Common Skin Conditions Flashcards
What can aloe possibly treat?
Aloe is a natural product produced from the aloe vera plant that is used for many skin conditions, including sunburn and psoriasis. It has little proven efficacy, but if used as a gel or lotion, it may provide a soothing effect
What can tea tree oil possibly treat?
Tea tree oil is used for a variety of skin conditions, such as acne. It may be helpful for onychomycosis symptoms (depending on the dose and application schedule) but will not eradicate the infection in most patients
What can lysine be possibly used for?
Lysine, taken as a tablet, capsule or applied topically, is used for cold sore (herpes simplex labialis) prevention and treatment
What can biotin be possibly used for?
Biotin is a vitamin used for hair loss and brittle nails
What can topical vitamin D be possibly used for?
Topical vitamin D is used in skin conditions, such as diaper rash and psoriasis
What are some examples of drugs that can discolor skin and secretions to the color brown?
Entacapone, Levodopa, Methyldopa
What are some examples of drugs that can discolor skin and secretions to the colors brown/black/green?
Iron (black stool), methocarbomol
What are some examples of drugs that can discolor skin and secretions to the colors brown/yellow?
Nitrofurantoin, Metronidazole, Tinidazole, Riboflavin (B2)
What are some examples of drugs that can discolor skin and secretions to the colors purple/orange/red?
Chlorzoxazone
What are some examples of drugs that can discolor skin and secretions to the colors orange/yellow?
Sulfasalzine
What are some examples of drugs that can discolor skin and secretions to the colors yellow-green?
Propofol, Flutamide
What are some examples of drugs that can discolor skin and secretions to the colors red-orange?
Phenazopyridine, Rifampin, Rifapentine
What are some examples of drugs that can discolor skin and secretions to the color red?
Anthracyclines, Deferasirox (urine)
What are some examples of drugs that can discolor skin and secretions to the color blue?
Methylene blue, Mitoxantrone
What are some examples of drugs that can discolor skin and secretions to the color blue-gray?
Amiodarone, chloroquine
What are the primary determinants of acne?
Androgens, along with the presence of the bacteria, Cutibacterium acnes and fatty acids (sebum) present in oil (sebaceous) glands
How are acne lesions classified?
Acne lesions are classified as whiteheads (closed comedones), blackheads (open comedones), papules, pustules and nodules (sometimes called “cysts”)
How is acne treatment determined?
Treatment is determined by severity: mild (few, occasional pimples), moderate (inflammatory papules) or severe (nodules)
What are the primary group of medications to treat acne?
Acne is treated with these primary groups of medications: OTC benzoyl peroxide and salicylic acid, retinoids, topical or systemic (oral) antibiotics and systemic isotretinoin
What is considered first-line treatment for mild acne?
Topicals: BPO and/or retinoid
What are alternative treatments for mild acne?
Add topical retinoid or BPO, switch to another retinoid, topical dapsone or clascoterone
What is the first-line treatment for moderate acne?
Topicals: combination (BPO + topical antibiotic, BPO + retinoid or BPO + retinoid +topical antibiotic)
or
PO antibiotic + BPO + topical retinoid (+/- topical antibiotic)
What are alternative treatments for moderate acne?
Other combination therapy, switch PO antibiotic, add combined OCP or spironolactone (females) or PO isotretinoin
What are first-line treatment for severe acne?
Topical combination + PO antibiotic or oral isotretinoin
What are alternative treatments for severe acne?
Switch PO antibiotic, add combined OCP or spironolactone (females) or PO isotretinoin (if not previously tried)
What is benzoyl peroxide?
Benzoyl peroxide (BPO) is an effective OTC medication and is recommended for most patients with acne. It is also available by prescription, including in combinations with hydrocortisone, the retinoid adapalene or with the antibiotics erythromycin or clindamycin
How is salicylic acid supplied?
Salicylic acid is available OTC and is supplied in several different formulations, including washes, “medicated pads” and lotions
What are retinoids used for?
Retinoids, primarily topical tretinoin and derivatives, are the usual prescription drug of choice and are also used to reduce wrinkles
What is a warning about retinoids?
Retinoids are teratogenic. They must be avoided in pregnancy or breastfeeding
What is the mechanism of retinoids?
Retinoids are vitamin A derivatives. The mechanism is primarily to reduce adherence of the keratinocytes (outer skin cells) in the oil gland
What are some counseling points about retinoids?
- They are well-tolerated when used topically, with mild skin irritation (redness, drying) and photosensitivity possible. Retinoids should be applied daily at night with the correct (pea-sized_ amount. Thus can be decreased to every other night if irritation occurs. A moisturizer, followed by sunscreen, should be used each morning
- Retinoids take 4-12 weeks to work, and acne can worsen initially. Minocycline can be used with topical retinoids to help reduce worsening. Tazarotene often works better than tretinoin; it is used for difficult cases
What is required for the used of oral retinoid isotretinoin?
The oral retinoid isotretinoin has many safety considerations. Isotretinoin is FDA-approved for severe, recalcitrant nodular acne only, though it is also used off-label for moderate, treatment-resistant acne. Cholesterol and pregnancy tests are required, among other monitoring
What is the benefit of oral contraceptive pills for the treatment of acne?
Some women find benefit with oral contraceptive pills, especially if acne occurs around the menstrual cycle or if irregular menses or symptoms of androgenic excess are present
What is the benefit of using spironolactone for the treatment of acne?
Spironolactone is an aldosterone receptor antagonist with antiandrogen effects. It is not FDA-approved for acne, but is recommended as a useful treatment for some females
What is azelaic acid and what can it be used for?
Azelaic acid (Azelex, Finacea) is a topical dicarboxylic acid cream or gel available OTC and prescription for acne and rosacea
What is clascoterone used for?
Clascoterone (Winlevi) is a recently-approved topical androgen receptor inhibitor. It can be used as an alternative for the treatment of mild acne in patients age 12 and older
What are some examples of topical retinoids and acne products?
Tretinoin, Adapalene, Tazarotene, Trifarotene, Benzoyl peroxide, topical antibiotics and combinations, salicylic acid, azelaic acid, Dapsone, Winlevi
What is note applicable to all topical retinoids?
Topical retinoids should be avoided in pregnancy
What is a note about Retin-A Micro and Avita?
Slower release, less skin irritation
What is a note about Tazarotene?
Contraindicated in pregnancy, lotion is approved in individuals aged 9 years and older
What is a note about Altreno?
0.05% lotion form of tretinoin, less irritating
What is a note about Fabior?
Stronger, more irritating
What are some safety/counseling points of topical retinoids?
- Limit sun exposure
- Apply daily, usually at bedtime, about 20 minutes after washing face
- If irritation occurs, use lower strength or every other night. May need to reduce contact initially (was off if skin is irritated)
- A pea-sized amount is sufficient (for facial application); it should be smoothed over the entire surface of the face, not just on acne
- Avoid salicylic acid scrubs or astringents; will worsen irritation
- Wash only with mild soap twice daily
- Takes 4-12 weeks to see response; may worsen acne initially
What are some notes about Benzamycin and BenzaClin?
Add indicated amount of purified water to the vial (70% ethyl alcohol for Benzamycin) and immediately shake to completely dissolve medication (use additional purified water to bring level up to mark if needed). Add solution in the vial to the gel; stir until homogenous (1 to 1.5 minutes). Place a 3-month expiration date on the label foloowing mixing
*Benzamycin is kept refrigerated and BenzaClin is kept at room temperature
What are some notes about Winlevi?
- Keep refrigerated before dispensing; store at room temperature after dispensing
- Expires 180 days after dispensing if unopened or 1 month after opening the container, whichever is sooner
What are some safety/counseling points about BPO?
- Can bleaching clothing and hair
- Start with 2.5-5% BPO, generally adequate and less irritating than the higher strengths
- Limit sun exposure
What are some safety/counseling points about Clindamycin topicals?
- Clean face, shake (if lotion), apply a think layer once or twice daily. Avoid contact with eyes; if contact, rinse with cold water
- Takes 2-6 weeks for effect and up to 12 weeks for full benefit
What is a counseling point about Dapsone gel?
Avoid in G6PD deficiency
What is a counseling/safety point about Clascoterone?
- HPA axis suppression may occur during or after treatment; more likely with use over a large surface area, prolonged use, and use with occlusive dressings
- Apply a thin layer twice daily after washing and drying the skin
What is an example of an oral retinoid?
Isotretinoin
What are some notes about Isotretinoin?
- Only FDA-approved for severe, refractory nodular acne
- Female patients must sign patient information/informed consent form about birth defects if the fetus is exposed to isotretinoin. Must have had 2 negative pregnancy tests prior to starting treatment
- Cannot get pregnant for 1 month before, while taking the drug, or for 1 month after the drug is stopped. Do not breastfeed or donate blood until at least 1 month has passed after the drug is stopped
- Do not use with vitamin A supplements, tetracyclines, steroids, progestin-only contraceptives or St. John’s wort
- Must swallow capsule whole, or puncture and sprinkle on applesauce or ice cream (may irritate the esophagus)
What are some boxed warnings about Isotretinoin?
- Birth defects have been documented; must not be used by women who are pregnant or may become pregnant
- Can only be dispensed by a pharmacy registered and activated with the pregnancy REMS (iPLEDGE) program. 1-month Rx at a time, fill within 7 days with yellow sticker attached
What are some warnings about isotretinoin?
Dry skin, chapped lips, dry eyes/eye irritation (may cause difficulty wearing contact lenses), decreased night vision (may be permanent), arthralgia, skeletal hyperostosis (calcification of ligaments that attach to the spine), osteoporosis, psychiatric issues (depression, psychosis, risk of suicide), increased cholesterol and BF=G
What are some counseling points of isotretinoin?
Pregnancy testing must be repeated on a monthly basis. 2 forms of birth control are required (cannot use a progestin-only pill). Carry bottled water, eye drops and lip balm
What are some antibiotics used for acne?
Doxycycline, Sulfamethoxazole/trimethoprim, Sarecycline, Erythromycin
What are some notes about antibiotics used for acne?
- Doxycycline and minocycline are more effective than tetracycline in eradicating C. acnes
- Sulfamethoxazole/trimethoprim is also used. Erythromycin is used less commonly due to resistance
- Sarencycline is a tetracycline derivative for non-nodular moderate to severe acne
What are some safety/counseling points of antibiotics used for acne?
- Can cause photosensitivity, rash in susceptible patients, dizziness, diarrhea, somnolence
- Like other tetracyclines, can cause fetal harm if administered during pregnancy
- May cause permanent discoloration in teeth if used when teeth are forming (up to 8 years of age)
What type of virus causes cold sores?
Cold sores are usually due to herpes simplex virus type-1 (HSV-1) but can be caused by HSV-2 when due to oral/genital sex
How does the herpes simplex virus spread?
The virus spreads mostly with active lesions; kissing and sharing drinks can transmit the infection
When and where does the sore occur?
Sore eruption is preceded by prodromal symptoms (e.g. tingling, itching, soreness). In most patients, the sore appears in the same location repeatedly. The most common site is the junction between the upper and lower lip
What are some triggers that instigate sore outbreaks?
Triggers that instigate sore outbreaks include fatigue, stress, stress to the skin (e.g. sun exposure, acid peels) and dental work
What is the prodromal period?
The prodromal period is the optimal time to start treatment (topical or oral) to reduce blister duration
What can be done if recurrences of cold sores are frequent?
If recurrences are frequent (>4 times/year), chronic suppression, taken daily, can be used
How many days does OTC and prescription topicals shorten the duration of cold sores?
OTC and prescription topicals shorten the duration by up to one day
How many days does oral (systemic) antivirals shorten the duration of cold sores?
Oral (systemic) antivirals shorten the duration by up to two days
What natural product is used commonly for cold sore prevention and treatment?
Lysine
What products are available for the treatment of cold sores?
- OTC: Docosanol (Abreva)
- RX: Acyclovir topical cream/ointment (Zovirax), Acyclovir buccal tablets (Sitavig), Penciclovir topical cream (Denavir)
What are some counseling points of Abreva cream?
Apply 5x daily at first sign of outbreak, continue until healed
What are some counseling points of Zovirax cream?
Apply 5x daily for 4 days (can be used on genital sores)
What are some counseling points of Sitavig tablets?
Apply one 50 mg tablet as a single dose to upper gum region
What are some counseling points of Denavir cream?
Apply every 2 hours during waking hours for 4 days
When does dandruff occur?
Dandruff occurs when the scalp is itchy and/or scaling with white oily flakes (dead skin) in the hair and on the shoulders, back or clothing
What can dandruff be caused by?
Dandruff can be due to either eczema or fungal (yeast) overgrowth, and is worsened by hormones, the weather or shampoo
What is seborrheic dermatitis?
Seborrheic dermatitis is a common form of eczema that causes flaking, itchy skin on the face, back, chest or head. If it is on the scalp, it is commonly referred to as dandruff
What are some products to treat dandruff?
- OTC: Ketoconazole 1% shampoo, selenium sulfide, pyrithione zinc, coal tar shampoos
- RX: Ketoconazole 2% shampoo
What are some safety/counseling points for antifungal shampoo?
- Rub shampoo in well, leave in for 5 minutes, then rinse out
- Shampoo daily. If the shampoo stops working switch products
What are some safety/counseling points of Nizoral A-D?
- Apply twice weekly, for up to 8 weeks
- Do not use if open sores on scalp
- Can cause skin irritation
What is the most common cause of hair loss?
The most common cause of hair loss is hereditary male-pattern baldness and less commonly, female-pattern baldness
What are some less common causes of hair loss?
Hormonal changes in women that can result in hair loss are usually associated with pregnancy, childbirth or menopause
What medical conditions can cause hair loss?
Medical conditions that cause hair loss include hypothyroidism, alopecia areata (an autoimmune condition), scalp infections and some other conditions including lupus, zinc and vitamin D deficiency
What drugs can contribute to alopecia?
Various chemotherapeutics, valproate, spironolactone, heparin, warfarin, clomiphene, hydroxychloroquine, interferons, lithium, some types of oral contraceptives, levonorgestrel and procainamide
What is a medication that can be used to treat alopecia?
Finasteride, Minoxidil, Bimatoprost
What are some notes about Finasteride?
- Must be used indefinitely or condition reappears
- Do not dispense to patients taking finasteride for BPH
What is a contraindication of Finasteride?
Pregnancy
What is a warning of Finasteride?
Hazardous drug for females of childbearing age - can harm a male fetus
What are some side effects of Finasteride?
Lower dose than Proscar; lower risk of sexual side effects