derm

Question 1

first line therapy for acne

Answer 1

benzoyl peroxide 2.5%

antibacterial for P acnes

Question 2

benzoyl peroxide teaching

Answer 2

start with less potent

may cause bleaching of fabric

Question 3

topical antibiotics for acne info

Answer 3

clindamycin 1% preferred, dapsone

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

Question 4

dapsone

Answer 4

inhibits dihydrofolic acid in bacteria; anti-inflammatory

topical AEs, orange/brown discoloration

12 weeks for effect

Question 5

retinoids

Answer 5

vitamin A derivatives

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

topical AEs - photosensitivity

tretinoin - no use w BP

Question 6

azalaic acid

Answer 6

cream/foam/gel
Qweek, 2x/week

use for post-inflammatory dyspigmentation

local AEs

Question 7

oral antibiotics for acne

Answer 7

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

Question 8

doxycycline teaching

Answer 8

take with water on empty stomach
avoid admin with other ions

AE - teeth staining, GI discomfort, photosensitivity

avoid in pregnancy, children <8

Question 9

isotretinoin

Answer 9

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

Question 10

isotretinoin dosing

Answer 10

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

Question 11

isotretinoin AEs

Answer 11

CYP2C9, 3A4, 2B6

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

monitor lipids/LFTs

avoid in breast feeding/teratogenic!!!

Question 12

mild acne regimen

Answer 12

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

Question 13

moderate/severe ance regimen

Answer 13

BP w topical retinoid ando/or systemic antibiotic

Question 14

comedal acne regimen

Answer 14

topical retinoids only

Question 15

inflammatory/nodular (cystic) acne regimen

Answer 15

topical retinoid w oral abx

combination therap

Question 16

atopic dermatitis

Answer 16

most common type of eczema - presents in childhood

Question 17

atopic dermatitis treatment

Answer 17

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

Question 18

dupilumab

Answer 18

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

Question 19

contact dermatitis

Answer 19

eczema related to contact w specific substance

tx w antihistamines, corticosteroids

Question 20

seborrheic dermatitis

Answer 20

eczema develops in areas where skin is oily

adults btw 30-60

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

Question 21

corticosteroids MOA

Answer 21

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

Question 22

topical corticosteroids

Answer 22

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

Question 23

antihistamines

Answer 23

indicated for pruritus
H1 blockers

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

oral and topical

Question 24

psoriasis

Answer 24

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

Question 25

psoriasis treatment

Answer 25

``` topical, then systemic therapy topical steroids, retinoids, vitamin D3 derivatives phototherapy methotrexate, cyclosporine biologics ```

Question 26

calcipotriene

Answer 26

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

Question 27

tazarotene

Answer 27

topical retinoid used for cutaneous manifestations of psoriasis AE - peeling, erythema, edema, photosensitivity

Question 28

acitretin

Answer 28

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

Question 29

methotrexate

Answer 29

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

Question 30

calcineurin inhibitors

Answer 30

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

Question 31

biologic agents

Answer 31

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

Question 32

topical ectoparasiticides

Answer 32

permethrin, ivermectin - indicated for topical scabies or head lice neurotoxin AE - burning, stinging, puriritis

Question 33

imiquimod

Answer 33

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

Question 34

sinecatechins

Answer 34

antioxidant, antiviral, antiangiogenic, proapoptotic and immunomodulator indicated for genital wards more effective than imiquimod

Question 35

topical antifungals

Answer 35

polyenes - nystain azoles allyamines