-easy to apply
-good acceptance
-requires freq applications
-not ideal for very dry skin

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Gels

-great for alcohol soluble drugs
-can apply to most areas
-nongreasy
-can be drying

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Solutions, foams, sprays

-can apply to most areas
-easy to apply in hairy earea
-not ideal for drug delivery
-can be drying
-not ideal for hydration
-requires freq application

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best vehicles for hair bearing skin

-solution/spray
-foam
-gel
-cream

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Dry Skin (xerosis)

-fall and winter
-feet, lower legs
-hands, elbows, face
-rough, dry, scales, cracks
-itching common

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Who is at risk of dry skin (xerosis)

-elderly
-dec activity of sweat and sebaceous glands
-warm, dry environments
-freq bathing

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Dry skin (xerosis) tx

emollients
agents for itching
alter bathing habits

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Rule of 3s

-bathe no more than 3x week
-water 3 degress above body temp
-bathe 3 minutes
-pat dry
-apply emollients within 3 minture 3x daily

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Emollients

-vaseline
-aquaphor
-cetaphil, cerave
-eucerin
-ointments vs creams vs lotions

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Agents to reduce itching

-menthol + camphor
-praxomine
-aluminum acetate
-hydrocortisone

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Menthol and camphor

-relieve itching
-0.5-1%
-cooling sensation

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Praxomine

-relieve itching
-1%
-local anesthetic

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Aluminum acetate

-relieve itching
-0.2%
-alters C-fiber nerve transmission

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Hydrocortisone

-relieve itching
-0.5-1%
-anti-inflammatory

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Dermatitis

-inflammatory process of upper two layers of skin

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Acute dermatitis

-red patches/plagues
-pebbly surface or blisters
-INTENSE itching
-contact dermatitis

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Contact dermatitis

-acute
-irritant vs allergic
-poison ivy

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Sub-acute dermatitis

-dry
-less red
-crusting, oozing
-mild thickening
-itching common
-atopic dermatitis

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Atopic dermatitis

-sub-acute
-eczema

Chronic dermatitis

-epidermal thickening -exaggerated skin markings -excoriations, fissures, scaling -LICHENIFICATION -less itching -stasis dermatits -any long standing acute/sub-acute dermatitis

Irritant contact dermatitis

-non-immunologic -more common than allergic -rx within a few hours -metals, cosmetics, adhesives

Poison Ivy

-24-48 hrs after exposure -Pruritis is intense (2' infections) -wash skin and nails within 10 min -topical therapy okay if less than 10% of BSA

Poison Ivy tx

-remove source -calamine -topical antihistamines -oral antihistamines -topical vs oral corticosteroids

MOA of topical corticosteroids

-anti-inflammatory -anti-mitotic -immunosuppressive -apply BID-QID 3-4 days

Oral corticosteroid regimen for acute dermatitis tx

-start Prednisone 40-60mg qd -taper every 3 days -minimum 10-14 days -avoid dose packs bc they dont last long enough

Non-sedating antihistamines

-loratidine (claritin) -Desloratidine (clarinex) -Fexofenadine (Allegra)

Sedating antihistamines

-diphenhydramine (benadryl) -cetirizine (zyrtec) -Hydroxyzine (atarax) rx -Doxepin rx

Atopic triad

-comorbidities: 1. atopic dermatitis 2. allergic rhinitis 3. asthma

atopic dermatitis

-pruritis -sym red papules/plaques -scaling -DRY -redness, inflammation -hist of allergic disease -risk of 2nd infection

Atopic dermatitis in infants

-cheeks -neck, trunk, groin

Atopic dermatitis in children

-face, neck, creases of arms and legs

Atopic dermatitis in adult

-hands and neck -arms and legs

Atopic dermatitis triggers

-detergents -infections

Nonpharma tx of atopic dermatitis

-baths -emollients -avoid trggers -trim nails -comfy clothes

Stepwise tx of atopic dermatitis

1. nonpharm 2. topical 3. systemic 4. Acute flares 5. Refractory 6. Maintenance

Topical tx of atopic dermatitis

-corticosteroids -calcineurin inhibitor therapy -JAK inhibitor -strength/duration based on severity

Systemic tx of atopic dermatitis

1. phototherapy 2. oral immunosuppresants 3. oral JAK inhibitors 4. injectable biologic agents

Acute flares tx of atopic dermatitis

-mod to severe -medium-potency corticosteroid BID for up to 3 days beyond clearance of lesions

Refractory tx of atopic dermatitis

1. phototherapy or oral immunosuppresives 2. consider biologics

Maintenance therapy of mod to severe atopic dermatitis

-low topical corticosteroid qd -OR TCS + anti-inflammatory 2-3x weekly -written action plan

Chose TCS based on:

-location -type -severity -degree of skin penetration desired

TCS potency

-very high - low (I-VII) -vehicle impacts delivery AND potency -only 2% absorbed into skin

Occlusion

-enhances penetration of TCS upto 10%

Side effects of TCS

-thinning of skin -dilated blood vessels -bruising -skin coloring changes -risk of HPA suppression w long-term use -tolerance development (tachyphaylaxis)

Very high potency TCS Class 1

Betamethasone potency

-very high as ointment -high as cream -mod as lotion

slide48 maybe

Topical calcineurin inhibitors

-MOA: blocks pro-inflammatory cytokine genes -can be used on any area -equiv to mid potency TCS -no risk of atrophy -burning sensation -$$$ -pimecrolimus and tacrolimues

Pimecrolimus and Tacrolimus

-topical calcineurin inhibitors -2nd line tx of atopic dermatitis -intermittent use only -risk of malignancies -risk infection in kids under 2

Crisaborole 2% ointment

-Phosphodiesterase-4 inhibitor (non steroidal) -alt to TCS and TCI -mild or mod AD -BID for 28 days -expensive

Ruxolitinib (Opzelura 1.5% cream)

-mild to mod atopic derm -JAK inhibitor -thin layer BID upto 20% BSA -short term use -max 60g/week -AVOID in immunocompromised pts

Upadacitinib (Rinvoq)

-mod-severe atopic dermatitis -JAK inhibitor -15-30mg PO qd -well tolerated -higher rates of CV/thrombosis

Dipilumab (Dupixent)

-biologic for mod-severe atopic derm -mAb against IL-4 a -600mg then 300mg SC q 2 weeks -expenziveee