Derm 4 Flashcards
What 3 agents reduce hyperpigmentation of the skin?
- Hydroquinone
- Mequinol
- MBEH (monobenzyl ether of hydroquinone)
How do these reduce hyperpigmentation?
- Hydroquinone
- Mequinol
- MBEH (monobenzyl ether of hydroquinone)
Inhibit tyrosinase, interfering with the biosynthesis of melanin
Temporary lightening
- Can be combined w/ tretinoin or glycolic acid to speed up lightening
- Hydroquinone
- Mequinol
Irreversible depigmentation
- May cause hypopigmentation at sites distant from the area of application
MBEH (Monobenzyl ether of hydroquinone)
What 2 agents help w/ reducing hypopigmentation?
Psoralens
- Trioxsalen
- Methoxypsoralen
What drugs?
- Repigmentation of depigmented macules of vitiligo
- Photo-activated by UVA light
- Topical or oral psoralen
- Risks of psoralen photochemotherapy
- Cataracts and skin cancer
Psoralens
- Trioxsalen
- Methoxypsoralen
What are the 2 topical medications against sunlight?
- Sunscreens
- Sunblock
Which med against sunlight?
•Contain chemical compounds that absorb ultraviolet light
Sunscreens
Which med against sunlight?
•Contain opaque materials such as titanium dioxide that reflect light
Sunblock
What are the 3 classes of compounds used in sunscreens?
-
p-aminobenzoic acid (PABA) and its esters
- Most effective available absorbers in the B region
-
benzophenones
- Oxybenzone, dioxybenzone, and sulisobenzone
-
dibenzoylmethanes
- Avobenzone
Sunscreens
- SPF really only measures ___ protection
- What chemical should you look for in sunscreen? (has complete UVA coverage)
- ____ by L’Oreal was recently FDA approved and has better UVA/UVC coverage than ____
- Apply __ mins before going out and replace every __ hours
- UVB
- Parsol 1789 or Avobenzone
- Mexoryl (Antheliose)
- 20 / 2
Broad spectrum sunscreens add what 3 things?
- Oxybenzone
- or
- Avobenzone
- and
- Mexoryl
What is a new proposed sunscreen rating system?
- UVA protection: 1-4 stars* (low/medium/high/very high protection)
Sunblocks
- Contain ____ or ____
- NO chemical rxn required to work (can go out immediately after application)
- Not as good ___ coverage as sunscreen
- Need to reapply ever __ hours
- Apply large amounts to assure good coverage
- zinc oxide paste / titanium dioxides
- UVA
- 2
_____ refers to the the process of breaking down or dissolving keratin. The result is a softening of the stratum corneum of the epidermis promoting peeling
Keratolytic / Destructive Agents
What are the 5 Keratolytic / Destructive Agents?
- Salicylic acid
- Urea
- Podophyllum resin & podophyllotoxin
- Fluorouracil
- Aminolevulinic acid (ALA)
Which Keratolytic / Destructive Agent?
- Used in as a keratolytic agent
- Concentrations of 3-6%
- Greater than 6%, destructive to tissues
- Used in acne treatment, psoriasis, warts
- Care must be exercised when using the drug on the extremities of diabetics or patients with peripheral vascular disease
Salicylic Acid
Which Keratolytic / Destructive Agent?
- Softening and moisturizing effect on the stratum corneum
- Makes creams and lotions “feel less greasy”
- Humectant (increases water content of the stratum corneum) , used in concentrations of 2-20% in creams and lotions
- Carmol 10, Nutraplus
- Keratolytic agent, 20% concentration and greater
- Hyperkeratosis of palms and soles
- Carmol 20
- Concentrations of 30-50% useful in softening the nail prior to avulsion
Urea
Which Keratolytic / Destructive Agent?
- Major use of ______ - condyloma acuminatum
- Application should be restricted to wart tissue only
- Cytotoxic agent with specific affinity for mitotic spindle
- Normal assembly of the spindle is prevented and epidermal mitoses are arrested
- Wash off the preparation 2-3 hours after initial application
- Contraindicated during pregnancy
Podophyllum Resin & Podophyllotoxin
Which Keratolytic / Destructive Agent?
- Used topically for actinic keratoses
- Erythema, vesiculation, erosion, superficial ulceration, necrosis, and reepithelialization
- Healing process continues for 1-2 months after therapy is discontinued
- Excessive exposure to sunlight during treatment increases the intensity of the reaction
Fluorouracil
What are the 5 drugs used for warts?
- Salicylic acid
- Topical retinoids
- Podophyllum resin
- Imiquimod
- Trichloroacetic acid
(Pretty TITS)
Which drug for warts?
- Activates immune cells through the toll-like receptor 7 (TLR7)
- Secrete cytokines (primarily interferon-α (INF-α), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α)
- Used for treatment of warts (FDA approved condylomata), actinic keratoses, basal cell and squamous cell carcinoma and lentigo maligna melanoma
Imiquimod
Which drug for warts?
- Condylomata
- Caution: Serious injuries, including skin damage, burns, swelling, and pain may occur following improper application
Trichloroacetic Acid
- What are agents for hair growth called?
- What are the 3 agents called?
Trichogenic Agents
- Topical minoxidil (Rogaine)
- Finasteride (Propecia)
- Bimatoprost (Latisse)
Which Trichogenic Agent?
- Reversing the progressive miniaturization of scalp hairs in androgenic alopecia
- Vertex balding is more responsive to therapy than frontal balding
•MOA: Stimulation of hair growth is secondary to vasodilation, increased cutaneous blood flow, and stimulation of resting hair follicles.
- The effect is not permanent
- Cessation will lead to hair loss in 4-6 months
Topical minoxidil (Rogaine)
Which Trichogenic Agent?
Blocks production of dihydrotestosterone
- Oral finasteride, 1 mg/d
- Promotes hair growth
- Prevents further hair loss in many men with androgenic alopecia
- Not for use in women of child-bearing age
- Treatment for at least 3-6 months is necessary
- Adverse effects include: decreased libido, ejaculation disorders, and erectile dysfunction.
Finasteride (Propecia)
Which Trichogenic Agent?
- Prostaglandin analogue
- Eyelashes
- Adverse effects: red or itchy eyes, skin pigmentation, permanent brown pigmentation of iris
Bimatoprost (Latisse)
What is the name of the Anti-Trichogenic Agent?
Eflornithine
Anti-trichogenic Agent - Eflornithine
- Irreversible inhibitor of _____ that catalyzes the biosynthesis of _____.
- _____ required for cell division
- (affects rate of hair growth)
- Effective in reducing _____ in 30% of women when applied twice daily for ___ months
- Return to pre-treatment levels __ weeks after discontinuation.
- ornithine decarboxylase / polyamines
- Polyamines
- facial hair growth / 6 months
- 8 weeks
Treatment for Psoriasis
- _____ psoriasis is most common
- Well demarcated erythematous plaques with overlying _____.
- ____ plaque psoriasis is typically symmetric & bilateral
- Plaques may exhibit ____ (bleeding after removal of scale)
- _______ (lesions induced after trauma)
- Initial tx is generall ______
- ______.
- Plaque
- silvery scale
- Chronic
- Auspitz sign
- Koebner phenomenon
- High potency topical steroid
- Phototherapy
Which Topical drug for Psoriasis?
- Vitamin D3 analog
- Cream, ointment or scalp solution
- Rare reports of hypercalcemia
- May be used in combination with topical steroids or in rotation
Dovonex
Which Topical drug for Psoriasis?
- Liquor carbonis detergens (LCD) and liquor picis carbonis (LPC)
- Shampoo, soap and ointment
- Treatment for dandruff and psoriasis
- Denorex, Balnetar, Tegrin, T/Gel, and Neutar
Tars
Which Topical drug for Psoriasis?
- Binds to beta and gamma retinoid receptors
- Topical synthetic retinoid general prescribed with topical corticosteroids
- ADE-skin irritation, photosensitivity
- Topical Retinoid
Tazarotene
Which systemic drug for Psoriasis?
•Binds to alpha, beta and gamma retinoid receptors—inhibits expression of IL-6 (proinflammatory cytokine)
•MUST NOT be used by women who are pregnant or may become pregnant while undergoing treatment or at any time for at least 3 years after treatment is discontinued
- Ethanol MUST be strictly avoided during treatment with acitretin and for 2 months after discontinuing therapy
- Patients MUST NOT donate blood during treatment and for 3 years after acitretin is stopped
Retinoid metabolite
- Acitretin
Which systemic drug for Psoriasis?
- Phosphodiesterase-4 enzyme inhibitor
- decreases intracellular levels of cAMP
- Decreases expression of inflammatory mediators
- Such as IL-23, TNF-ɑ, nitric oxide synthase
ADEs
- Diarrhea
- Nausea
- URI
Apremilast
Which systemic drug for Psoriasis?
- Folate antagonist
- Prevents the action of folic acid on cellular function
- 2.5mg and 10mg tablets and solution for injection
- 15 mg Weekly, but can vary
- Single or divided dose
Contraindications
- Avoid in pregnancy and breastfeeding (category X)
- Males are advised not to father children while on MTX or for at least 3 months afterwards
Methotrexate
Which systemic drug for Psoriasis?
- Should not be taken by patients with low blood counts (anemia, leukopenia, thrombocytopenia)
- Not for patients with severe liver disease
- Controversy about liver biopsy at accumulated 1.5 gm
- Use with caution in patients with mild liver disease, kidney disease (CrCl < 50ml/min), infections, obesity or diabetes.
•Labs:
CBC, LFTs, Creatinine, Chest Xray
Methotrexate
What are the 2 types of Biologic Agents for Psoriasis?
-
Tumor necrosis factor alpha (TNF alpha) blockers
- Enbrel
- Humira
- Remicade
- Simponi
- Blocks excess cytokine
-
Interleukin 12/23
- Stelara
- associated w/ psoriasis inflammation
Which Biologic Agent for Psoriasis?
- Injected in legs, abd, arms typically by individual or family member
- Enbrel
- Humira
- Simponi
Which Biologic Agent for Psoriasis?
- Subcutaneous injection by health care provider
Stelara
Which Biologic Agent for Psoriasis?
- IV infusion in office or infusion center
- Half life: 9 days
- Antibody
Remicade
3 contraindications for Biologic Agents for Psoriasis
- Immunocompromised
- Active infection
- Screen for tuberculosis (TB)
2 risks of using biologic agents in Psoriasis
- Increase risk of infection
- Impact on developing fetuses or nursing infants is not known…
3 common side effects of biologic agents for psoriasis
- Respiratory infections
- Flu-like symptoms
- Injection site reactions
Rare Side Effects of Biologic Agents for Psoriasis
-
Serious nervous system disorders
- MS, szs, optic neuritis
- Hemolytic anemia
- Lymphoma
Onset of benefit for immunotherapy / biologic agent?
(Humira, Enbrel, Remicade)
2 - 4 weeks
Which Biologic Agent for Psoriasis?
- Half life: 5 days
- Receptor
Enbrel
Which Biologic Agent for Psoriasis?
- Half life: 12-14 days
- Antibody
Humira
SE of which Immunotherapy?
- Injection site rxns, URI (colds, sinusitis, bronchitis)
Humira & Enbrel
SE of which Immunotherapy?
- Infusion rxns (itching, hives, rash, nausea, HA)
- URI (colds, sinusitis, bronchitis)
Remicade
