Derm 1 Flashcards
Eczematous dermatitis
Tx
Acute: topical corticosteroids, antihistamines for itching. Topical calcineurin inhibitors to avoid steroids. Prevent: daily emollients, avoid irritants, phototherapy, bleach baths to avoid 2ry infxn
Dyshidrosis (eczema)
Tx
Topical steroids (ointments), cold compresses, Burrow’s solution
Lichen simplex Tx
Avoid scratching/rubbing, high strength topical steroids, antihistamines
Drug eruptions (fixed) Tx
Drug avoidance & antihistamines
Lichen planus Tx
Most remit spontaneously in 1-2 yrs Topical corticosteroids (clobetasol, betamethasone) Intralesional injections of triamcinolone Generalized: PO steroids. Oral: paste. Phototherapy
Pityriasis rosea
Tx
Symptomatic Patient education -benign lasts 4-10wks
Psoriasis Tx
All forms: sun exposure, sea bathing, moisturizers, relax, Tar, salicylic acid lotion Determine severity→ Mild/mod <5% BSA. Severe >5% BSA Mild/Mod: Intermittent therapy-topical corticosteroids, vit D analog, tazarotene (retinoid) Continuous-Calcineurin inhib (tacrolimus) Severe: systemic tx (Methotrexate, cyclosporine, biologics (-mabs))
Erythema multiforme
Tx
Usu resolves spontaneously in 3-5 weeks Stop any drug related cause Oral antihistamine and steroids for sx’s Recurrent/prophylaxis: PO acyclovir
Stevens - Johnson syndrome
Tx
Withdrawal agent, transfer to burn unit if severe necrolysis, manage fluid and electrolyte IVIG, Corticosteroids, antibiotics debateable
Toxic epidermal necrolysis
Tx
Withdrawal agent, transfer to burn unit if severe necrolysis, manage fluid and electrolyte IVIG, Corticosteroids, antibiotics debateable
Bullous pemphigoid
Tx
Corticosteroids, Immunosuppressants (rituximab, sulfasalazine, methotrexate, IVIgG
Prone to relapse
Acne vulgaris Tx
Comedones: topical retinoid or adapalene Mild: topical abx (clinda, erythro, metro), + benzoyl peroxide, + retinoid/adapalene Moderate: See mild + PO abx (tetracyclines, erythro, clinda) Severe (nodular or cystic): isotretinoin Hormone related/excess androgens in F: add OCPs +/- spironolactone Isotretinoin AEs: depression hepatitis, increase triglycerides, premature long bone closure, highly teratogenic (-preg tests, 2 forms birth control)
Rosacea Tx
Redness: topical brimonidine (a2 agonist) Papulopustules & telangiectasias: topical metronidazole, azelaic acid, acne meds, retinoids, sulfacetamide, ivermectin cream, topical & PO abx Refractory: isotretinoin
Actinic keratosis
Tx
Cryosurgery, Curettage, Electrosurgery Topical chemotherapy (5FU)
Seborrheic keratosis
Tx
No tx -benign Cosmetic -cryotherapy
Basal cell carcinoma
Tx
Electrodessication/curettage +/- Mohs for face or recurrent Small/superficial: imiquimod and 5FU (nonfacial)
Kaposi sarcoma
Tx
HAART therapy Radiation for local
Melanoma Tx
Complete wide surgical incision +/- adjuvant therapy (a-interferon, immunotherapy, radiation) PO & topical
Thickness is most important prognostic factor for METS
Squamous cell
carcinoma
Tx
Wide local surgical excision is treatment of choice
Electrodessication and curettage, Mohs, radiation
Lice Tx
Permethrin for 10 min (head) 8-10hrs (body) 2nd line: Lindane (neurotoxic). Systemic: PO Ivermectin Wash bedding/clothing hot water and detergent and dried in hot drier
Scabies Tx
Lindane or permethrin from chin to bottom of feet overnight x7d. Tx all close contacts. Wash all clothes/bedding Antihistamines or topical steroids for itching.
Spider bites Tx
BW: Clean w/ soap and water, NSAIDs, opioid. Moderate to Severe: opiods +- muscle relaxant. Antivenom for non responsive pts if available (consult tox.) BR: Pain control (NSAIDs), tetanus, wound debridement for necrosis
Condyloma acuminatum
Tx
No tx is curative, relapses are common Cryotherapy, Laser ablation, Inter-lesional interferon Drugs: Imiquimod, 5FU Vaccine prevention (9 types) Close to 100% efficacy
Viral exanthems (Roseola) Tx
Supportive, antipyretics
Viral Exanthems (Coxsache) Tx
Complications: aseptic meningitis, pericarditis, myocarditis, pleurodynia Supportive -antipyretics, topical lidocaine
Viral exanthem (Rubeola) tx
Supportive: vitamin A reduces mortality Complications: diarrhea, AOM
Viral exanthem (5th Dz) Tx
Supportive Complications: increased fetal loss in pregnancy, may cause aplastic crisis in pts w/ sickle cell dz or G6PD deficiency
Herpes simplex
Tx
Acyclovir, famcyclovir, valacyclovir Higher dosing for primary, can prophylax
Molluscum contagiosum
Tx
Self-limited (2 mo for single lesion) Cryotherapy NO STEROIDS
Varicella -zoster
Tx
Vaccine for >60 Urgent referral for ophthalmic (Hutchinson sign) Antiviral w/in 72 hrs. Pain control
Verrucae Tx
Cryotherapy
Cellulitis Tx
PO: MSSA-Cephalexin, Augmentin, Dicloxacillin MRSA-Clindamycin, Bactrim, doxy, linezolid IM/IV: MSSA-Cefazolin, Nafcillin or oxacillin MRSA-Clindamycin MRSA-Vanco, daptomycin, linezolid
General: Elevate bed or extremity, warm compresses, tylenol or ibu for pain Symptomatic improvement in 24-48 hrs, visible up to 72 hrs
Erysipelas Tx
PO: Penicillin Amoxicillin Cephalexin (keflex) Dicloxacillin IM/IV: Cefazolin or Ceftri General: Elevate bed or extremity, warm compresses, tylenol or ibu for pain Symptomatic improvement in 24-48 hrs, visible up to 72 hrs Tx 7-14 days
Impetigo
Bactroban (Mupirocin): drug of choice If systemic,: Cephalexin (Keflex)
Candidiasis Tx
Topical clotrimazole, miconazole, or nystatin PO fluconazole
Tines Capitis Tx
1st line: PO Griseofulvin 2nd: PO terbinafine, itraconazole or fluconazole
Tunes Corporis Tx
Topical Antifungal
Tibet Pedis Tx
Topical antifungal Clean shoes w/ antifungal spray, keep feet dry
Tinea Cruis Tx
Topical antifungal Avoid tight clothing, use desiccant powders
Onychomycos is
Tx
48 weeks with topical meds (ciclopirox) PO: efinaconazole, terbinafine, griseofulvin, itraconazole, terbinafine (AE -hepatotoxicity)
Pityriasis Veriscolor Tx
Topical (days-4wks): selenium sulfide, zinc pyrithione, azole antifungals PO: itraconazole or fluconazole Taks 2mo for rash to resolve w/ tx
Alopecia Areata Tx
Intralesional corticosteroids topical steroids topical immunotherapy
Relapse common. Can resolve or progress to total hair loss.
Male and Female pattern hair loss
Minoxidil increases anagrn phase, increase follicle size
Surgery
M: finasteride lowers DHT in scalp
F: spironolactone
Paronychia Tx
Warm soaks I and D Abx as needed
Acanthosis nigricans
tx
Treat underlying condition If no identifiable cause, look for malignancy
Burns
Parkland, Debridement, Pain management, +/- Antibiotics, IV fluid (Lactated ringers)
1st: heals in 7 days, aloe/lotion 2nd: Heals in 14-21 days, may leave pigment 3rd: months 4th: does not heal well
Hidradenitis suppurativa
Tx
All: punch debridement or I&D, diet, stop smoking Mild: topical clinda, intra-lesional steroid injection, +/- PO abx (doxy or minocycline) Mod: PO abx (up to 3mo), hormonal (spironolactone), Severe: prednisone, TNF-a inhibitors, PO isotretinoin Refractory: sx excision of apocrine glands
Lipomas / Epithelial inclusion cysts
Tx
May surgically remove for cosmetics
Melasma Tx
Hydroquinone Acid peel Retinoids
Prevention: stop OCP, Use sunscreen
Pilondal Dz Tx
Sits, Antibiotics I&D
Pressure Ulcers
Wet to dry dressings, hydrogels I, II- local wound care, pain management, III and IV may need surgical debridement
Urticaria Tx
Wet to dry dressings, hydrogels I, II- local wound care, pain management, III and IV may need surgical debridement
Vitiligo Tx
Sun protection, Cosmetics. Topical steroids Phototherapy-induced pigmentation Depigmentation 40%+ BSA involved. Skin grafting.
