Derm Flashcards
How does regional variation determine the potency you choose in dermatology?
lighter potency in more sensitive areas like skin and groin, and heavier potency in areas like forearm and palm
When someone displays resistance to your first line therapy, what do you do?
increase concentration
What is a vehicle?
substance that carries a drug to the skin to help treat skin conditions. ointment, cream, lotion, gels, powders, pastes
What helps maximize efficacy?
occlusion – plastic wrap, mittens/socks
What are low potency topical corticosteroids?
hydrocortisone (hytone, cortizone), hydrocortisone acetate (cortaid), triamcinolone acetonide (aristocort, kenalog)
What are medium potency topical corticosteroids?
hydrocortisone valerate (westcort), mometasone furoate (elocon), betamethasone valerate (valisone), triamcinolone acetonide (aristocort, kenalog)
What are high potency topical corticosteroids?
fluocinonide (lidex), betamethasone dipropionate (diprosone, maxivate), triamcinolone acetonide (aristocort, kenalog)
What are very high potency topical corticosteroids?
betamethasone dipropionate (diprolene) ointment, clobetasol propionate (temovate, olux)
What are low potency topical steroids used for?
face and groin, children
What are medium potency topical steroids used for?
most adults for majority of areas
What are high potency topical steroids used for?
thick plaques not responding to treatment, palms and soles
When are topical steroids recommended?
atopic dermatitis, eczema, seborrheic dermatitis, contact dermatitis, psoriasis
“inflammation”
What’s the MOA of corticosteroids?
depress formation, release, and activity of chemical mediators of inflammation (induction of ph.A), decreases leukocytes, suppresses cytokines , vasoconstrictive…
Why do topical steroids only work on inflammation?
absorption markedly increased in inflamed skin
What are ADRs of topical steroids?
tachyphylaxis, rapid tolerance, can do one week on, one week off. skin atrophy, striae, common skin conditions caused by steroidal use
What are ADRs of topical corticosteroids that are systemic?
iatrogenic cushing’s syndrome – weight gain, “Buffalo hump” “moon face”, HTN, hypokalemia, hyperglycemia, osteoporosis, ulcers, muscle weakness, cataracts or glaucoma
What is preferred for infants and elderly patients?
low potency agents
When should you use topical steroid ointments?
for thick, lichenified lesions to enhance penetration
When should you use topical steroid cream?
acute and subacute dermatoses; moist skin, intertriginous areas
When should you use topical steroid gels, solutions, or sprays?
scalp or non-oil based vehicles needed
How long should very high potency steroid agents be used?
no longer than 2-3 weeks
What is acne vulgaris treatment for mild non-inflam disease?
topical retinoid or salicyclic acid
without improvement, can add topical antibiotic
What is acne vulgaris treatment for mild inflammatory disease?
topical retinoid (adapalene) + BPO in AM or topical abx +BPO
no improvement, add oral abx
What is acne vulgaris for moderate disease?
topical retinoid + topical abx in AM + oral abx + BPO
What should you consider for hormone-related acne?
combined oral contraceptive and topical retinoid + oral abx + BPO for longer term
What should you do about severe acne vulgaris?
refer to derm
Oral abx + topical therapy
oral retinoid if all else fails
What is the MOA of salicylic acid?
Keralytic —- dissolve cell surface proteins that keep outermost epidermal layer intact, applied to whole treatment area
What are ADRs of salicylic acid?
skin irritation (limit area), photosensitivity, allergic reaction (note: not good for any aspirin allergies)
What is the MOA of topical retinoids?
Keratolytic: allowing treatment in, opens up comedones, aids in extraction
How are topical retinoids used?
entire affected area, do not use with alcohol or astringents
What are ADRs of topical retinoids?
skin irritation, photosensitivity (wear sunscreen), teratogenicity
What is the MOA of BPO?
lipophilic oxidizing agent – oxidizes bacterial proteins, active against p. acnes
When should you use BPO?
adjunct to topical and oral abx, more effective than either alone!
also acne rosacea
What are ADRs for BPO?
skin irritation, allergic contact dermatitis, inactivation of topical retinoids (apply at different times), bleaching agent
What is the MOA of azelaic acid (azelex)?
inhibits effect of conversion of testosterone to dihydrotesterone
When do you use azelaic acid (azelex)?
alternative to topical abx or BPO, less irritating but less effective
What are ADRs of azelaic acid?
skin irritation, hypopigmentation, vitiligo depigmentation, hypertrichosis
What are indications for topical antibacterials?
prevention in a clean wound, early treatment, reduce staph colonization, acne, combo with corticosteroids
What is bacitracin?
gram+, most anaerobes, Neisseriae, tetanus, diptheria, can be Neosporin or PolymyxinB
What is polymyxin B sulfate?
gram- (pseudomonas, e.coli, enterobacter, klebsiella), resistant to proteus and serratia and g+, avoid with sulfa allergy
What is neomycin?
gram-, generally avoid up to 25% have allergic reaction (redness in wound), found with polymyxin in Neosporin
What is mupirocin?
most g+ including MRSA, treats impetigo, intranasal, can be irritating
What is clindamycin?
fights p.acnes, mild to moderate cases, foam can be drying, lotion/gel is better tolerated
systemic reactions are rare
What is erythromycin?
mild to moderate cases of acne, unknown MOA, but can see resistance so stop and treat with oral abx
water based gel is less irritating
What is metronidazole?
anti-inflamm action common for rosacea, but maybe carcinogen. ADR=dryness, burning, cream is better
What do you use topical antifungals for?
treat superficial fungal infections, mostly candida
What are miconazole and clotrimazole?
miconazole (monistat) - cream, lotion, or suppositories
clotrimazole (lotrimin) - cream, lotion, vaginal cream/tablets stronger than niastatin
What is ketoconazole (nizoral)?
cream for dermatophytosis and candidiasis , shampoo for seborrheic dermatitis
What is clotrimazole-betamethasone dipropionate cream?
antifungal + corticosteroid = rapid symptomatic relief, very strong, “fungus on steroids”
What is nystatin?
prescription, narrow spectrum, swallowing treatment, may cause GI issues
What is imiquimod (aldara)?
genital and perianal warts, BCC on trunk/neck/extremities max 16 week use
What is permethrin?
Nix = lice, apply for 10 minutes and rinse or Elimite = scabies (leave on for 8-14 hours)
What is ivermectin?
sklice – 6 months and older, apply for 10 minutes then rinse
where is tinea corporis?
body
Where is tinea capitis?
head
Where is tinea cruris?
groin
Where is tinea pedis?
feet
Where is tinea unguium?
nail
What do you treat dermatophytes with?
-azoles, except nails – need stronger
What is the yeast that causes pityriasis/tinea versicolor?
malassezia furfur
What is the treatment for tinea versicolor?
selenium sulfide (selsun blue)
What is pruritus ani?
perianal itching and discomfort, from cycle of scratching, treat with high potency topical corticosteroids
What are treatments for breastfeeding?
lanolin (oil that is emollient action to condition skin), nipple fissure –> mupirocin, betamethasone, clotrimazole
