Chapter 88: Skin Flashcards
anatomy of skin
Epidermis
Dermis
Subcutaneous tissue
topical medication preps
ointment
greatest absorption
good for dry skin, thicken skin, oozing skin
cream
mix of oil and water
not good for ozing skin
lotion
water or alcohol base
good for skin on skin areas
gel
water or alcohol base
liquefies on contact with skin
foam
aerated solutions
powder
talc or corn starch base
reduces friction between skin surfaces
paste
ointment plus powder
good for diaper rash
*more water, less absorption
Topical glucocorticoids
(cream, ointment, or gel)
Uses
To relieve inflammation and itching
Drying agent
Adverse effects
thinning of skin
Stretch marks
Purpura
Telangiectasia
Hypertrichosis
Possible systemic toxicity -More likely with higher doses and long-term therapy. Growth retardation in children, Adrenal suppression
Don’t want to se long term in one area- thin the skin. *
administration
Apply in a thin film and gently rub into the skin
Do not use occlusive bandages (or tight-fitting diapers and plastic pants) -Increases absorption
Keratolytic Agents
Promote shedding of horny layer of the skin
Primary agents and uses
Salicylic acid: Warts, corns
Sulfur: Acne, dandruff, psoriasis, seborrheic dermatitis
Benzoyl peroxide
treatment for thickening of ski
acne tx
Nondrug therapy
Cleansing
Drug therapy
Benzoyl peroxide
Antibiotics: Topical: Clindamycin, erythromycin. Oral: Tetracycline antibiotics,
PO isotretinoin, hormonal agents
Retinoids -toplical
Tretinoin
Adapalene
Tazarotene
azelaic acid
most common skin disease.
~85% of all teenagers get acne and it may persist into adulthood
acne AB
agents of choice: Doxycycline [Vibramycin], minocycline [Minocin]
Alternatives (resistance is common): Tetracycline [Sumycin], erythromycin [Ery-Tab]
See changes in 3-6m switch to topical for long term use
Isotretinoin
Used to treat severe nodulocystic acne vulgaris
Teratogenic -> ipledge
contraindicated in pregnancy
Triglyceride levels must be monitored
Potentiated by alcohol
Adverse effects
nose bleeds, lip inflammation, dry eyes, itching dry skin, muscle pain, stiffness, depression
tetracycline increases effects of isotretinoin
PO acne drugs
Hormonal agents
Spironolactone [Aldactone]
Sunscreens (UVA)
UVA penetrates the epidermis and deep into the dermis
UVA penetrates much deeper than UVB
UVA is the primary cause of immunosuppression, photosensitive drug reactions, and photoaging of the skin
most UV radiation is UVA
UVB
UVB penetrates into the epidermis but goes no deeper
Tanning and sunburn are caused primarily by UVB
Sunscreens (UVA and UVB)
Both UVA and UVB promote damage to DNA, so both can cause premalignant actinic keratoses, basal cell carcinoma, squamous cell carcinoma, and malignant and nonmalignant melanoma
sunscreens
Impede penetration of UV radiation to viable cells of the skin
Can protect against sunburn, photoaging of the skin, and photosensitivity reactions to certain drugs (e.g., tricyclic antidepressants, phenothiazines, sulfonamides, sulfonylureas)
Can also reduce the risk of actinic keratoses, squamous cell carcinoma, and melanoma
organic sunscreens
Also known as chemical screens
Absorb UV radiation and then dissipate it as heat
15 of approved sunscreens
Must include avobenzo
inorganic screens
Also known as physical screens
Scatter UV radiation
Titanium oxide and zinc oxide
Now micronized and clear for applying to skin
Good for nose, tips of ears, lips
Sun Protection Factor (SPF)
SPF is an index of protection against ultraviolet B (UVB) radiation
SPF does not address ultraviolet A (UVA) protection
Methods for obtaining SPF are not precise
Relationship between SPF and protection against sunburn is not linear (SPF 30 is not twice as much protection as SPF 15)
SPF sun protection
SPF of 15 indicates 93% block of uvb
SPF 30 is 96.7% block of uvb
SPF 40 is only 97.5 % block
FDA blocks sunscreens from marketing high spf. SPF higher than 50 can only be labeled 50+
SPF 2-14 only protects from sunburn -have to disclose this on label.
broad spectrum sunscreens
covers both UVA and UVB
broad spectrum SPF 15 of higher is protective against sunburn, skin cancer, and photoaging effects
sunscreens water/sweat resistance
can’t say sunscreen is waterproof -can say water resistant and have to say how how long it is resistance for on label.
safe sun exposure
Sunglasses, hats, protective clothing, avoid the sun 10a-4p, shade, reflective sunburn off water
Psoriasis
Red patches with silver scales
Common, chronic inflammatory disorder that follows an erratic course
Initial episode usually develops in early adulthood
Subsequent attacks may occur spontaneously or in response to triggers
Varying degrees of severity
Symptoms result from:
Accelerated maturation of epidermal cells
Excessive activity of inflammatory cells
Treatment for Psoriasis
Topical drugs
Systemic drugs
Phototherapy
Most antipsoriatic drugs suppress activity of inflammatory cells
topical psoriasis drugs
Glucocorticoids
Vitamin D analogs: Calcipotriene, calcitriol
Vitamin A derivative: Tazarotene
Anthralin
Tars
systemic drugs for psoriasis
conventional agents:
Methotrexate
Acitretin
Glucocorticoids
Cyclosporine
biologic agents for psoriasis
Etanercept
Infliximab
Adalimumab
Ustekinumab
procedures for psoriasis
Photochemotherapy
Coal tar + ultraviolet B irradiation
Actinic Keratoses (AKs)
Rough, scaly, red or brown papules caused by chronic exposure to sunlight
Half of all skin cancers in the United States begin as AKs
Drugs for AK
Fluorouracil
Diclofenac sodium
Imiquimod
Aminolevulinic acid + blue light
atopic Dermatitis (Eczema)
Chronic inflammatory skin disease
Dry scaly skin intense itching
Underlying cause has to do with T cells
Keep skin moist with cream
drugs
Glucocorticoids
Topical immunosuppressants
May cause skin cancer or lymphoma
Second line
Only use in folks that do not response to glucocorticoids
Tacrolimus
Pimecrolimus
Venereal Warts
Form around, vagina, valva, urethra, glans, anus, anal canal
Caused by HPV 6 and 11
STI
Commonly identifying during vaginal exams
Agents Used to Remove Venereal Warts
Physical measures
Cryotherapy, electrodesiccation, laser surgery, and conventional surgery
Topical drugs (must be applied by provider)
Podophyllin (must be applied by provider) -Needs to be washed off a few hours later, Small areas done at once
Bichloroacetic acid (BCA) and trichloroacetic acid (TCA) -Destorys wats by chemical coagulation, Can be repeated weekly
Topical drugs (can be applied at home)
Imiquimod-Cream, Stimulates production of interferon alpha tumor necrosis factor, Itching burning, skin at site
Podofilox
Kunecatechins
Common Warts
a vulgaris: Hard, rough, horny papules
Majority of common warts are caused by just three types of human papillomavirus (HPV): HPV-1, HPV-2, and HPV-3
Physical measures for removal
Cryotherapy, electrodesiccation, curettage, and laser therapy
Topical drugs
Salicylic acid, podophyllin, podofilox, imiquimod, trichloroacetic acid, and topical fluorouracil
Antiperspirants
Aluminum chlorohydrate, aluminum chloride, and buffered aluminum sulfate; these agents can reduce the flow of eccrine sweat by 20% to 50%
Deodorants
Carbanilide, triclocarban, and triclosan inhibit the growth of the surface bacteria that degrade components of apocrine sweat into malodorous products; they do not suppress sweat formation
Drugs for seborrheic dermatitis and dandruff
Pityrosporum ovale, a microbe in the yeast family
Symptoms respond rapidly to topical treatment with ketoconazole, an antifungal drug with activity against yeast
Treatment of hair loss
Topical minoxidil –topical direct vasodilation, delays loss of hair and stimulate hair growth, takes several months to develop
Finasteride [Propecia]
PO
Treatment of unwanted facial hair
Eflornithine [Vaniqa]
Available in creams
Inhibits enzyme required for hair growth
Only moderately effective
Benefits develop over 4-8wk and fade within 8wks after stopping med itself
Impetigo
Most common bacterial infection of the skin: Staphylococcus aureus
Usually seen in children 2 to 5 years of age
Two forms:
Bullous -From toxin in SA, Typically in moist areas of skin
Nonbullous -Crust Hands, feet, legs
Impetigo is treated with antibiotics
PO -cephlexin, dioxcyline, clindamyin, augmentin
topical -Bactroban and atabax
Local Anesthetics
Can be applied topically to relieve pain and itching associated with skin disorders
Benzocaine
Lidocaine
Pramoxine
