Ch6: Dermatology Flashcards
keratosis pilaris is a variation of ______
eczema
acneiform lesions in someone of age 30-60yo, think…..
acne rosacea
what is a primary lesion
result from a disease process
has not been altered by outside manipulation, treatment, or the natural course of the disease (e.g., vesicle)
what is a secondary lesion
lesion that is altered by outside manipulation, treatment, or the natural course of the disease e.g., crust
what is a “vesicle”
fluid-filled lesion that is <1cm in diameter
think varicella (chickenpox), herpes zoster (shingles), HSV1 and 2
what is “crust”
raised lesion caused by dried serum and blood remnants that develops when a vesicle ruptures
single, uniformly brown-colored, slightly raised, irregularly-shaped with defined borders, 6mm in diameter
papule
must be RAISED
single, flat non-palpable area of skin discoloration, irregularly-shaped, and 0.5cm in diameter
macule
must be FLAT
single, firm, smooth, raised, dome-shaped fluid-filled flesh-colored encapsulated lesion of 1.5cm with liquid seeping out sometimes
cyst
A BALL OF FLUID
cysts are not transformative, they do not evolve into a malignancy, almost ALWAYS benign and self-limiting
raised, irregularly-shaped lesions with defined-borders, different color than surrounding skin, patches of >2cm in diameter located over the knees which bleeds a little when picked
plaque
(2) most common sites for psoriasis
tips of the elbows, front of knees
may be anywhere on the body, including the scalp, when widespread but tends to spare the face
flat, non-blanchable confluent purple-colored irregularly-shaped lesions on the skin ranging in size from 2-20mm
purpura
NON-BLANCHABLE is key (vs. vascular lesions will blanch)
purpura are [blanchable vs. non-blanchable]
non-blanchable
clustered, smooth, slightly-raised, circumscribed, pruritic skin-colored lesions of various sizes up to 2cm surrounded by area of erythema which began all over after starting an antibiotic
wheal
e.g., hives = urticaria
hives are an example of this skin lesion
wheal (urticaria)
umbilicated, waxy-looking lesions, suspect….
molloscum contagiosum
presentation of varicella (chickenpox)
presents with primary and secondary lesions including vesicles and crusts that are scattered over the entire body. usually in children or young adults. mild-moderately systemically ill with a fever, myalgias, significant pruritis.
typical for the vesicular lesions to start on the trunk and spread to the limbs 2-3 days latter.
presentation of herpes zoster (shingles)
presents with primary and secondary lesions including vesicles and crusts usually unilateral in a dermatomal pattern. usually in an adult >50yo but possible at any age if they have a history of varicella. they may be miserable with pain, some itch, but usually do not have a fever.
which can be treated with oral antiviral therapy: varicella or herpes zoster?
both!
priority complications of varicella (chickenpox)
bacterial superinfection of the lesions
priority complications of herpes zoster (shingles)
post-herpetic neuralgia, ophthalmic involvement, superimposed bacterial infection
treatment for varicella (chickenpox)
- antiviral medications such as oral acyclovir in early illness (start within 24-48 hours of skin eruption), particularly in higher risk groups (children with underlying health conditions, most adults)
- antivirals help minimize the duration and severity of the illness
- AVOID ASPIRIN THERAPY AND NSAIDs d/t risk for Reye’s syndrome and necrotizing fasciitis
priority medications to avoid with varicella (chickenpox) (2)
- NSAIDs d/t risk for necrotizing fasciitis
- Aspirin d/t risk for Reye’s syndrome
treatment for herpes zoster (shingles)
- high dose antiviral medication in early illness (within 72 hours) can help minimize duration and severity
- provide analgesia (??_
- itch can be treated systemically (??) and with local ice pack, calamine lotion, and avoiding the clothes rubbing on the lesions
efficacy of the varicella vaccine
80% with first dose
99% with second dose
lifetime immunity
what is “clustered” pattern
occurring in a group without pattern, such as lesions in HSV1 (clustered vesicles)
what is “linear” pattern
in a line, streaks
typically with phytodermatitis by exposure to plant oil
HSV1 tends to be where…..
above the waist
but can also be below
HSV 2 tends to be where….
below the waist
does not tend to go above the waist
what is “scattered” pattern
generalized over the entire body without a specific pattern or distribution such as seen in viral exanthems (e.g., rubella - German measles)
what is “confluent” or “coalescent” pattern
multiple lesions blending together, such as in psoriasis
what is a viral examthem
a rash that goes along with a viral infection (non-specific)
common in children (benign, self-limiting), very uncommon in adults
what is “annular” pattern
in a ring,
e.g., bull’s eye characteristic of Lyme, or ring seen in tinea
what is “nummular” pattern
coin-shaped
scaling, flesh-colored lesions in a cluster ranging in size from 3-10mm on the dorsal aspect of the hand, present for a number of months without patient complaint in a 60yo m.
you suspect….
actinic keratoses (pre-cancer) - clinical dx
often on sun-exposed skin
well-demarcated round-to-oval erythematous coin-shaped plaques approximately 10mm in diameter over the anterior aspects of the lower legs described as intermittently itchy present for a number of months.
you suspect…
nummular eczema - clinical dx
patient notes loss of pigment in patches of skin present for weeks-months
you suspect…
vitiligo - clinical dx, auto-immune
pt presents with a painless, ulcerated lesion approx 1.5cm in diameter over the sternum presents for a number of weeks
you suspect….
squamous cell carcinoma – needs a biopsy
since vitiligo is auto-immune, it is often associated with….. (3)
other autoimmune conditions
- thyroid dz
- t1dm
- rheumatoid arthritis
classic presentation of actinic keratosis
on skin surface (looks like someone loosely glued a cornflake onto the skin)
red or brown, scaly, often tender but usually minimally symptomatic
occasionally flesh-colored, more easily felt but running a finger over the affected area than seen
they can remain unchanged, spontaneously resolve, or progress to SCC
clinical dx, biopsy is usually not required
how common is it for actinic keratoses to progress into SCC
1 in 100
treatment options for actinic keratosis
- topical 5-flourouracil cream (5FU)
- topical imiquimod cream 5%
- topical diclofenac gel (NSAID)
- photodynamic therapy with topical delta-aminolevulinic acid (derm specialty office only)
- cryosurgery with liquid nitrogen (generalist NP can do)
- medical-grade laser resurfacing or chemical peel (derm specialty office)
which is more common? basal vs. squamous cell carcinoma
basal cell carcinoma
common presentation of basal cell carcinoma
papule, nodule
with or without central erosion
pearly or waxy appearance usually with relatively distinct borders and with or without telangiectasia
which has a greater risk of metastasis? basal vs. squamous cell carcinoma
basal cell carcinomas have virtually no metastatic risk
metastatic risk is greater with SCC, at 3-7%
highest risk for SCC skin cancer metastasizing when they are located where? (3)
- lip
- oral cavity
- genitals
risk for squamous cell carcinoma of skin becoming metastatic
3-7%
ABCDE is for what type of skin cancer?
malignant melanoma
ABCDE of malignant melanoma
Asymmetric Borders (irregular) Color (not uniform) Diameter (usually >6mm) Evolving (new, changing)
malignant melanomas are most commonly greater than ____mm
> 6mm
most melanomas evolve from [new vs. existing] moles
new
most common place for malignant melanomas in darker skin folks (3)
- soles of feet
- palms of hands
- nailbeds
sensitivity and specificity of ABCDE when 2 or more features are present
100% sensitive, 98% specific
refer for excisional biopsy
treatment for psoriasis vulgars
medium-potency topical corticosteroids
if limited, a couple times a day until under control and then try 3x per week
treatment for scabies
permethrin lotion
treatment for verruca vulgaris (common warts)
imiquimod cream (Aldara)
an immune modulator that causes the body to mount an immunologic reaction to keep HPV in check
what causes warts?
HPV (many types)
treatment for tinea pedis (athlete’s foot)
topical ketoconazole
treatment for acne rosacea
topical metronidazole (MetroGel)
common derm condition that presents in folks of the elbow (antecubital fossa) and behind the knees (popliteal space)
eczema (atopic dermatitis)
common locations for scabies to present (4)
- webs of fingers
- under the breasts
- under the arms (upper arm)
- waistband area on the trunk
warm places
derm condition characterized by a preceding herald patch on the trunk followed by the development of scattered lesions in a christmas-tree pattern
generally pt is not bothered by the rash, no other symptoms
pityriasis rosea
we dont know what causes it for sure and tends to be mild and self-limiting
hyperpigmented plaques with a velvet-like appearance on the nape of the neck and axillary region
acanthosis nigricans
most common locations for acanthosis nigricans
- neck
- axilla
- groin folks
- elbows
- knuckles
tends to spare the plantar surface of the feet
cutaneous manifestation of insulin resistance
acanthosis nigricans
another skin finding commonly presenting with acanthosis nigricans
multiple skin tags
can acanthosis nigricans ever go away?
yes, it can regress, may not go away completely but can get much much lighter with weight loss and dietary changes with reduction in insulin resistance
plant phytodermatitis covering >20% total BSA, consider prescribing the following:
- systemic corticosteroids **
- oral anthistamine
once >___% of BSA is affected by a plant dermatitis, do a systemic corticosteroid
> 20%
reasons to consider prescription for SYSTEMIC corticosteroids in someone with a plant phytodermatitis
- > 20% BSA is affected
- severe rash (e.g., large number of blisters)
- rash impacts the face, genitals, or hands
- rash impacts the ability to work
duodenal ulcers are caused by…..
h pylori
gastric ulcers and gastritis can be caused by…..
systemic corticosteroids
pharm topical treatment for plant dermatoses
- optimal for localized acute contact dermatitis
- mid or high potency topical corticosteroids (e.g., triamcinolone or clobetasol)
- use lower potency (e.g., desonide) for thinner skin areas (e.g., flexural surfaces, eyelids, face, ano-genital)
- ointment is preferred over cream because medication contacts skin longer
- risk for skin atrophy with protracted use (2-3 weeks or more) with higher potency topical steroids
systemic pharm treatments for plant dermatoses
- prednisone 0.5-1mg/kg/day PO x5-7 days
- will usually provide relief within 12-24 hours
- should be followed by an additional 5-7 of 50% of dose to minimize risk of recurrence (total course = 10-14 days)
- do not need an additional taper when systemic steroids are used only short-term (<14 days)
you do not need an oral steroid taper when it is used for less than ____ days
<14 days
other non-pharm and OTC options for plant dermatoses beyond topical or systemic steroids
- cool compress
- calamine lotion
- colloidal oatmeal baths
(dry and soothe oozing lesions) - OTC analgesics to relieve pain
- oral anthistamines for pruritis
what is “bullae”
big blisters - aka, big vesicles
clinical presentation of non-bullous impetigo
erythematous macules (flat) that rapidly evolves into a vesicle or pustule, then ruptures, and when the contents dry leaves a honey-colored crusted exudate
(2) most likely causative agents of non-bullous impetigo
- staph aureus
- strep pyogenes (GAS)
treatment for nonbullous impetigo
- often can be treated with topical antimicrobials such as muciprocin (Bactroban)
- systemic antibiotics when extensive lesions or if topical tx fails (penicillin VK, cephalexin, dicloxacillin, clindamycin)
clinical presentation of bullous impetigo
most common in children
bulla contain clear, yellow fluid that turns cloudy, dark yellow.
the bulla rupture easily, within 1-3 days, leaving a rim of scale around red, moist base followed by a brown-lacquered or scalded-skin appearance
treatment for bullous impetigo
usually requires PO systemic antibiotics due to extensive distribution
which impetigo is most likely limited to only one area of the body vs. generalized all over body
nonbullous impetigo = localized
bullous impetigo = generalized
clinical presentation of cellulitis
infection of the dermis and subcutaneous fat usually including heat, redness, and discomfort in the region
cellulitis is almost always caused by…..
strep pyogenes (GAS)
most common causative pathogens for cellulitis (3)
- strep pyogenes (GAS)
- staph aureus (MSSA; methicillin-susceptible)
- MRSA
clinical presentation of cutaneous abscess
skin infection involving a hair follicle and the surrounding tissue, usually presenting with heat, redness, and discomfort in the region
most common causative organism for cutaneous abscess (1)
staph aureus (MSSA or MRSA)
(4) PO antibiotics used to treat mild impetigo
- cephalexin (Keflex) ** first choice **
- penicillin VK
- dicloxacillin
- clindamycin
- PO penicillin VK –> only drawback is will not work against beta-lactamase producing strains
- PO cephalexin (Keflex) –> this is cheap, easy on the stomach, BID dosing, and works well against beta-lactamase producing organisms so BEST CHOICE
- PO dicloxacillin –> works well but is 4x per day dosing, not preferred
- PO clindamycin –> risk factor for C. diff, not preferred
antibiotic most commonly associated with C. Diff in the community
clindamycin
topical antibiotic of choice for mild impetigo
mupirocin (Bactroban)
mild abscess treatment
- I&D
- warm compress
moderate abscess treatment
- I&D with culture & sensitivity
- empiric antibiotics with TMP/SMX (Bactrim) or doxycycline … both of which will cover MRSA
- tx further refined by culture & sensitivity results
(2) first line antibiotic therapies for moderate abscess
- TMP-SMX (Bactrim)
- doxycycline
If culture & sensitivity of an abscess returns MRSA, what antibiotics are your best options? (2)
- TMP/SMX PO
- doxycycline PO
If culture & sensitivity of an abscess returns MSSA, what antibiotics are your best options? (2)
- dicloxacillin PO
- cephalexin (Keflex) PO
doxy and bactrim (TMP-SMX) do well with MRSA but they don’t have great coverage of MSSA
most common reason in the USA for a new-onset ulcerating skin lesion
MRSA infection
presentation of a brown recluse spider bite
“red white and blue” sign
blue=central lesion where bit occurred
red = red ring
white = blanched area between red ring and blue interior
central blistering with surrounding gray-to-purple discoloration at bite site surrounded by a ring of blanched skin surrounded by a larger area of redness
treatment for brown recluse spider bite
- ice at the time of event to keep venom from spreading
- local debridement
- elevation and loose immobilization
- dapsone (antibiotic) is often used with little evidence of its being helpful
where does brown recluse spider like to hide
footwear, boxes, hidden things
where is the most common place to get a brown recluse spider bite
hand, foot
what will a second degree (partial thickness) burn present as
red, moist with peeling borders and scattered bulla
may be swollen and painful
caused by scalds, flash burns, flame
what will a first degree (superficial) burn present as
reddened skin, easily blanched with gentle pressure
burn site is red, painful and dry with no blisters
caused by sunburn, scald, flash flame
first degree burns affect the…..
epidermis only (outer layer) - superficial
second degree burns affect the….
epidermis and dermis (partial thickness)
third degree burns affect the…..
epidermis, dermis, and hypodermis/underlying fat (full thickness)
equivalent to 1% of BSA
size of the palmar surface of the hand
what will a third degree (full thickness) burn present as
can appear white or charred
caused by flame, hot surface, hot liquids, chemical, or electric
treatment recommendations for a first degree (superficial) burn
cool compresses
lotion or ointment
acetaminophen or ibuprofen
treatment recommendations for a third degree (full thickness) burn
referral to burn specialty care
% of burns treatment that can be managed in the outpatient setting
95%! most are superficial, partial-thickness burns involving limited BSA
Treatment recommendations for second degree (partial thickness) burns
- pain control with acetaminophen or NSAIDs
- run under cool water for 15-20 minutes
- clean the wound with sterile water
- eave the blisters intact if possible; otherwise, debride large blisters with thin walls that will prevent movement of a joint or that are likely to rupture
- use topical agents and dressings to keep the area MOIST
- ensure adequate hydration for wound healing
- topical antibiotics such as bacitracin, mafenide acetate (Sulfamylon), mupirocin (Bactroban), silver sulfadiazine (Silvadene)
topical antimicrobial therapies for second-degree burns (4)
- bacitracin
- mafenide acetate (Sulfamylon)
- mupirocin (Bactroban)
- silver sulfadiazine (Silvadene)
when to refer a burn to a burn center
- pts with preexisting medical conditions that could complicate management or prolong recovery
- partial and full-thickness burns that affect the face, hands, feet, genitals, perineum, or major joints
- chemical burns
- electrical burns including lightning injury
- inhalational injury
- partial-thickness burns of >10% BSA
- third degree burns in any age group
% BSA: head and neck
9%
% BSA: upper limbs (front and back)
9% each
% BSA: trunk (front and back)
36%
% BSA: genitalia
1%
% BSA: palmar aspect of hand
1%
% BSA: lower limbs (front and back)
18% each
Sun safety information for adults
- covering up is the best first defense = hat with a brim or bill, sunglasses that block 99-100% of UV rays, cotton clothing with a tight weave
- stay in the shade when possible and limit sun exposure during peak intensity hours (10am-4pm)
- on all days (even cloudy), wear a sunscreen with SPF at least 15 that protects against UVA and UVB
- apply enough sunscreen = 30mL (1oz) per sitting
- reapply sunscreen Q2 hours or after swimming or sweating
- use extra caution near reflective surfaces that can cause sunburn more quickly including water, sand, and snow
words for PRIMARY lesions
- macule, patch
- papule, nodule, mass
- plaque
- wheal (urticaria, hives)
- vesicle, bulla
- cyst
- pustule
words for SECONDARY lesions
- scale
- crust
- erosion
- ulcer
- fissure
- scar
- lichenification
words for the SHAPE of skin lesions
- annular (round)
- iris or targetoid (concentric, bulls eye)
- gyrate (curved)
- linear (line)
- nummular (coin-shaped)
- polymorphous
- punctate (tiny)
- serpinginous (snake like)
words for the LOCATION/DISTRIBUTION of skin lesions
- solitary
- satellite
- grouped
- confluent
- diffuse
- discrete
- generalized
- localized
- symmetrical
- zosteriform
what is a MACULE
1cm or less
flat
non-palpable
what is a PATCH
> 1cm
flat
non-palpable
what is a PAPULE
1cm or less
raised
round-topped
what is a NODULE
> 1cm
raised
round-topped
medical term for a mole
benign nevus (pl. nevi)
collection of melanocyte cells
what is a MASS
raised lesion >3cm
bigger than a papule or nodule
what is a PLAQUE
> 1cm
raised
flat-topped
what does a seborrheic keratosis present as
elevated, flat topped “stuck-on” plaque, brownish-tan, older folks
what is a WHEAL
edematous plaque peripheral redness transient (<24h) probably pruritic aka "hive"
what are hives (wheals) caused by
transient, d/t allergic rxn in the skin (histamines) –> cause the vessels to be leaky
goes away in 24h
what is a VESICLE
1cm or less
raised
contains clear, serous, or serosanguinous fluid
what is a BULLA
> 1cm
raised
contains clear, serous, or serosanguinous fluid
aka blister
what is a PUSTULE
1cm or less
raised
vesicle that contains pus
what is a CYST
any size raised/elevated thick-walled/subcutaneous contains liquid or semisolid material encapsulated
most common type of cyst
epidermal (inclusion) cyst
what is a FURUNCLE
> 1cm
deep
contains pus/purulent exudate
aka boil or abscess
what is SCALE
dried fragments of dead epidermal cells, major component of household dust
usually white
e.g., white flakes of skin on top of a primary lesion
DANDRUFF
what is CRUST
dried sebum, blood, or pus
aka “scab”
what is an EROSION
loss of SUPERFICIAL layers of the epidermis
smooth, moist, erythematous
what is an ULCER
loss of the entire epidermis and all or part of the dermis
what is a FISSURE
a linear ulcer, sharply defined
what is LICHENIFICATION
thickened epidermis, increased skin lines, results from scratching
what is EXCORIATION
linear abrasions of the epidermis, results from scratching
NON-BLANCHING lesions (3)
petechiae
purpura/ecchymosis
hematoma
BLANCHING lesion
vascular lesions = telangiectasia
are telangiectasias blanchable?
yes
are purpura/hematomas blanchable?
no
what is PETECHIAE
non-blanching
reddish brown
macule (flat, small)
what is PURPURA/ECCHYMOSIS
non-blanching
reddish brown
patch (flat, larger)
what is HEMATOMA
deep collection of blood
non-blanching
usually as a result of blunt trauma
most common cause of telangiectasias
sun damage
When taking a pt’s blood pressure, you see a shower of petechiae to the lower arm after placing the tourniquette. you suspect….
scurvy, vitamin C deficiency
satellite lesion distribution, most commonly from what kind of infection?
yeast (candida)
e.g., under the breasts, in armpits, in skin folds
what is ZOSTERIFORM
skin lesions arranged in a dermatomal pattern
If a mole does not change at all over the course of ______, it is very unlikely to turn into a melanoma
6-12 months
what is a telangiectasia?
a blanching dilated capillary
treatment for seborrheic keratosis
benign, treatment is not necessary
if irritating, can use cryotherapy (liquid nitrogen)
most common causative agent of acne vulgaris
p. acnes (propionibacterium acnes)
(2) topical antibiotic options for treatment of acne vulgaris
- topical clindamycin
- topical erythromycin
(4) oral antibiotic options for the treatment of acne vulgaris
- doxycycline 100mg PO QD-BID
- minocycline 100mg PO QD
- erythromycin 500mg PO BID-TID
- TMP-SMX (Bactrim) 800/160mg 1 tablet BID
classes of medications for treatment of acne vulgaris (from mild to severe)
- topical benzoyl peroxide cream or gel
- topical retinoids (tretinoin, adapalene)
- topical antibiotics (clindamycin, erythromycin)
- OCPs (low progesterone or drospirenone progesterone)
- oral antibiotics (doxycycline, minocycline, erythromycin, TMP-SMX)
- oral spironolactone (anti-androgen, uncommon)
- isotretinoin (Accutane) – only for severe, nodulocystic acne
medication options for the treatment of acne rosacea
- topical metronidazole cream or gel BID (Metrogel)
- azelaic acid
- ivermectin
- sulfur products
- oral antibiotics if severe including doxycycline, minocycline, or erythromycin
dx: a chronic eruption of scaly plaques on the EXTENSOR surfaces that may involve the scalp and nails. well-defined plaque with thick silvery scale with associated pitting of the nails
psoriasis
psoriasis tends to affect [flexor vs. extensor] surfaces
extensor
eczema tends to affect [flexor vs. extensor] surfaces
flexor
what causes psoriasis?
largely unknown – possible genetic, environmental, and physical factors?
immune dysregulation drives condition (auto-immune)
medication options for the treatment of psoriasis
- topical steroid creams and ointments
- topical calcipotriene cream or ointment
- topical tazarotene (retinoid) gel
- topical tar-containing ointments
- phototherapy (UVB & PUVA)
- oral methotrexate, acetretin (retinoid) or cyclosporine (immune modulator)
- injectable biologic response modifiers (etanercept, infliximab, adalimumab, etc.)
Class I-VII topical steroid potencies – which is the strongest vs. weakest?
class I&II are the strongest, NEVER use on face or skin folds
Class VII is the weakest, safe for skin folds and face
Topical steroid options from least to most potent: TRIAMCINOLONE
(more gentle)
Class VI
- triamcinolone acetonide 0.025% cream
Class V
- triamcinolone acetonide 0.025% ointment
Class III
- triamcinolone acetonide 0.1% ointment
(more potent)
Topical steroid options from least to most potent: BETAMETHASONE
(more gentle)
Class V
- betamethasone valerate 0.1% cream
Class I
- betamethasone diproprionate 0.05% ointment
(MOST potent of all)
Topical steroid options from least to most potent: CLOBETASOL
Class I
- clobetasol propionate 0.05% ointment or cream
(MOST potent of all)
Topical steroid options from least to most potent: HYDROCORTISONE
(MOST gentle of all)
Class VII
- hydrocortisone 0.5%, 1%, and 2.5% ointment and cream
Class IV
- hydrocortisone valerate 0.2% ointment
(more potent)
can retinoid skin products (topical or oral) be used in pregnancy?
NO!
choosing a topical steroid for limited plaque psoriasis treatment
- class I or II (most potent) for short term (14 days) control
- class III-IV for daily maintenance therapy
medication treatment for mild-moderate eczema (atopic dermatitis)
- good skin care (mild cleanser, lukewarm showers, fragrance free lotions)
- topical steroids for flares ONLY (class I or II for severe flares for 14 days; class IV-VII for mild flares)
- consider topical antibiotics if the lesions are crusted (bacitracin/polymyxin, avoid neomycin)
- consider oral antibiotics if widespread or grossly infected (cephalexin [Keflex] or erythromycin)
- consider biologic response modifiers (tacrolimus, pimecrolimus) topically for refractory disease (expensive!)
therapy options for severe or widespread eczema
- dermatology referral!
anticipatory guidance for they can expect options to include: oral or IM steroids, phototherapy, oral methotrexate
what causes urticaria
local histamine release in the skin
Type I hypersensitivity reaction mediated by IgE mast cell degranulation which causes the release of histamine and other chemical mediators»_space; leading to increased capillary permeability and tissue edema
medication therapy for urticaria
- identify the allergen and avoid (drugs, pollen, chemicals, food, bacteria, preservatives, malignancy)
- oral antihistamines, e.g., loratidine (Claritin) 10mg QD, cetirizine 10mg QD, fexofenadine 180mg QD, hydroxyzine 10-20mg Q6-8 hrs
- AVOID systemic steroids
topical antifungal cream options for the treatment of fungal skin infections (dermatophyte fungi)
- miconazole 2% BID
- clotrimazole 1% BID
- econazole 1% QD-BID
- ketoconazole 2% QD-BID
- terbinafine 1% QD-BID
topical nystatin and fungal infections?
only works against candida species
has NO effect on dermatophyte fungi
are combination topical antifungals-steroids a good idea for fungal skin infections?
NO - avoid!
topical steroids cause localized immunosuppression which promotes fungal growth
can cause permanent skin atrophy due to the strong topical steroid
priority risks/side effects of oral antifungals
- photosensitivity
- GI upset
- elevated liver enzymes
most common causative agent of tinea corporis (fungal infection on the body)
trichophyton rubrum
most common causative agent of tinea capitis (fungal infection of the hair)
trichophyton tonsurans
most common causative agent of tinea unguium (fungal infection of the nails)
trichophyton rubrum
topical antifungals are ineffective against which types of tinea infection (fungal infection) (2)
- tinea capitis (hair)
- tinea unguium (nails)
treatment options for tinea capitis
- topical agents are ineffective
- oral griseofulvin suspension 15-20mg/kg/day x8 weeks
- terbinafine 250mg QD x2-8 weeks
- selenium sulfide 2.5% shampoo daily to reduce infectivity
treatment options for tinea unguium
- topical agents are ineffective
- terbinafine 250mg QD x6 weeks (fingers) or 12 weeks (toes)
- itraconazole pulse therapy 400mg QD x 7 days Q4 weeks x2 pulses (fingers) or 3 pulses (toes)
treatment options for scabies
- permethrin 5% cream (Elimite)… apply to all skin sparing the face for 8-12 hours as a single application
- topical steroids class III-IV for itching
- oral antihistamines for itching
may take 3-4 weeks for itching to resolve completely
treatment options for herpes simplex labialis (cold sore)
- no treatment is necessary
- topical acyclovir is not very effective
- can consider topical bacitracin/polymyxin ointment to prevent a bacterial superinfection
treatment options for herpes genitalis
- oral acyclovir 400mg TID x5 days (recurrent infection) - 7 days (primary infection)
- can consider topical bacitracin/polymyxin ointment to prevent bacterial superinfection
what topical ointment has excellent action against staph and strep, the most common skin pathogens
mupirocin (Bactroban)
