Common Skin Conditions Flashcards
Aloe
Natural product made from aloe vera plant
Used for sunburn, psoriasis
Provides a soothing effect
Tea Tree Oil
Used for acne
Lysine
Used for cold sore (Herpes simplex labialis) prevention & treatment
Topical vitamin D
Used for diaper rash & psoriasis
Drugs that cause brown discoloration/secretions
Entacapone
Levodopa
Methyldopa
Drugs that cause Brown/Black/Green discoloration/secretions
Iron (black stool)
Drug that causes Brown/Yellow discoloration/secretions
Nitrofurantoin
Drug that causes orange/yellow discoloration/secretions
Sulfasalazine
Drug that causes yellow/green discoloration/secretions
Propofol
Drugs that cause Red/Orange discoloration/secretions
Phenazopyridine
Rifampin (Rifadine)
Drug that causes red discoloration/secretions
Anthracyclines
Drug that causes blue discoloration/secretions
Methylene blue
Mitoxantrone
Drug that causes Blue/Gray discoloration/secretions
Amiodarone
What are the primary determinants of acne?
Androgens
Bacteria (Cutibacterium acnes, formerly known as propionibacterium acnes)
Fatty acids (Sebum present in oil (sebaceous) glands
Acne: Treatment (general)
OTC benzoyl peroxide & salicylic acid
Retinoids
Topical/Systemic steroids
Antibiotics
Systemic isotretinoin
Retinoids MoA
Vit A derivatives
Reduce adherence of keratinocytes in the oil gland
Retinoids: contraindication
Teratogenic
Pregnancy/Lactation
Retinoids: administration
Daily at night with pea-sized amount
Can decrease to every other night if irritation occurs
Moisturizer, followed by sunscreen should be applied every morning
How does it take for retinoids to work?
4-12 weeks
Acne may worsen initially
Oral retinoid (Isotretinoin): use
Severe, recalcitrant nodular acne
Isotretinoin: required testing
Pregnancy
Cholesterol
Clascoterone
Topical androgen receptor inhibitor
For 12+ years old
Mild acne: 1st line treatment
Topicals: BPO or retinoid OR
Topicals: combination
Topical combination therapy includes
BPO + topical antibiotic, BPO + retinoid or BPO + retinoid + topical antibiotic
Moderate acne: first line treatment
Topicals: combination OR
PO antibiotic + BPO + topical retinoid (+/- topical abx)
Severe acne: first-line treatment
Topicals: combination + PO abx OR
PO isotretinoin
Topical Retinoids: examples
Tertinoin (Atralin, Renova, Retin-A, Retin-A micro, Altreno)
Adapalene (Differin)
Advantage of Retin-A micro
Provides slower release, allowing for less irritation
Topical retinoids: counseling points
Limit sun exposure
Apply daily at HS, 20 minutes after washing face
Irritation? dec. strength or switch to every other night
Smooth a pea-sized amount all over the face, not JUST on the acne
Wash with only mild soap BID
Takes 4-12 wks to work, may worsen initially
What patients do you want to avoid dapsone gel in?
G6PD deficiency
Clascoterone: warning
HPA axis suppression
Isotretinoin & pregnancy
2 negative pregnancy tests prior
Do not get pregnant 1 month before or 1 month after
Do not breastfeed until atleast 1 month after drug stopped
Pregnancy test repeated monthly, 2 forms of birth control required
Isotertinoin: ADRs
Dry skin, chapped lips, dry eyes/eye irritation
Cold sores: cause
HSV-1
Spreads from active lesions, kissing, sharing drinks
Cold sores: ideal time to start treatment
Prodromal period It precedes sore eruption
Drugs for cold sores
Docosanol (abreva) - OTC: 5x/day at first sign of outbreak
Zovirax (Rx): 5x/day x4 days (Can use on genitals)
Drugs for dandruff
Ketoconazole 1% (Nizoral-AD) - OTC
Selenium sulfide (Selsun) - OTC
Pyrithione zinc (Head & Shoulders) - OTC
Coal tar shampoo (T/Gel) - OTC
Ketoconazole 2% (Nizoral) - Rx
Medical conditions that cause alopecia
Hypothyroidism
Zinc & Vit D deficiency
Drugs that cause alopecia
Chemotherapeutics
Valproate
Tacrolimus
Heparin
Drugs for alopecia
Propecia 1mg daily (takes 3 months to see results)
Baricitinib - causes serious infections, malignancy, and thrombosis
Rogaine
Bimatoprost (Latisse) - for hypotricosis
Eczema: presentation
Skin rashes which become crusty & scaly
Rash is itchy, red, dry & sore
Eczema: non-pharm approaches
Hydration & moisturizers
Eczema: drug for itching
Antihistamines
Eczema: treatments
Topical steroids (PO PRN)
Calcineurin inhibitors
Topical calcineurin inhibitors: age limit
do not use in < 2 yrs. Risk of lymphomas & skin cancer
Tinea pedis
Athletes foot
Tinea corporis
Ring worm
Tinea cruris
Jock itch
Tinea pedis: symptoms
feet itching, peeling, redness, mild burning
Tinea pedis: common infection places
Public pools, showers, locker rooms
Tinea cruris affects where?
genitals, inner thighs, buttocks
Tinea cruris: presentation
rash that is red, itchy and ring-shaped
Tinea corporis: presentation
circular, red, flat sores with dry, scaly skin.
Occasionally, ring is not present, just itchy, red skin. Outer part can be raised while the skin in the middle appears normal
Tinea capitis
“ringworm” on the scalp
Funal infection treatments: counseling points
Don’t barefoot with foot infection
Apply meds 1-2 inches beyond the rash
use for 2-4 weeks, even if it appears to be healed
Reduce moisture to affected area
Terbinafine: brand name
Lamisil AT
Butenafine: brand name
Lotrimin ultra
Clotrimazole: brand name
Lotrimin AF
Miconazole: brand name
Lotrimin AF
Tolnaftate: brand names
Tinactin
Betamethasone/Clotrimazole
Lotrisone
Ketoconazole: brand name (cream)
Extina
Undecylenic acid: brand names
Toelieva
When to refer pts to physicians for vaginal infections
> 4 infections in a year OR
Symptoms recur within 2 weeks
Onychomycosis: treatment
Itraconazole PO (avoid use in HF)
terbinafine PO (can cause hepatotoxicity)
pH & vaginal infections
pH > 4.5 is consistent with bacterial vaginosis or trichomoniasis infection
** OTC test kits available to test pH**
Onychomycosis: diagnosis
20% KOH smear
Miconazole
Monistat-3
Butoconazole
Gynazole-1
How long to treat complicated/pregnancy related vaginal infections?
7-10 days or refer to physician
Diaper rash: prevention
Petrolatum ointment (A&D ointment)
Petrolatum with zinc oxide (Desitin) - desicant used to dry skin
Diaper rash: treatment
Clotrimazole, miconazole, nystatin
Hydrocortisone
Hemorrhoids: treatment
Psyllium - reduce straining
Phenylephrine (Preparation H)- vasocontrictor to shrink hemorroids
Hydrocortisone (Anusol-HC, Preparation H)
Witch hazel (Tucks medicated cooling pads)
Pinworm (vermicularis): presentation
anal itching, usually in kids
“Tape test”
Used in pinworm infection to identify eggs
Can take up to 3 morning tape tests to identify eggs
Pinworm: treatment
Mebendazole
Pyrantel pamoate
Albendazole
Mebendazole, Albendazole warnings
headache, nausea, hepatotoxicity
Albendazole: administration
Take with high fat meal
Topical ivermectin
Sklice
Used to treat head lice
Available OTC
Permethrin difference in treating lice vs scabies
lice: permethrin lotion 1% (Nix)
Scabies: permethrin cream 5%
Oral ivermectin
Stromectol
For 15kg +
ADRs: lymph node enlargement, arthralgias, skin tenderness, pruritis & fever
Lice
pediculus humanus capitis
Which shampoo is no longer recommended as a treatment for lice d/t neurotoxicity?
Lindane shampoo 1%
Malathion lotion 0.5%
Ovide
Organophosphate
only for 6+ yr old
Irritatble to skin & flammable
Retreatment is needed on days 7-10 for most lice products, what is the exception?
Topical ivermectin (Sklice)
How often should you use the nit comb to remove nits & lice after treatment?
every 2-3 days
Pyrethrin/piperonyl: brand name
RID
NIx and RID retreatment day
9
Burn: characterization
1st dregree: red/painful, minor swelling
2nd degree: thicker, very painful, produce blisters
3rd degree: damage to all layers, skin appears white/charred
Aquaphor
80% oil, 20% water ointment
Used to protect skin for minor burns
Holds in moisure & prevents scarring
Diabetes & burns
even a minor burn on foot can dead to amputation
Silver sulfadiazine
Silvadene, SSD
reduces infection risk & promotes healing
Mupirocin: coverage
Strep & staph (including MRSA).
Don’t use SSD in
Sulfa allergy
G6PD deficiency
Poison ivy: transmission
oak or sumac poisoning
Allergic rxn from touching saps of plants containg urushiol
Hydrocortisone strengths avaliable OTC
0.5%
1%
Poison ivy: treatment
Aluminum actetate (astringent)
Collodial oatmeal (Aveeno)
Zanfel
Topical or oral steroids PRN
Steroid vehicles from highest to lowest potency
“Finger tip” unit
Used to estimate amount
From the fingertip to the first joint
“Broad spectrum” sunscreen definition
Protects against both UVA and UVB
Sunscreen counseling points
Apply liberally every 2 hours
Reapply after swimming or sweating
Keep babies < 6 months out of the sun
Time to burn (TTB) equation
TTB = SPF & TTB (without suncreen)
Sunscreen & “waterproof”
Labels can no longer write “water proof” or “water resistant” because they all wash off
Can be water resistant for 40-80 minutes
