Derm Flashcards
what are 5 clinical uses of topical corticosteroids?
atopic dermatitis
seborrheic dermatitis
allergic and nonallergic dermatitis
eczema
psoriasis
what are the MOA of topical steroids?
inhibition of phospholipase A2
decreases leukocytes and cytokines
antimitotic- reduces cell turnover
vasoconstrictive properties
low potency topical steroids are indicated for what areas and what populations?
face and intertriginous areas in any pop.
infants, children, and elderly
what strength are these topical steroids?
hydrocortisone
hydrocortisone acetate
triamcinolone acetonide (0.025%)
low potency
medium potency topical steroids are indicated for use in what population/ areas?
adults for the majority of areas
what strength are these topical steroids?
hydrocortisone valerate
mometasone furoate
betamethasone valerate
triamcinolone acetonide (0.1%)
medium potency
when are topical high potency steroids indicated?
palms and soles
adults with thick plaques not resopnding to low potency
what type of strength are these topical steroids?
fluocinonide
betamethasone dipropionate (0.05%) cream
triamcinolone acetonide (0.5%)
high potency
what type of strength of topical steroid are these?
betamethasone dipropionate (0.05%) ointment
clobetasol propionate (0.05%)
very high potency
does normal or inflamed skin have more absorption?
inflamed skin
are ointments or creams better for topical steroid penetration?
typically ointments
what are some ADRs of topical steroids?
tachyphylaxis (tolerance)
skin atrophy
rosacea, dermatitis, acne
secondary skin infection
what are systemic ADRs of topical steroid use?
iatrogenic cushing’s disease (buffalo hump, moon face)
PUD
myopathy, cataracts, glaucoma
this type of vehicle for topical steroids should be used for thick, lichenified lesions
ointment
this type of vehicle for topical steroids should be used for acute and subacute dermatoses and can be used on moist skin and intertriginous areas
creams
these vehicles for topical steroids should be used where a non-oil vehicle is needed
solutions
gels
sprays
these medications are indicated for mild non-inflammatory acne vulgaris
topical retinoid or salicylic acid QHS
if no improvement in 2-3mo, add topical abx
this tx is indicated for mild inflammatory acne vulgaris
benzoyl peroxide in AM, may use with abx
if no improvement in 2-3mo, add oral abx
this tx is indicated for moderate non-inflammatory acne vulgaris
topical retinoid QHS
if no improvement in 2-3mo, add topical abx
this tx is indicated for moderate inflammatory acne vulgaris
topical retinoid QHS
topical abx w/ benzoyl peroxide AM
oral abx
this tx is indicated in hormone related acne vulgaris in non-pregnant females
oral contraceptive
topical retinoid QHS
inflammatory- oral abx w/ benzoyl peroxide
this tx is indicated for severe cystic or nodulocystic acne vulgaris
derm referral
oral abx + topical retinoid
what is the clinical use of topical salicylic acid?
mild noninflammatory acne
what is the MOA of salicylic acid?
keratolytic agent
softens tissue
may dissolve protein that keep stratum corneum together
>6% destructive and used for corn/ wart removal
ADRs of salicylic acid
skin irritation
photosensitivity
allergic rxn (cross sensitivity with aspirin)
is salicylic acid more or less effective than topical retinoids?
less effective
what is the clinical use of topical retinoids?
mild to severe non-inflammatory and inflammatory acne
what are 3 examples of topical retinoids?
tretinoin- Retin-A
adapalene- Differin
tazarotene- Tazorac
what is the MOA of retinoids?
keratolytic agents
derivative of vitamin A
opens up closed comedones
ADRs of topical retinoids
skin irritation
photosensitivity
teratogenicity (causes fetal abnormalities)
clinical use of benzoyl peroxide includes what?
mild to moderate inflammatory acne
adjunct with topical or oral abx
rosacea
MOA of topical benzoyl peroxide
lipophilic oxidizing agent- releases free radicals (oxidizes bacterial proteins)
peeling and comedolytic effects
ADRs of benzoyl peroxide
bleaching agent
skin irritation (2% just as effective as 10%)
allergic contact dermatitis
inactivation of topical retinoids
clinical uses of topical azelaic acid
post-inflammatory hyperpigmentation
rosacea
alternative to topical abx or benzoyl peroxide
MOA of topical azelaic acid
antimicrobial activity against P. acnes
mild anti-inflammatory properties
inhibits effect of conversion of testosterone to dihydrotestosterone
ADRs of topical azelaic acid
skin irritation
hypopigmentation
hypertrichosis
topical abx may be used in combo with corticosteroids for what 3 instances?
secondarily infected dermatosis
diaper dermatitis
otitis externa
this antimicrobial agent can be used in nares to decrease staph, is poorly absorbed, and can be used as ointment alone or in combo with polymyxin B
bacitracin
what type of bacterial does bacitracin target
G+: strep, pneumo, staph
most anaerobes: neisseriae, tetanus, diptheria bacilli
what type of bacteria does polymyxin B sulfate target?
G- : pseud, e coli, enterobacter, kleb
resistant: most proteus and serratia
this antimicrobial agent should be avoided in pts with sulfa allergies and can be used alone or in combo
polymyxin B sulfate
what type of bacteria does neomycin target?
G- : e coli, proteus, kleb, entero
this antimicrobial agent is an aminoglycoside and should be avoided if possible (25% have allergic rxn) and is usually used in combo
neomycin
this antimicrobial agent targets G+ bacteria including MRSA
mupirocin
this abx is a tx for impetigo and usually is in a polyethylene glycol vehicle
mupirocin
what type of bacteria does clindamycin target?
p. acnes
this abx is used for mild to moderate inflammatory acne, lotion and gel is better than the foam, and can be used solo or in combo
clindamycin
this abx is used for mild to moderate inflammatory acne and the water-based gel is less irritating
erythromycin
this medication is used to tx rosacea and some rat studies show some carcinogenic effects so it should be avoided in pregnant women
metronidazole
this topical antifungal can be used as vaginal cream or suppositories for vulvovaginal candidiasis
miconazole (monistat)
this topical antifungal can be used as vaginal cream or tablets
clotrimazole (lotrimin)
this topical antifungal can be used:
cream- dermatophytosis and candidiasis
shampoo- foam for seborrheic dermatitis
ketoconazole (nizoral)
this topical antifungal targets c. albicans and is used for thrush, diaper rash, and vaginitis
nystatin
what are 3 clinical uses of imiquimod (aldara) which is a topical immunomodulator?
genital and perianal warts
actinic keratoses on face and scalp
basal cell carcinoma on trunk, neck, and extremities
how to apply imiquimod for warts
apply 3x a week and wait 6-10 hrs before washing off
how to apply imiquimod for actinic keratoses
apply 2x a week and wash off 8 hrs later
what are 2 common ectoparasiticides?
permethrin
ivermectin
tx for pityriasis/ tinea versicolor
selenium sulfide (selsun blue)
tx for nipple irritation due to breastfeeding
lanolin
tx for nipple fissures
mupirocin
betamethason
clotrimazole
