CME and randoms Flashcards
acyclovir - most common toxicity?
GI is most common but renal is the worst
sebaceous nevus - 5 tumours benign 2 malignant?
BMi + smoking + alcohol - > in AA trichoBlastoma, tricholeMomma, DESMO tricholemmoma, SCAP, Sebaceous Adenoma, Apocrine Adenoma, poroma > sebaceous carcinoma, BCC
PDT full name for ALA and mALA? what is an active product
5-aminolevulinic acid
methylaminovulinate
- >
protoporphyrin IX
light used with ALA? mALA?
ALA - blue - 417
mALA - red - 630
what is the light used in in PDT and what does it convert?
visible light
O2 into singlet O2 which does tissue damage
c/i for TCS ?
allergy to vehicle or active steroid ingredient
epidermal thinning
active infection
ulcera or loss of epidermal barrier (NOT IN BOLOGNA)
pregnancy lactation
Vit D3 analogues maximum doses and names of 3 D3 analogues?
calciPOtriol
100 g/ week BID
calcipotriene
calcitriol - non-synthetic
200 g/ BID
tacalcitol
70 g
indications and c/i for anthralin?
Pso -
UNSTABLE
PUSTURAR
ERYTHRODERMIC
ie cannot use in acute
maximum area that can be treated by bazarotene?
10-20% max
nB UVB - wavelength
311
excimer laser wavelength?
308
contraindications for phototherapy - name 5?
photo aggravated conditions like PCP, SLE
light sensitive genodermatoses
CsA
pregnancy and lactation
OCA
photo aggravated dermatosis
solar urticaria
HIGH PREVIOUS PUVA > 200
genetic conditions w/ increased photosensitivity
CsA
hx of skin cancer
preggo lactation
skin type I
photosensitive dermatoses
vitiligo
ARSENIC
atypical melanocytic nevi
SEIZURE disorder
bad compliance
no contraception for PUVA
LIVER impairment PUVA
CATARACTS PUVA
MTX - c/i - 7?
immunodeficiency syndrome
active infection
pregnancy, lactation
obesity, T2DM - relative
severe hepatic disease
alcohol use
unreliable
severe heme abn - severe anemia, leukopenia, thrombocytopenia
bologna also: impaired kidney function
concominant meds that increase MTX levels like Septra
significantly reduced pulmonary function
planning to have children
concomitant radiation
hypersensitivity to MTX
gastritis or peptic ulcer
MTX - risks for hepatic complications?
old fat druggie and alcoholic with hepatitis and diabetes
ALCOHOL
obesity
IVDU
hepatitis
personal or family hx of liver dz
T2DM esp insulin
age
cutaneous s/e of methotrexate
oral erosions
necrosis /tenderness
alopecia
delayed phototoxicity
urticaria
angioedema
vasculitis
CsA - c/i = 5
CHIKS
active malignancy
hypertension - uncontrolled
hypersensitivity
active infection
severe kidney dysfunction
relative:
immunodeficiency disorder
vaccine - live
<18 >65
preggo/lactation
PUVA
drugs interfering with function
significant hepatic dz
scontrolled HTN
unreliable
MTX
drug c/i with TNF? MTX?
anakinra; CsA
acitretin - dose for plaque? erythrodermic and pustular?
plaque - 0.5 mg/kg/day, erythrodermic 0.25 and pustular 1 mg/kg day -
“mild cheilitis is the goal”
acitretin - c/i?
severe liver dysfunction
severe kidney dysfunction
pregnancy or lactation
no contraception
hyperlipidemia
excessive alcohol
unreliable
hepatotoxic drugs like methotrexate
pancreatitis
atherosclerosis
PLEVA infection? med (2 each)
HIV, Parbo B19
radio contrast dye and TNF alpha
PLEVA PATH
interface derm
WEDGE SHAPED
lymphocytes and neutrophis
focal parakeratosis
epidermal necrosis
erythrocyte extravasation frequeint
PLEVA ddx (only more atypical ones)
vasculitis
VZV
arthro
EM
lichenoid drug
follidulitis
Pleva/plc - 3 drug classes? TOC for fulminant
tetracyclines
azitromycin/erythromycin
MTX = for fulminant
if severe CS, IVIGI, CsA
reports of TNFs, bromelin, PDT
PRP - drug trigger?
imatinib
6 biologic agents for psoriasis and dose
a. adalimumab: 80, 40 1 week apart, then 40 q2weekly ada40Q2
b. infliximab: 5mg/kg 0, 2, 6, q8 IN0,2 ,6,Q8
c. Etanercept 50mg twice weekly 3 months, then once weekly
d. Secukinumab: 300mg 0, 1, 2, 3, 4, then every 4 weeks l’amour a trois x 5 doses, then Q4 3e5u4inumab
e. Brodalumab 210 q 0, 1, 2 then every 2 weeks
f. Guselkumab: 0, 4, then every 8 100mg
g. Ustekinumab: 0, 4, then every 12 if <100kg 45mg; if >100kg 90mg
h. Ixekizumab: 160mg x1, then 80 mg q2wks x6, then 80mg q4 weeks Humira like HS -> ex
anthralin MOA
topical agent that binds DNA, inhibiting synthesis of nucleic protein, and reduces mitotic activity.
Hep B - 3 signs, Hep C - 3 cutaneous findings per CME?
hep B : BaG and PANtSS – B -> Gianotti Crosti and PAN, Serum sickness like
but see nipple -> CC NPL: C = Cryo necrolytic acral erythema PCT and LP
3 tx for atrophic vagina
estradiol cream or vaginal tablets
moisturizers/lubricants for sexual activity
HC
fractional CO2
increased risk of candidiasis - give flu 200 mg weekly PRN
vvulvodynia management - 4 categories?
ALL THE SOFTS - pelvic, botox, acupuncture, sex ed, TCAs, education
patient education, avoidance of irritants
pelvic floor physio
topicals: lidocaine 5% gaba 5% ambaclofen, etc
PO: duoloxetine, gaba (100->1200), pregabalin, TCAs
counselling - CBD, sex therapy
BOTOX, acupunture
AD IL?
TSLP, IL 4, Il 13, IL 31, 33
Q 4 steroids that you should avoid in budesonide allergy
fluocinonide, desonide, amcinonide, triamcinolone acetonide, HC-17-butyrate (group D2 cross reacts)
descriptions of hand dermatitis
- explosive, fast resolving
- reaction to fungal infxn
- central palm
- hyperkeratotic (peeling skin) with hyperhidrosis-
- (acral peeling skin syndrome:
- explosive, fast resolving- pompholyx
- reaction to fungal infxn - vesicles on lateral fingers- id reaction/ autosensitization
- central palm- hyperkeratotic hand eczema
- hyperkeratotic (peeling skin) with hyperhidrosis- keratolysis exfoliativa
- (acral peeling skin syndrome: transglutaminase 5)
humectants - 4
a. Glycerin
b. Honey
c. Urea
d. Propylene glycol
e. Gelatin
f. HA
HUMECTANS HHUG – Honey HA Urea glycerin prop glycol gelatin
what are emollients? humectants? occlusives?
- Lanolin, glyceryl stearate, and soy sterols are oily substances that make up true emollients. They fill cracks in the skin’s outermost layer, which improves the skin’s appearance by creating a smooth skin surface, increasing light reflection, and enhancing skin flexibility [6].
- Protein-based emollients are rejuvenators and are mainly used for cosmetic purpose
- Humectants such as urea, glycerol, and lactic acid are used to increase the skin’s water content by their ability to attract water vapour [6]. Glycerol (glycerine) is the most effective humectant [1,6].
- Occlusives such as petroleum jelly (paraffin), mineral oil, and dimethicone are hydrophobic moisturisers that prevent evaporation by forming a waterproof barrier on the skin’s surface. For optimal results, it is recommended to apply occlusive agents on slightly dampened skin [1,6].
terbinafine MOA dose for nails
squalene epoxidase inhibitor - > dermatophyte and non-DM 250 PO 6 weeks/12 weeks nails
terbinafine MC s/e and which CYP
headache, GI and rash → LFT, taste disturbances, an, category B, CYP 450 inhibitor
predictor of liver injury on terbinafine?
idiosyncratic
best drug for nondermatophytes? MOA
itraconazole
lanosterol 14 alpha DEMEthylase
I try but I’m DUM
itraconazole - dose, CYP
200 mg BID x 1 week on 3 weeks off - 2 pulses
200 mg PO OD x 12 weeks for toes
I try but i’m dum/messy – itraconazole lanosterol 14 alpha DeMethylase 222222
2 x 2 x 2 pulses
2 x 1 x 12 toes
CYP 3A4
itraconazole when can’t use ?
ventricular dysfunction, including CHF, pregnancy and 2 MONTHS (2222222 for itra )
fluc CYP and dosing ?
CYP 2C9 fluke 2 see 9 toes
and CYP 3a4
terbinafine pulse dosing for onychomycosis
2 cycles of 250 mg 4 weeks on 4 weeks off (2 months total like itra, except itoa was 200 BID x 1 week on 3 off)
again terbinafine 5 s/e
headache, diarrhea/ GI pain, rash, taste disturbances, LFT elevation
VISUAL DISTURBANCES (connect to taste), can also lead to anemia and hearing loss
terbinafine - 4 cutaneous s/e
morbilliform drug
SLE
SJS/TEN
angioedema
itraconazole enzyme and 6 s/e
lanosterol 14 alpha Demethylase
headache, GI pain, diarrhea, URTI, hyperglyceredemia, LFTs, peripheral neuropathy, CHF, QT prolongation, pancreatitis, SJS/TEN, sexual - menstrual and erectile dysfunction
iTRY - TRUNK - URTI, CHF, QT, menstrual, erectile, pancreatitis and hyperglyceredemia
fluconazole enzyme, dose and 7 s/e
150 mg PO OW x 6 months, 12 mo for nails
headache, nausea, vomingit, rash, transaminase elevation, liver injury, QT, torsades
leukopenia, agranulocytosis, TEN, taste changes
3- topical treatments - onychomycosis
Ciclopirox olamine 8 Cytochrome inhibition
Efinaconazole 10 - lanosterol 14 alpha demethylase (effin conazole 10%)
tavaborole 5 tRNA synthase (tavaborole like crisaborole aminoacyl transfer RNA synthase)
what drug poses a very high risk of invasive aspergillosis?
ritux
what is the highest risk factor for disseminated Mucormycosis?
DM
also high iron states - feed on iron
chemo induced eyelash hypotrichosis tx?
bimatoprost 0.03%
5 cutaneous reactions to EGFR inhibitors
so EGR acne, nail (CAMERAS), xerosis, pruritis, alopecia, trichomegaly, hirstusm, mucositis, photosensitivity, rad induced dermatitis → so acne, dryness, nail/hair
- Papulopustular eruption, paronychia, acne, itch, dryness*
- UptoDate (): papulopustular/acneiform, abnormal scalp/facial/eyelash hair growth, paronychia +/- pyogenic granuloma, telangectasias, xerosis, pruritus, purpuric xerotic dermatitis, alopecia, hand foot skin reaction*
what’s specific about acne like lesions of EGFR?
tender, pruritic papules
seborrheic distribution
actually improves with TCS! (and oral CS/retinoids, but not topical retinoids, tetracyclines work super well for them)
MEK inhibitors - 5 s/e
this is eGFR without acne and radiation/photo
PRURITIS,
alopecia, paronychia, trichomegaly, mucositis,
imatinib - 5 cutaneous s/e?
cKIT so pigmentary cue
hair depigmentation
skin hypopigmentation
photosensitivity
general: alopecia, morbilliform, pruritis, mucositis
periorbital edema → treats eosinophil d/o helps to remember
BRAF - 6 cutaneous s/e?
KA and SCC → know that keratinizing so also
acral erythema and acral keratoses
other tumours - eruptive nevi and 1 MM elsewhere
also morbilliform, alopecia, pruritis - no mucositis
Q. 2 diagnostic tests to confirm the drug causing DRESS.
(2019)
- Patch test*
- Leukocyte transformation test*
3 most common classes of drugs that cause FDE
SNoT
- a. Sulfonamides*
- b. NSAIDs*
- c. Tetracyclines*
3 histologic findings of toxic erythema of chemotherapy
Eccrine squamous syringometaplasia, vacuolar degeneration of basal layer, keratinocyte necrosis, mild spongiosis
1 drug that causes hand - foot syndrome aka calluses?
dabrafenib, vemurafenib, etc
HLA for abacavir?
HLA B 5701
3 presentations of halogenodermas
aceniform eruption/pustules > granulomatous/vegetative plaques/ulcers
2 MC drug eruptions
- exanthematous drug eruption
- urticaria
What are 3 classic clinical findings in Dapsone hypersensitivity syndrome
- morbilliform rash, fever, pharyngitis, hepatitis, eosinophilia
2 histopath features of atrophie blanche
a. HUALINE thrombi in vessels
b. fibrin in vessel walls
c. no vasculitis
d. ulceration
5 risk factors for warfarin induced necrosis
a. Lack of bridging heparin
b. Women
c. 6th/7th decade
d. partial deficiency of protein C
e. high loading doses
f. Obesity
g. CME:
i. Protein C, S, FVL, AT3 def
ii. HIT
iii. malignancy
3 features of cholesterol emboli - clinical? labs? reason (3)
i. livedo reticularis
ii. peripheral gangrene
iii. cyanosis
iv. nodules
v. purpura
vi. ulceration
vii. Labs:
1. Eosinophilia, decreased complement, leukocytosis, eosinophilouria, elevated ESR, Cr, BUN
ix. Settings:
1. Prolonged anticoagulation
2. Arterial/coronoary cath
3. Acute thrombolytic therapy
6 systemic diseases associated with urticarial vasculitis
SLE, RA, Sjogren syndrome,
HepB, HepC, cryoglobulinemia - C3/C4 deficiency yo!
plasma cell dyscrasia, lymphoma, Castlemans
Pregnant patient, best treatment for the following
a. PV who needs steroid sparing agent
b. Psoriasis who failed topicals
c. Scabies
d. Acute cutaneous lupus not responding to topicals
Pregnant patient, best treatment for the following 2016
a. PV who needs steroid sparing agent
i. IVIg
b. Psoriasis who failed topicals
i. TNF, phototherapy, secukinumab (B)
c. Scabies
i. Permethrin 5% x 2 hours
d. Acute cutaneous lupus not responding to topicals
i. Plaquenil ©
what is the active metabolite of hydroxyzine?
cetirizine
SDRIFE criteria
- drug exposure
- erythema of gluteal/perianal area
- at least one other intertriginous area
- SYMMETRIC
- NO SYSTEMIC SIGNS
5 MC drugs to induce alopecia
R I BAL
retinoids interferons betas antiCOAGULANTS Lithim
2 common morphologies of HITS?
retiform branching purpura or non-inflammatory necrosis
at heparin sites or distal sites
days 5-10
organ systems involve
GI
CNS including seizures and motor neuropathies
CV/pulmoanry - tachy, resp distress, etc
