derm Flashcards

1
Q

first line therapy for acne

A

benzoyl peroxide 2.5%

antibacterial for P acnes

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2
Q

benzoyl peroxide teaching

A

start with less potent

may cause bleaching of fabric

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3
Q

topical antibiotics for acne info

A

clindamycin 1% preferred, dapsone

gels, creams, ointments, foams
photosensitivity
clinical improvement in 4-8 weeks

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4
Q

dapsone

A

inhibits dihydrofolic acid in bacteria; anti-inflammatory

topical AEs, orange/brown discoloration

12 weeks for effect

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5
Q

retinoids

A

vitamin A derivatives

bind to retinoid receptors & turn on genes that promote keratinocyte differentiation

topical AEs - photosensitivity

tretinoin - no use w BP

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6
Q

azalaic acid

A

cream/foam/gel
Qweek, 2x/week

use for post-inflammatory dyspigmentation

local AEs

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7
Q

oral antibiotics for acne

A

1- TETRACYCLINES
2- macrolides
3 - trimethoprim-sulfamethoxazole

decrease P acnes colonization

used after trial w topical agents

clinical improvement in 6-10 weeks

limit duration 3-4months

not used as monotherapy

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8
Q

doxycycline teaching

A

take with water on empty stomach
avoid admin with other ions

AE - teeth staining, GI discomfort, photosensitivity

avoid in pregnancy, children <8

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9
Q

isotretinoin

A

used for severe, recalcitrant acne

prevents scarring & resistant acne

potential toxicity - hypervitaminosis A, IBS, SI/anxiety/depression, HLD, elevated LFTs

iPledge program for providers to be registered; pregnancy tests every 30 days BBW

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10
Q

isotretinoin dosing

A

0.5mg/kg/day x 1 month
1 mg/kg/day as tolerated

lower dose for AEs

treatment duration 4-5 months, repeated after 2-month washout interval

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11
Q

isotretinoin AEs

A

CYP2C9, 3A4, 2B6

dry skin, cheilitis (lips), hypertriglycerideia, leukopenia, photosensitivity, depression

monitor lipids/LFTs

avoid in breast feeding/teratogenic!!!

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12
Q

mild acne regimen

A

benzoyl peroxide or BP with topical abx (clindamycin/erythromycin)

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13
Q

moderate/severe ance regimen

A

BP w topical retinoid ando/or systemic antibiotic

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14
Q

comedal acne regimen

A

topical retinoids only

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15
Q

inflammatory/nodular (cystic) acne regimen

A

topical retinoid w oral abx

combination therap

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16
Q

atopic dermatitis

A

most common type of eczema - presents in childhood

17
Q

atopic dermatitis treatment

A

low potency topical steroids
crisaborole - non-steroids PDE4 inhibitor 2% ointment
dupilumab

18
Q

dupilumab

A

IL-4 inhibitor indicated for moderate-to-severe refractory atopic dermatitis
monoclonal antibody/immune modulator
SC injection

AE - oral herpes, HSV, injection site rxn, conjunctivitis, HA, nasopharyngitiis

monitoring - baseline PPD, CBC with diff, hep B/C screening

19
Q

contact dermatitis

A

eczema related to contact w specific substance

tx w antihistamines, corticosteroids

20
Q

seborrheic dermatitis

A

eczema develops in areas where skin is oily

adults btw 30-60

tx w steroids, calcineurin inhibitors, antifungals, shampoos if scalp involvement

21
Q

corticosteroids MOA

A

regulate genes/protein synthesis
decrease synthesis of histamine, kinins, lysosomal enzymes, prostaglandins, leukotrienes
decrease edema/erythema/pruritis by inhibiting migration of macrophages and leukocytes

not used for rosacea

22
Q

topical corticosteroids

A

admin 2x/day max
drug holiday
do not use for >4 weeks

AE - skin atrophy, acne, rosacea, HPA-axis suppression, hyperglc, development of cushingoid features, tachyphylaxis, rebound flare

children monitoring - adrenal function tests, adults >50g/week high potency, BG

23
Q

antihistamines

A

indicated for pruritus
H1 blockers

AE - anticholinergic, sedation
2nd gen - less CNS sedation

oral and topical

24
Q

psoriasis

A

lifelong, chronic, autoimmune, inflammatory disease

not fully understood mechanism

skin w raised white-to-silver scales with underlying erythema

clinical diagnosis

types - plaque (80%), guttate (trunk), inverse (armpit, groin), pustular, erythrodermic (everywhere, rare)

psoriatic arthritis - lesions on hands/feet/joints

25
Q

psoriasis treatment

A
topical, then systemic therapy
topical steroids, retinoids, vitamin D3 derivatives
phototherapy
methotrexate, cyclosporine
biologics
26
Q

calcipotriene

A

vitamin D3 derivative
topical used for plaque-psoriasis w moderate severity
cream/ointment

admin 1-2x/day

AE - hypercalcemia, kidney stones, irritation, contact dermatitis, photosensitivity

improvement seen in 2 weeks - 8 weeks

27
Q

tazarotene

A

topical retinoid used for cutaneous manifestations of psoriasis

AE - peeling, erythema, edema, photosensitivity

28
Q

acitretin

A

oral retinoid used for cutaneous manifestations of psoriasis (especially pustular form)

25-50 mg QD w food
duration of therapy 6 mos

half life days long!

CI in breastfeeding/PREGNANCY (REMS program), no use w methotrexate, no alcohol use

AE - dry skin, hepatotix, hypertriglyceridemia, photosensitivity, chelitis

rarely rarely used

29
Q

methotrexate

A

inhibits dihydrofolate reductase

used for psoriasis at low doses
7.5-15 mg/week

check CrCl - CI if <30

AE - anemia, leukopenia, hepatotox, GI, N/V, pulm toxicity

CI - pregnancy, renal impair, cirrhosis, leukopenia/thrombocytopenia

30
Q

calcineurin inhibitors

A

pimecrolimus & tacrolimus used for psoriasis

interrupt inflammatory process by inhibiting T cells, langerhans cells, mast cells, keratinocytes

2-3 weeks for clinical effect

BID, no occlusive dressings BBW for long-term use

local AE, CYP3A4

31
Q

biologic agents

A

used for psoriasis and psoriatic arthritis

immune modulators - inhibit T cell activation and alter immune response, block activity of inflammatory cytokines

less systemic immunosuppression

monitor baseline PPD, CBC w diff, hep B/C

32
Q

topical ectoparasiticides

A

permethrin, ivermectin - indicated for topical scabies or head lice

neurotoxin

AE - burning, stinging, puriritis

33
Q

imiquimod

A

anti-viral indicated for genital warts, actinic keratosis, superficial basal cell carcinoma

34
Q

sinecatechins

A

antioxidant, antiviral, antiangiogenic, proapoptotic and immunomodulator

indicated for genital wards

more effective than imiquimod

35
Q

topical antifungals

A

polyenes - nystain

azoles

allyamines