derm Flashcards
first line therapy for acne
benzoyl peroxide 2.5%
antibacterial for P acnes
benzoyl peroxide teaching
start with less potent
may cause bleaching of fabric
topical antibiotics for acne info
clindamycin 1% preferred, dapsone
gels, creams, ointments, foams
photosensitivity
clinical improvement in 4-8 weeks
dapsone
inhibits dihydrofolic acid in bacteria; anti-inflammatory
topical AEs, orange/brown discoloration
12 weeks for effect
retinoids
vitamin A derivatives
bind to retinoid receptors & turn on genes that promote keratinocyte differentiation
topical AEs - photosensitivity
tretinoin - no use w BP
azalaic acid
cream/foam/gel
Qweek, 2x/week
use for post-inflammatory dyspigmentation
local AEs
oral antibiotics for acne
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
doxycycline teaching
take with water on empty stomach
avoid admin with other ions
AE - teeth staining, GI discomfort, photosensitivity
avoid in pregnancy, children <8
isotretinoin
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
isotretinoin dosing
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
isotretinoin AEs
CYP2C9, 3A4, 2B6
dry skin, cheilitis (lips), hypertriglycerideia, leukopenia, photosensitivity, depression
monitor lipids/LFTs
avoid in breast feeding/teratogenic!!!
mild acne regimen
benzoyl peroxide or BP with topical abx (clindamycin/erythromycin)
moderate/severe ance regimen
BP w topical retinoid ando/or systemic antibiotic
comedal acne regimen
topical retinoids only
inflammatory/nodular (cystic) acne regimen
topical retinoid w oral abx
combination therap
atopic dermatitis
most common type of eczema - presents in childhood
atopic dermatitis treatment
low potency topical steroids
crisaborole - non-steroids PDE4 inhibitor 2% ointment
dupilumab
dupilumab
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
contact dermatitis
eczema related to contact w specific substance
tx w antihistamines, corticosteroids
seborrheic dermatitis
eczema develops in areas where skin is oily
adults btw 30-60
tx w steroids, calcineurin inhibitors, antifungals, shampoos if scalp involvement
corticosteroids MOA
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
topical corticosteroids
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
antihistamines
indicated for pruritus
H1 blockers
AE - anticholinergic, sedation
2nd gen - less CNS sedation
oral and topical
psoriasis
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
psoriasis treatment
topical, then systemic therapy topical steroids, retinoids, vitamin D3 derivatives phototherapy methotrexate, cyclosporine biologics
calcipotriene
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
tazarotene
topical retinoid used for cutaneous manifestations of psoriasis
AE - peeling, erythema, edema, photosensitivity
acitretin
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
methotrexate
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
calcineurin inhibitors
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
biologic agents
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
topical ectoparasiticides
permethrin, ivermectin - indicated for topical scabies or head lice
neurotoxin
AE - burning, stinging, puriritis
imiquimod
anti-viral indicated for genital warts, actinic keratosis, superficial basal cell carcinoma
sinecatechins
antioxidant, antiviral, antiangiogenic, proapoptotic and immunomodulator
indicated for genital wards
more effective than imiquimod
topical antifungals
polyenes - nystain
azoles
allyamines
