acne and adnexal Flashcards
first line for periorificial derm
PO doxy
abx dosing for periorificial derm
-doxy or minocycline 100mg BID for 4-8 weeks
-erythromycin 250mg BID - TID
topicals for periorificial dermatitis
metronidazole x 8-14 weeks
erythromycin or clindamycin BID x 7 weeks
tacrolimus or pimecrolimus BID (especially for corticosteroid induced periorificial derm)
rosacea:
treatment for facial redness
-alpha-2 agonists
brimonidine 0.33%
oxymetazoline 1%
-PO doxy 20-40mg
rosacea:
TOPICAL treatment for papules and pustules, perilesional erythema, demodex
TOPICALS
-metronidazole
-azelaic acid 20%
-sulfur wash or product
-ivermectin
-permetherin (off label)
-topical minocycline
-encapsulated BP 5%
rosacea:
SYSTEMIC treatment for papules and pustules, perilesional erythema, demodex
SYSTEMIC
-(submicrobial) doxycycline 40mg
-(antimicrobial) doxycycline or tetracycline (difference being higher dose) reason to not use is resistance can occur quickly
-isotretinoin in severe cases
symptoms of ocular rosacea (5)
- red eyes
- blepharitis
- gritty sensation
- burning
- itching
rosacea:
tx for ocular rosacea
-eyelid hygiene: ophthalmic wash and moisturizers
-topical ivermectin
-PO doxy
-refer to ophthalmology if no improvement
hallmark sign of hidradenitis suppurativa
double headed comedone (multiple blackheads within one follicle) - arises from follicular occlusion
topical therapy for HS
Topical ABX:
-topical abx are mainstay
-clindamycin + BP
Cleansers:
-BP
-chlorhexidine
-zinc pyrithione
Keratolytic agents:
-resorcinol 15% cream BID (antiseptic and keratolytic) between flares
PO antibiotics for HS
-tetracyclines
-clindamycin
-rifampin
-dapsone
-3 months until improvement
Hormonal therapy for HS
OCP’s:
-ethinyl estradiol / noregestrol
-ethinyl estradiol and cyproterone acetate
-progesterone only med may worsen HS
Spironolactone:
-100-150mg daily
-off label
Metformin:
-off label
-500mg BID-TID
-patients with history of PCOS
HS adjunct treatments
Zinc Gluconate
-anti-inflammatory
-90mg/day
IL TAC
-TAC 10 between 0.2-3mL
management of pain in HS patients
-Lidocaine 5% ointment
-Diclofenac 1% gel
-ice packs
-tylenol
-gabapentin
-lyrica
-duloxetine
lifestyle management for acne keloidalis nuchae
-discourage picking of lesions
-avoid tight collared shirts and close shaving
-avoid hats and helmets
Topical treatment for acne keloidalis nuchae
-topical steroids BID every 2 weeks
-retinoid like tretinoin 0.025%
-clindamycin for pustular lesions
-IL TAC 5-40mg/ml every 4 weeks
-cryotherapy
-antiseptic or tar containing shampoo can be helpful to prevent secondary bacterial infection
Systemic treatment for acne keloidalis nuchae
-doxy 100mg BID
-minocycline 100mg BID
-PO retinoids (with concurrent folliculitis decalvans)
topical treatment for dissecting cellulitis of the scalp
-antibacterial soaps
-chlorhexidine
-benzoyl peroxide
systemic therapy for dissecting cellulitis of the scalp
-doxycycline 100mg BID
-minocycline 100mg BID
-PO retinoids for patients with concurrent folliculitis decalvans
diagnostic criteria for primary hyperhidrosis
(at least 2 of the following) - there are 6
- bilateral and symmetrical distribution
- impairment in normal daily activities
- occurring at least once per week
- onset younger than 25 yrs old
- does NOT occur during sleep
- positive family history
causes of secondary hyperhidrosis
(12)
- substance abuse (alcohol or narcotic withdrawal)
- COPD
- CHF
- endocrine/metabolic disorders
- febrile illness
- infections
- ingestion of spicy foods
- malignancies
- medications
- neurologic disorders
- menopause
- psych disorders
topical treatment for primary hyperhidrosis
Aluminum chloride 20% (drysol)
-FIRST line
-apply at bedtime 2-3 times weekly to intact skin
-can cause localized irritation which is common reason for d/c
Glycopyrrolate (robinul)
-medicated cloths
-FDA approved for pts 9+
-wash hands immediately after use and avoid contact with eyes
-SE: mydriasis and headache
oral treatment for primary hyperhidrosis
oral anticholinergics
-off label use
-glycopyrrolate and oxybutynin
SE’s of anticholinergics
-dry mouth
-abdominal symptoms
-constipation
-urinary retention
-tachycardia
-drowsiness
-blurred vision
