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Adult Health > Acne, Actinic keratosis, Pityriasis rosea, Psoriasis, Rosacea > Flashcards

Acne, Actinic keratosis, Pityriasis rosea, Psoriasis, Rosacea Flashcards

1
Q

Acne Vulgaris: What is it?

A
  • most common skin condition in the U.S.
  • begins during puberty and most common in adolescents
  • increased androgen production leads to increases in sebum production which leads to:
    * Comedones
    * Pustules
    * Papules
    * Cystic nodules
    * Scarring
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2
Q

Acne Vulgaris: Risk Factors

A
  1. genetics (50% have family history of acne)
  2. skin trauma
  3. milk consumption (skim and low-fat)
  4. high glycemic load diets
  5. insulin resistance
  6. low BMI
  7. worsens with stress and menses
  8. skin contact with chin straps, shoulder pads
  9. adolescents
  10. PCOS, adrenal hyperplasia, hormonal tumors
  11. white race
  12. hot, humid climates
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3
Q

Acne Vulgaris: Diagnostic Studies

A
  • clinical exam
  • If PCOS, investigate this further
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4
Q

Acne Vulgaris: Prevention

A
  • avoid occupational irritants
  • good hand/face hygiene
  • frequent gentle cleansing of the skin
  • rapid treatment for inflammatory and cystic acne
  • avoid anabolic steroids
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5
Q

Acne Vulgaris: Non-Pharmacological Management

A
  • address psychosocial concerns
  • phototherapy
  • laser therapy
  • address stress
  • mechanical extraction of comedones does not affect disease course, but may improve appearance
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6
Q

Describe Mild Acne

A
  • scattered, small (< 5 mm), comedonal or inflamed papules or pustules without associated scarring
  • limited skin involvement (involvement of one body area or relatively few lesions in more than one body area)
  • absence of nodules
  • absence of near confluent skin involvement
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7
Q

Describe Moderate-Severe Acne

A
  • visually prominent acne consisting of many comedonal or inflamed papules or pustules
  • presence of nodules
  • involvement of multiple body areas with more than a few scattered lesions
  • associated scarring
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8
Q

Mild Acne Management: Comedonal Lesions (first treatment)

A

Topical Retinoid:
1. Adapalene
2. Tazarotene
3. Tretinoin topical
4. Trifarotene

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9
Q

Mild Acne Management: Comedonal Lesions (if first treatment has unsatisfactory response)

A
  • Increase concentration of topical retinoid or change to an alternate topical retinoid.
  • If still has an unsatisfactory response, switch to treating as moderate or severe acne
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10
Q

Mild Acne Management: Papulopustular +/- Comedonal Lesions (first treatment)

A

Topical retinoid and benzoyl peroxide:
- if satisfactory response after 3-6 months, transition to topical retinoid therapy only

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11
Q

Mild Acne Management: Papulopustular +/- Comedonal Lesions (if first treatment has unsatisfactory response)

A
  • add topical clindamycin or topical dapsone (to the existing topical retinoid and benzoyl peroxide treatment already in place)
    * if this treatment is satisfactory after 3-6 months, then transition to topical retinoid therapy only
  • if unsatisfactory response, consider alternative topical therapies (clascoterone or minocyocline) or treat as moderate to severe acne
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12
Q

Moderate to Severe Acne Management: Papulopustular and/or nodular lesions are present

A

Treatment options include: (pick one)
1. Oral tetracycline
2. Combined estrogen-progestin OCP
3. Oral spironolactone
4. Oral isotretinoin

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13
Q

Moderate to Severe Acne Management: Papulopustular and/or nodular lesions are NOT present, comedones only

A

Treatment options include: (pick one)
1. Combined estrogen-progestin OCP
2. Oral spironolactone
3. Oral isotretinoin
* No tetracycline

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14
Q

Adapalene

A
  • Topical retinoid
  • apply daily at bedtime, after washing
  • redness, dryness, scaling of skin common in first 2-4 weeks
  • caution with other photosensitizing agents (tetracyclines, thiazides, sulfonamides, fluoroquinolones)
  • do NOT use on broken skin
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15
Q

Tazarotene

A
  • Topical retinoid
  • apply thin film at bedtime, after cleansing
  • caution with other photosensitizing agents (tetracyclines, thiazides, sulfonamides, fluoroquinolones)
  • do NOT use on more than 20% of body surface
  • women of childbearing potential: begin during normal menses
  • do NOT use on broken skin
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16
Q

Tretinoin Topical

A
  • Topical retinoid
  • apply sparingly to affected areas at bedtime
  • improvement may not occur before week 12
  • within 2 weeks: peeling, redness in treated areas
  • At 3-6 weeks, there could be new blemishes; continue to use
  • caution with other photosensitizing agents (tetracyclines, thiazides, sulfonamides, fluoroquinolones)
  • do NOT use on broken skin
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17
Q

Trifarotene

A
  • Topical retinoid
  • apply thin layer to affected areas of face and/or trunk once a day, in the evening on clean, dry skin
  • most common adverse reactions: skin irritation, pruritus, and sunburn
  • specifically indicated to treat acne on face and trunk
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18
Q

Benzoyl Peroxide

A
  • initial daily wash, may increase to BID or TID as tolerated
  • may bleach fabric or hair
  • avoid unnecessary sun exposure and use sunscreen
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19
Q

Actinic Keratosis

A
  • AKA solar keratosis
  • usually presents on sun-exposed areas as scaly, red papules or plaques
  • may progress to squamous cell carcinoma
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20
Q

Actinic Keratosis: Risk Factors

A
  • common in middle ages and older adults
  • more common in men
  • more common in those with fair skin or chronic sun exposure, tanning bed use
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21
Q

Actinic Keratosis: Assessment Findings

A
  • round or oval, raised, scaly papules or plaques
  • flesh-colored, red, pink, brown, or black
  • 2 mm to 5 mm
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22
Q

Actinic Keratosis: Diagnostic Studies

A
  • clinical exam
  • possibly a skin biopsy
23
Q

Actinic Keratosis: Prevention

A
  • sunscreen and protective clothing
  • lip balm
24
Q

Actinic Keratosis: Treatment on Head and Neck (one or a few isolated lesions)

A
  1. Flat: cryotherapy (preferred) or curettage and electrodessication
  2. Hypertrophic:
    - if clinically suspicious for cancer, then surgical excision and patho
    - if not suspicious for cancer, then cryotherapy with 2 freeze-thaw cycles OR shave removal plus electrodessication
25
Q

Actinic Keratosis: Treatment on Head and Neck (multiple lesions)

A
  1. Discrete, hypertrophic lesions present, then cryotherapy followed by topical fluorouracil
  2. Discrete, hypertrophic lesions NOT present, then field therapy with topical fluorouracil (preferred)
26
Q

Actinic Keratosis: Treatment on other body sites such as dorsal hands, forearms, and/or legs

A
  1. Cryotherapy followed by topical fluorouracil
    OR
  2. gentle curettage followed by photodynamic therapy (PDT)
27
Q

Actinic Keratosis: When to Refer

A
  1. Refer to dermatologist if AK lesions appear with frequency; may require biopsy of lesions or more intensive treatment
  2. Any lesion unresponsive to topical therapy warrants referral
28
Q

Fluorouracil

A

Antineoplastic Treatment for Actinic Keratosis
- apply with fingertips BID, wash hands afterward
- contraindicated in women who are or may become pregnant
- use for 2-6 weeks usually

29
Q

Pityriasis Rosea: What is it?

A
  • AKA Christmas tree rash
  • idiopathic, self-limiting skin disorder characterized by papulosquamous lesions distributed over the trunk and proximal extremities
  • cause is unknown, but may be viral or autoimmune
30
Q

Pityriasis Rosea: Risk Factors

A
  • more common in patients with atopic dermatitis
  • slightly more common in females
  • more common in older children and young adults
31
Q

Pityriasis Rosea: Diagnostic Tests

A
  • usually a clinical diagnosis
  • may look like ringworm, so may need to do a KOH test on the scales
  • if sexually active, do a VDRL/RPR test (to rule out syphilis)
32
Q

Pityriasis Rosea: Assessment Findings

A
  • “Herald” patch 1-2 weeks before the generalized rash
  • salmon-colored oval plaques with fine scales
  • mild pruritus
33
Q

Pityriasis Rosea: Treatment

A
  1. Topical antipruritic - calamine lotion
  2. Oral antihistamines - 1st gen (Benadryl); 2nd gen (Zyrtec, Claritin)
  3. Medium potency topical steroids (Groups 4 & 5); apply 2-3 times daily for 2-3 weeks (thin layer)
  4. If severe or not getting better after several weeks, then REFER
34
Q

Pityriasis Rosea: Topical Corticosteroids

A
  1. Betamethasone
  2. Fluocinolone
  3. Fluticasone
  4. Hydrocortisone
  5. Mometasone
  6. Triamcinolone
35
Q

Psoriasis: What is it?

A
  • a chronic, pruritic, inflammatory skin disorder characterized by rapid proliferation of epidermal cells
  • frequent remissions and exacerbations
  • plaque psoriasis is more common
36
Q

Psoriasis: Risk Factors

A
  • more common in adults
  • men and women affected equally
  • strep infection
  • family history
  • genetics
  • low vitamin D
  • stress
  • smoking, obesity, alcohol
  • Drugs: beta blockers, lithium, anti-malarial drugs, systemic steroids
37
Q

Psoriasis: Assessment Findings

A
  • silvery, white scale on erythematous base
  • pruritus
  • Positive Auspitz sign (pinpoint bleeding when lesions scraped)
  • Koebner phenomenon (when skin lesions appear on healthy skin following a skin injury)
  • Pitted nails (particularly common in psoriatic arthritis)
  • common distribution on elbows, knees, scalp, gluteal cleft, fingernails, toenails, palms, and soles of feet
38
Q

Psoriasis: Diagnostic Tests

A

History and physical exam

39
Q

Psoriasis: Non-Pharmacologic Treatment

A
  • warm soaks
  • moisturizers and emollients
  • oatmeal baths
  • UV lamps/sunlight
40
Q

Psoriasis: Pharmacologic Treatment

A
  • Topical steroids
  • Systemic treatments
    ** Limit use of steroids with high potency to less than 2 weeks
41
Q

Psoriasis: Treatment if able to tolerate topical therapy

A
  1. Topical corticosteroid (high or ultra-high potency) not on the face or other sensitive area
    WITH or WITHOUT
  2. Vitamin D analog (calcipotriene ointment)
    ** If good response after 4 weeks, switch to vitamin D analog only
    ** If suboptimal response, adjust topical therapy or add intralesional corticosteroid injections
    ** If still unsatisfactory response, switch to systemic therapy
42
Q

Psoriasis: Treatment if topical therapy is not feasible

A
  1. Phototherapy
    * If satisfactory response after 3 months, taper the phototherapy
43
Q

Psoriasis: Treatment if topical therapy and phototherapy is not feasible or effective

A
  1. Systemic therapy which includes
    - biologic agents
    - small molecule agents
    - other nonbiologic agents
    ** Usually managed by a specialist
44
Q

Guttate Psoriasis

A
  • AKA Eruptive psoriasis
  • more common in children and young adults
  • associated with strep throats and may occur several weeks following the infection
  • may become a chronic condition, but usually resolves spontaneous over several months
  • may occur on any part of the body
  • treat with mild steroids and sunlight (Avoid sunburns)
45
Q

Rosacea: What is it?

A
  • a common chronic disorder of the skin characterized by redness, flushing, and other cutaneous findings, such as telangiectasis and roughened skin
  • primarily affects the central face, including the cheeks, chin, nose, and central forehead
  • may also experience watery or irritated eyes
  • characterized by periods of remission and exacerbation
46
Q

Rosacea: Risk Factors

A
  • fair skin
  • warm temperatures, hot baths, hot drinks
  • females over 30
  • sunlight, exercise
  • alcohol, spicy food
  • emotional stress
  • hot flashes
47
Q

Rosacea: Assessment Findings

A
  • erythema
  • telangiectasias
  • papules and pustules
  • burning or stinging with episodes of flushing and extremely cosmetic intolerant skin
  • facial distribution
  • may also have ophthalmic disease: blepharitis, keratitis, chalazion
48
Q

Rosacea: Diagnostic Studies

A

Usually a clinical diagnosis

49
Q

Rosacea: Non-Pharmacologic Treatments

A
  • avoidance of triggers
  • sunscreen
  • cool compresses
  • frequent skin moisturization
  • laser or intense pulsed light therapy
50
Q

Rosacea: Pharmacologic Treatment for Facial Erythema

A
  1. Topical brimonidine tartrate 0.33% gel
  2. Topical oxymetazoline
    ** Monitor for hypotension (affects vasodilation)
51
Q

Rosacea: Pharmacologic Treatment for Papulopustular Disease (mild to moderate)

A
  1. Topical metronidazole
  2. Topical azelaic acid
  3. Topical ivermectin
52
Q

Rosacea: Pharmacologic Treatment for Papulopustular Disease (moderate to severe)

A
  1. Oral tetracycline
  2. Oral doxycycline
  3. Oral minocycline
    ** May need to combine with a topical therapy
53
Q

Rosacea: Pharmacologic Treatment for Papulopustular Disease (refractory)

A

Oral Isotretinoin (teratogenic)

Adult Health (11 decks)

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