Derm 2 Flashcards
Corticosteroids
- _____ effects on epidermis
- MOA in diseases w/ increased cell turnover such as ____.
- Minimally absorbed following application to _____ skin.
- Occlusion w/ plastic wrap leads to ____ increase in absorption.
- Penetration increases in ____ skin such as ____ and exfoliative diseases.
- Antimitotic
- psoriasis
- normal
- ten-fold
- inflamed skin / atopic dermatitis
Corticosteroid Selection
- ____ are used for severe dermatoses over non-facial and non-intertriginous areas (scalp, palms, soles, thick plaques on extensor surfaces)
Super high potency (class 1)
Corticosteroid Selection
- ______ are appropriate for mild to moderate non-facial and non-intertriginous areas
- Are okay to use on flexural surfaces for limited periods
Medium to high potency (class 1, 2, 3, 4, 5)
Corticosteroid Selection
- ______ can be used for large areas and on thinner skin
- Face, eyelid, genital, intertriginous areas
Low potency (class 6 & 7)
What duration of therapy for Super High Potency Corticosteroids?
< 3 weeks
What duration of therapy for medium - high potency corticosteroids?
< 6 - 8 weeks
What duration of therapy for low potency corticosteroids?
1 - 2 weeks to avoid skin atrophy, telangiectasia, and steroid induced acne
(SE are rare)
- What class of corticosteroid?
- Which potency?
- Duration
- Location
- Clobetasol proprionate cream or ointment
- Class 1
- Super High Potency
- Tx for < 3 weeks
- Scalp, palms, soles, thick plaques on extensor surfaces
- What class of corticosteroid?
- Which potency?
- Duration
- Location
Betamethasone diproprionate cream
Fluocinomide cream, gel, ointment, solution
- Class 2
- Medium - high
- < 6-8 weeks
- non-facial / non-intertriginous areas
- okay on flexural surfaces for limited periods)
- What class of corticosteroid?
- Which potency?
- Duration
- Location
Betamethasone diproprionate cream
Betamethasone diproprionate lotion
Betamethasone valerate ointment
- Class 3
- Medium - high
- < 6 - 8 weeks
- non-facial and non-intertriginous areas
- Okay to use on flexural surfaces for limited periods
- What class of corticosteroid?
- Which potency?
- Duration
- Location
Fluocinolone acetonide ointment
Triamcinolone acetonide cream or ointment
- Class 4
- Medium - high
- < 6 - 8 weeks
- non-facial and non-intertriginous areas
- Okay to use on flexural surfaces for limited periods
- What class of corticosteroid?
- Which potency?
- Duration
- Location
Fluocinolone acetonide cream
- Class 5
- Medium - high
- < 6 - 8 weeks
- non-facial and non-intertriginous areas
- Okay to use on flexural surfaces for limited periods
- What class of corticosteroid?
- Which potency?
- Duration
- Location
Triamcinolone acetonide cream
- Class 6
- Low Potency
- 1 - 2 weeks
- Large areas / thinner skin
- face, eyelid, genital, intertrignous areas
- What class of corticosteroid?
- Which potency?
- Duration
- Location
Hydrocortisone ointment
- Class 7
- Low Potency
- 1 - 2 weeks
- Large areas / thinner skin
- face, eyelid, genital, intertrignous areas
What are the 5 “Systemic” SE of Topical Glucocorticoid Therapy?
- Suppression of hypothalamic-pituitary-adrenal axis
- Cushing’s Syndrome
- Pseudotumor cerebri
- Growth retardation
- Sodium retention and edema
What are the 5 “Ocular” SE of Topical Glucocorticoid Therapy?
- Cataract
- Glaucoma
- Retarded healing of corneal abrasion
- Extension of herpetic infection
- Increased susceptibility to bacterial and fungal infection
What are the 7 “Cutaneous” SE of Topical Glucocorticoid Therapy?
- Atrophy (both epidermal and dermal)
- Striae distensae
- Telangiectasias, purpura (senile type) and ecchymosis
- Hypopigmentation
- Retardation of wound healing
- Contact allergic dermatitis - glucocorticoid-induced (rare), vehicle-induced (common)
- Topical glucocorticoid “habituation”
Contact dermatitis
- Allergic contact dermatitis to new eye shadow.
- What is the treatment?
- Desonide 0.5% cream (topical corticosteroid) for limited period
Twice daily for 1 week, followed by once daily for 1-2 weeks, then discontinue
Dermatitis of Eyelid
Which drug?
- Too potent, class 1
Clobetasol ointment 0.05%
Dermatitis of Eyelid
Which drug?
- Too potent, gels have alcohol and may burn on the eyelid, class 2
Flucoinonide gel 0.05%
Dermatitis of Eyelid
Which drug?
- treats fungal infection
Ketoconazole cream 2%
What are the 7 different antibacterial agents?
- Bacitracin
- Mupirocin
- Polymyxin B
- Neomycin
- Gentamicin
- Topical abx in acne
- Oral abx in acne
Which antibacterial agent?
- Active against gram + organisms (Strep, staph, pneumo)
- Compounded in an ointment base alone or in combo w/ neomycin, polymyxin B, or both
- Poorly absorbed through skin
- systemic toxicity is rare
- allergic contact dermatitis is frequent (neomycin most likely)
Bacitracin
Which Antibacterial Agent?
- Active against gram + infections (MRSA)
- ADE: stinging, burning, pruritis, HA
- Cream or ointment
Mupirocin
What makes up the Triple Antibiotic Ointment?
- Polymyxin B
- Neomycin
- Bacitracin
Which drug in the TAO? (Triple Antibiotic Ointment)
- Effective against gram negative organisms
- p aeruginosa
- Enterobacter
- E. coli
Polymyxin B
Which drug in the TAO? (Triple Antibiotic Ointment)
- Active against aerobic Gram Positive and Gram Negative Bacilli
- S aureus
- E. coli
- Sensitization as high as 30% (contact dermatoses)
Neomycin (an aminoglycoside)
Which drug in the TAO? (Triple Antibiotic Ointment)
- Primarily active against the Gram Positive bacteria
- S aureus
- streptococci
Bacitracin
What severity of acne?
- <20 comedones
- <15 inflammatory lesions
- <30 total lesions
Mild
What severity of acne?
- 20-100 comedones
- 15-50 inflammatory lesions
- 30-125 total lesions
Moderate
What severity of acne?
- >5 cysts
- >100 total comedone count
- >50 total inflammatory lesion count
- >125 total lesions
Severe
Tx for comedones
Tretinoin
Tx for mild inflammatory acne
- topical retinoid alone
- topical benzoyl peroxide alone
- and/or topical abx
Tx for moderate acne?
- Topical Retinoid + Topical Benzoyl Peroxide
- +/- topical abx
-
Consider
- oral abx
- derm referral
- hormonal therapy for females
Tx for severe acne
- Topical Retinoid + Topical Benzoyl Peroxide + Oral Abx
- +/- topical abx
-
Consider:
- oral isotretinoin
- derm referral
- hormonal therapy for females
Tx for Cystic Acne
Intralesional triamcinolone
Benzoyl Peroxide is converted to ____ within the epidermis and dermis.
Benzoic Acid
- What are the 2 topical abx for mild to mod inflammatory acne?
- What are the 2 topical abx for Rosacea?
- Mild to Mod inflammatory Acne: Clindamycin & Erythromycin
- Rosacea: Metronidazole & Sulfacetamide
