Common Skin Conditions Flashcards
What are the natural products for skin conditions and their uses?
- Aloe vera (soothing effect): sunburn and psoriasis
- Tea tree oil: acne
- Lysine (tablet, capsule or topical): Cold sore (herpes simplex labialis) preventionn and treatment
- Biotin: hair loss and brittle nails
- Topical vitamin D: diaper rash and psoriasis
List drugs that can discolor skin and secretions
Brown
* Entacapone
- Levodopa
- Methyldopa
Brown/Black/green
* Iron (black stool)
- Methocarbamol
Brown/Yellow
* Nitrofurantoin
Purple/Orange/Red
* Chlorzoxazone
Orange/Yellow
* Sulfasalazine
Yellow-Green
* Propofol
Red-Orange
* Phenazopyridine
- Rifampin
Red
* Anthracyclines
Blue
* Methylene blue
- Mitoxantrone
Blue-Gray
* Amiodarone
What causes acne?
- Androgens (male sex hormone) are the primary determinant of acne
- Cutibacterium acnes (formerly known as propionibacterium acnes)
- Fatty acids (sebum) present in oil (sabeceous) glands
What are the teratment options for acne?
- Benzoyl peroxide (OTC)
- Salicylic acid (OTC)
-
Retinoids
- Teratogenic, must be avoided in pregnancy and breastfeeding
- They are vitamin A derivatives, the mechanism is primarily to reduce adherence of the keratinocytes in the oil gland
- Apply daily at night with the correct (pea-sized) amount
- Can take 4-12 weeks to work
-
Systemic isotretinoin
- Oral retinoid isotretinoin has many safety considerations
- FDA-approved for severe, recalcitrant nodular acne only
- Cholesterol and pregnancy tests are required
- Topical or systemic (oral) antibiotics
- Oral contraceptive pills
- Azelaic acid (Azelex, Finacea) (OTC/Rx)
- Clascoterone (Winlevi)
What are acne treatment options by severity?
Mild
* First-line: Topicals - BPO and/or retinoid
- Alternative - add topical retinoid or BPO, switch to another retinoid, topical dapsone or clascoterone
Moderate
* First-line: Topicals - combination or PO antibiotic + BPO + topical retinoid (+/- topical antibiotic)
- Alternative - other combination, switch PO antibiotic, add combined OCP or spironolactone (females) or PO isotretinoin
Severe
* First-line: Topicals - combination + PO antibiotic or PO isotretinoin
- Alternative - switch PO antibiotic, add combined OCP or spirinolactone (females) or PO isotretinoin (if not previously tried)
Topical combination therapy: BPO + topical antibiotic, BPO + retinoid or BPO + retinoid + topical antibiotic
Topical retinoids and acne products - brand/generic, safety/counseling
- Tretinoin (Atralin, Renova, retin-A, Retin-A Micro)
- Adapalene (Differin)
- Retin-A Micro and Avita: slower release, less skin irritation
- Tazarotene: CI in pregnancy
* Topical retinoids should be avoided in pregnancy
* Limit sun exposure* Apply daily, usually at bed time, about 20 minutes after washing face * If irritation occurs, use lower strenght, or every other night * A pea-sized amount is sufficient * Takes 4-12 weeks to see response; may worsen acne inititally
- Benzoyl peroxide (BPO) - can bleach clothing
- Salicylic acid
- Azelaic acid (Rx, OTC)
- Dapsone gel (Aczone) (Rx) - avoid in G6PD deficiency
- Clascoterone cream (Winlevi) (Rx) - HPA axis suppression
Oral retinoids - brand/generic, safety/counseling
Isotretinoin (Absorica, Amnesteem) (Rx - capsules)
* Only FDA-approved for severe, refractory nodular acne
- Female patients must sign informed consent form about birth defects if the fetus is exposed to isotretinoin; must have had 2 negative pregnancy tests prior to starting Tx
- Cannot get pregnant for 1 month before, while taking the drug, or for 1 month after the drug stopped
- BW: birth defects have been documented
- Can only be dispensed by a pharmacy registered and activated with the pregnancy REMS (iPLEDGE) program. 1 month Rx at a time
- SEs: dry skkin, chapped lips, dry eyes/eye irritation
- 2 forms of birth control are required (cannot use a progestin-only pill)
Antibiotics used for acne - brand/generic, safety/counseling
Minocycline (Minocin, Solodyn) (Rx)
* XR formulations: only approved for use in patients >= 12 years
- Can cause photosensitivity, fetal harm if administered during pregnancy, discoloration in teeth if used when teeth are forming (up to 8 years of age)
What causes cold sores and what are the symptoms?
- Cold sores ( herpes simplex labialis) is an infection usually due to HSV-1
- The virus spreads mostly with active lesions; kissing and sharing drinks
- Sore eruption is preceded by prodromal symptoms; tingling, itching, soreness
Which drugs are used for treatment of cold sores? include safety/counseling points
- Docosanol (Abreva) (OTC) - apply 5x daily at first sign of outbreak, continue until healed
- Acyclovir topical cream/ointment (Zovirax) (Rx) - apply 5x daily for 4 days (can be used on genital sores)
- Lysine for prevention and treatment (natural product)
What drugs are used for dandruff?
OTC:
* Ketoconazole 1% shampoo (Nizoral A-D)
* Apply twice weekly, for up to 8 weeks
* Do not use if open sores on scalp
* Can cause skin irritation
- Selenium sulfide (Selsun)
- Pyrithione zinc (Head&Shoulders)
- Coal tar shampoos (T/Gel)
Rx:
* Ketoconazole 2% shampoo (Nizoral)
What drugs and conditions can contribute to alopecia?
- Chemotherapeutics (primarily because hair cells are rapidly dividing and are affected by the treatment)
- Valproate
- Spironolactone
- Heparin
- Zinc and vitamin D deficiency
- Hypothyroidism
What drugs are used to treat alopecia? Include safety/counseling points
Finasteride (Proscar) - 5-alpha reductase type 2 inhibitor also approved for BPH
Finasteride (Propecia)
* Rx: tablet
- Take 1 mg daily; can take >= 3 months to begin to see effect
- CI: pregnancy
- Warning: hazardous drug for females of childbearing age - can harm a male fetus
- Do not dispense to patients taking finasteride (Proscar) for BPH
Minoxidil tablets
* Rx: Indicated for HTN (very rarely used)
Minoxidil topical (Rogaine)
* OTC: 5% foam, 2% and 5% solution
Bimaprost (Latisse)
* Rx: solution
- For thinning eyelashes (hypotrichosis)
- Do not use with PG analogs used for glaucoma (IOP may increase)
- Apply nightly to the skin at the base of the upper eyelashes only
What is eczema? What are the treatment options?
- Eczema is a general term for many types of skin inflammation
- Presents as skin rashes, which become crusty and scaly; blisters can develop
- The rash is itchy, red, dry and sore
- Hydration is essential; use moisturizers
- Treatment incudes topical steroids (occasional oral courses, if needed), antihistamines (for itching), calcineurin inhibitors (if topical steroids with hydration are not adequeate)
List Drugs and safety/counseling points for eczema
OTC
* Moisturizers with petrolatum, lanolin (Aquaphor, Eucerin)
Rx - Treat first with topical steroids and only use the drugs below if steroids failed;
- Topical Calcineurin Inhibitors: Tacrolimus (Protopic) - ointment, Pimecrolimus (Elidel) - cream
- Topical Phosphodiesterase-4 Inhibitor: Crisanorole (Eucrisa) - 2% ointment
- Monoclonal Antibody (IL-4 antagonist): Dupilumab (Dupixent) - injection
Safety/Counseling
* All topical products - wash hands after application
- Topical calcineurin inhibitors - do not use in children < 2 years of age; associated with lymphoma and skin cancer; use only as second-line drugs for short-term, intermittent treatment
What is hyperhidrosis and treatment?
- It is an excessive sweating
- OTC - Antiperspirants (Secret Clinical Strength, Certain Dri)
- Rx - Glycopyrronium topical (Qbrexza)
What is athlete’s foot (Tinea Pedis)? What are the symptoms?
- It is a fungal infection of the foot caused by various fungi.
- Common infection among those using public pools, showers and locker rooms
- Symptoms include feet itching, peeling, redness, mild burning
Jock itch (Tinea Cruris) affects genitals, inner thighs and __ . The rash is __, __, and can be ring-shaped.
Fill in the blanks
- Buttocks
- Red
- Itchy
What is ringworm (Tinea Corporis)?
- It is not a worm, but a fungal skin infection
- It presents as a circular, red, flat sores
- Occasionally the ring-like presentation is not present - just itchy red skin
- The outer part of the sore can be raised while the skin in the middle appears normal
T/F: Tinea capitis is “ringworm” on the scalp
TRUE
What is cutaneous (skin) candida infections?
- Topical Candida infections cause red, itchy rashes, most commonly in the groin, armpits or anywhere the skin folds
List drugs and safety/counseling points for treatment of fungal infections
OTC
* Terbinafine (Lamisil AT) - cream, gel, spray
- Butenafine (Lotrimin Ultra) - cream
- Clotrimazole (Lotrimin AF) - cream
- Miconazole (Lotrimin AF) - powder, spray
- Tolnaftate (Tinactin) - cream, powder, spray
- Undecylenic acid (Toelieva)
Rx
* Betamethasone/Clotrimazole (Lotrisone: used for tinea with inflammation/itching - cream, lotion
- Ketoconazole (Extina) - cream, foam
Safety/Counseling
* If infection on the foot, do not walk barefoot (to avoid spreading it)
- Apply medicine 1-2 inches beyond the rash
- Use for at least 2-4 weeks, even if it appears healed
- Reduce moisture to the infected area
Onychomycosis is a fungal infection of the __.
Fill in the blank
- Nail
Topical drugs are limited to mild cases and patients who cannot toleratesystemic therapies. They are not __ enough to cure most infections
Fill in the blank
- Potent
__ and __ are two drugs approved for fungal infections on the toenails and fingernails
Fill in the blanks
- Itraconazole (Sporanox)
- Avoid use in HF
- Terbinafine (Lamisil) - oral
- Lamisil AT; topical, used for fungal skin infections
- Risk of hepatotoxicity
__ therapy (intermittent) can be used for fungal infections of nails to reduce costs and possibly __, but may not be as __.
Fill in the blanks
- Pulse
- Toxicity
- Effective
T/F: A 20% potassium hydroxide (KOH) smear is essential for diagnosis as other conditions can produce a similar presentation
TRUE
A pH > __ consistent with bacterial vaginosis or trichomoniasis infection.
Fill in the blank
- 4.5
OTC test kits are available to test vaginal __.
Fill in the blank
- PH
___ or ___ with active ___ is thought to reduce infection occurence. However, this is rated as “possibly ineffective” by the Natural Medicines Database
Fill in the blanks
- Lactobacillus
- Yogurt
- Cultures
List drugs for treatment of vaginal fungal infections
Mild - moderate, infrequent infection
* 1, 3 or 7 day treatment with vaginal cream, ointment or vaginal suppository/tab
OTC, topical
* Clotrimazole (Gyne-Lotrimin)
- Miconazole (Monistat 3)
Rx, topical
* Butoconazole (Gynazole-1)
- Terconazole (Terazol 7)
Rx, oral
* Fluconazole (Diflucan) - 150 mg PO x 1
Complicated infections, pregnancy: 7-10 days Tx, or refer to healthcare provider
What are the prevention and treatment strategies in diaper rash?
Prevention
* Use skin protectant - petrolatum ointment, petrolatum with zinc oxide (a desiccant, used to dry out the skin)
Treatment
* Nystatin, clotrimazole, miconazole: for stubborn rashes, if yeast is thought to be involved
- OTC: Petrolatum (A&D Ointment), Petrolatum/zinc oxide (Desitin)
- Rx: Miconazole/zinc oxide/petrolatum (Vusion)
What are treatment options for hemorrhoids?
- If dietary fiber intake is not optimal, increasing fiber intake help reduce straining
- Products such as psyllium will mix with the stool to make it easier to push out
- A stool softener (such as docusate) will reduce straining
- Phenylephrine (Preparation H) is a vasocontrictor that shrinks the hemorrhoid and reduces burning and itching
- Hydrocortisone (Anusol-HC, Preparation H) comes in anal suppositories and various topicals. These reduce itching and inflammation
- Witch hazel (Tucks Medicated Cooling Pads) is a mild astringent that can relieve mild itching
What is pinworm (Vermicularis)? Include diagnosis, treatment and safety/counseling points
- It is an infection commonly occurs in children and presents as anal itching
- The “tape” test is used to identify eggs: stick a piece of tape around the anus in the morning prior to voiding and bring it to the healthcare provider, who examines it under the microscope to look for eggs
- It can take up to three morning tape tests to identify the eggs
Drugs - Anthelmintics
* OTC: Pyrantel pamoate (Reese’s Pinworm Medicine, Pamix, Pin-X) - suspension
- Rx (systemic worm infections, many types): Albendazole (Albenza), Mebendazole (Emverm)
- Both cause headache, nausea and are hepatotoxic
- Txs for systemic worm infections are toxic. In some cases, such as treating CNS infections, steroids and AEDs will be given with the anthelmintic (i.e., worm drug)
- When treating systemic infections, albendazole must be taken with high-fat meal to increase absorption
T/F: Lice, pediculus humanus capitis, occurs most commonly in elementary school-age children
TRUE
T/F: Topical pyrethrins and permethrin are the OTC drugs of choice for lice and scabies
TRUE
Elimite is a 5% permethrin cream used to treat ___, while Nix is a ___% ___ used to treat ___.
Fill in the blanks
- Scabies
- 1
- Lotion
- Lice
Lindane shampoo 1% is no longer recommended due to ___.
Fill in the blank
- Neurotoxicity
Malathion lotion 0.5% (Ovide) is an organophosphate only for use on persons 6 years of age and older. can irritate the ___ and is ___.
Fill in the blanks
- Skin
- Flammable
Topical ivermectin (Sklice) is approved to treat ___ lice.
Fill in the blank
- Head
T/F: After each treatment for removing the nits, check the hair and use a nit comb to remove nits and lice every 2-3 days
TRUE
List drugs for treatment of Lice and scabies. Include safety/counseling
Lice - OTC
* Permethrin (Nix), ages 2+ months
- Pyrethrin/Piperonyl butoxide (RID), ages 2+ months
- Ivermectin lotion (Sklice), ages 6 + months
- DOC: Permethrin and pyrethrin/Piperonyl butoxide. Repeat treatment on day 9
Scabies - Rx
* Permethrin cream (Elimite)
- Ivermectin oral (Stromectol)
Describe first degree, second degree and third degree burns
- First degree: red/painful, minor swelling
- Second degree: thicker, very painful, produce blisters
- Third degree: damage to all layers of skin, appears white or charred
Ointments (80% oil 20% water, such as Aquaphor) should be used for skin protection over a ___ burn to hold in ___ and reduce ___ risk.
Fill in the blanks
- Minor
- Moisture
- Scarring
Silver sulfadiazine (Silvadene; SSD) can be used topically to reduce ___ risk and promote ___.
Fill in the blanks
- Infection
- Healing
List drugs for treatment of burns
OTC
* Polymyxin/bacitracin/neomycin
- Triple antibiotic ointment (Neosporin Original)
- For neomycin allergy, use Polysporin (bacitracin and polymyxin) or bacitracin alone; either is sufficient
Rx
* Mupirocin (Bactroban) is an antibiotic cream or ointment; very good staph and strep coverage, including MRSA
- Bacitracin/neomycin/polymyxin B/hydrocortisone (Cortisporin ointment) - superficial skin infections
What is poison ivy, oak or sumac poisoning?
- Allergic reaction that results from touching the sap of these plants, which contain the toxin urushiol
List drugs for treatment of poison ivy, oak and sumac poisoning. include safety/counseling points
OTC
* Aluminum acetate solution (Boro-Packs, Domeboro Soothing Soak) - astringent (drying agent)
- Colloidal oatmeal (Aveeno)
- Calamine lotion/pramoxine (anesthetic):(Caladryl, IvaRest)
- Zanfel works by binding urushiol (this is the toxin) - low evidence for efficacy
Note: Topical or oral steroids will help (oral needed in severe rash)
The primary treatment for skin irritation is topical steroids. Two strenghts of hydrocortisone (HC) are available OTC are ___% and ___%; all other topical steroids are Rx only.
Fill in the blanks
Inflammation and Rash
- 0.5
- 1
T/F: The steroid vehicle influences the strength of the medication
Inflammation and Rash
TRUE
Rank the potency of steroid formulations from highest to lowest
Inflammation and Rash
Ointments > creams > lotions > solutions > gels > sprays
List the very high potency topical steroids
Inflammation and Rash
- Clobetasol propionate 0.05% lotion/shampoo/spray (Lobex), cream/ointment (Temovate), foam (Olux), gel
- Fluocinonide 0.1% cream (Vanos
List the high potency topical steroids
Inflammation and Rash
- Betamethasone dipropionate 0.05% cream (Diprolene AF)
- Fluocinonide furoate 0.1% ointment (Lidex)
- Mometasone furoate 0.1% ointment (Elocon)
List the high-medium potency topical steroids
Inflammation and Rash
- Fluocinonide 0.05% cream (Lidex-E)
List the medium potency topical steroids
Inflammation and Rash
- Mometasone furoate 0.1% cream (Elocon)
- Triamcinolone acetonide 0.1% cream (Triderm), 0.147 mg/g spray (Kenalog)
List the lowest potency topical steroids
Inflammation and Rash
- Hydrocortisone cream: 0.5%, 1% (Cortaid, Cortizone-10)
T/F: Hydroxyzine (Vistaril is used for general urticaria (hives) with severe itching. Side effects include sedation and dry mouth
Inflammation and Rash
TRUE
What is “fingertip” unit is used for?
Inflammation and Rash
- To estimate amaount: from the fingertip to the 1st joint provides enough medication to cover one adult hand
- Encourage patient not to use topical steroids more than directed as overuse has risks
- Do not apply for longer than 2 weeks
What is the formula for time to burn (TTB)?
TTB (with sunscreen in min) = SPF X TTB (without sunscreen)
T/F: Sunscreen labeling is no longer permitted to use “waterproof” or “sweatproof” but sunscreen can claim to be “water-resistant” but only for 40-80 minutes
TRUE
Apply sunscreen liberally and at least every ___ hours and reapply after ___ or sweating. The AAP recommends keeping babies less than ___ months old out of the sun.
Fill in the blanks
- 2
- Swimming
- 6
