Derm Flashcards
- Types of secondary skin infections as a complication from a preexisting skin disorder and possible pathogens
- secondary infection of ulcer/skin abrasion
- bacterial superinfection of eczema
- surgical wound/laceration
- superinfection
- human/animal bite
- diabetic foot infection
- Caused by:
- staph aureus
- MRSA
- streptococci, enterococci, anaerobes
Goals of treatment of psoriasis
- Decrease size and thickness of plaques
- Decrease pruritus
- Improve emotional well-being and quality of life
- Put the patient in remission with minimal side effects
goal of therapy in acne
- minimize the number of new lesions
- treatment is mainly preventative
- we want to decrease the keratinization and decrease the proliferation of P.acnes
- can take months
When do you need to refer or admit a pt with an abscess or skin infection
after 2 rounds of antibiotics and they are not improving or are getting worse
- Ointments- more potent, penetrate stratum corneum better
- help moisturize and increase absorption
- Foams/lotions- hairy and large areas, spread better
- Cream- drying, good for wet rashes
A superficial fungal infection of nonliving, keratinized portions of the skin
Tinea
Caused by several dermatophytes with regional predominance
In the US
- Microsporum
- Trichophyton
- Epidermophyton
can be spread by direct contact or fomites such as clothing, linens, or gym mats
Flares of acne rosacea can be caused by ___
- alcohol
- spicy foods
- caffeine
- stress
Adverse effects of calcineurin inhibitors for eczema
- may burn with application
- a/e: viral infections such as HSV, molluscum, varicella, warts
- s/e: flu-like symptoms, allergic reaction, asthma, cough, fever, headache
Pregnancy cat C
1st line pharmacological treatment for atopic dermatitis (eczema)
Topical Steroids- anti-inflammatory and works on immune cells
Maximum duration for topical steroid use for adults and children
Adults- 2 weeks
Infants- 1 week
then take a break
Skin disorder caused by uncontrolled accelerated replication of the basal epidermal cells
- Causes redness, flaking, thickened patches (plaques)
- frequently have exacerbations and remissions
- silvery scale on extensor surfaces of the body
- knees, elbows
Psoriasis
condition that includes characteristics such as erythema, scaling, fissuring, may have vesicles or papules
can be located on AC, popliteal fossa, neck, wrists, ankles
is puritic (ITCHES bad)
Excema (atopic dermatitis)
MOA of topical antibiotics for acne
- two specific drug names
- reduce microbial colonization
- decrease inflammatory response
- Erythromycin and clindamycin
- best in combo with benzoyl peroxide
Cautions/ pt education on griseofulvin (antifungal) for tinea capitis and tinea corpois
- Teratogenic- men need to avoid fathering for atleast 6 months after completing treatment
- safe in peds 2 and older
- Take with dinner- butter, gravy, whole milk, icecream- fatty food cause better absorption
- can cause hepatotoxicity
- Monitor LFTs- baseline then 1-2 months later
- increases warfarin, decreases oral BC and barbiturates
- name of abscess or boil typically without any systemic manifestations
- name of abscess or boil that is large and frequently has systemic signs such as fever or swollen lymph nodes
- Furuncle
- Carbuncle
Factors that can make psoriasis worse
- Skin trauam
- medications
- lithium, antimalarials, beta blockers
- sunlight: can improve or worsen
- stress/emotional upset
- alcohol and smoking
- hormonal changes
When are antibiotics recommended for abscesses
- severe or extensive disease (multiple sites)
- rapid progression in presence of associated cellulitis
- s/s of systemic illness
- associated comoribities or immunosuppression
- extremes of age (very old or very young)
- abscess in an area difficult to drain (face, hand, genitals)
- associated septic phlebitis
- lack of response to I&D alone
Topical retinoid used for psoriasis
(managed by dermatology)
name, uses, cautions
- Tazarotene (Tazorac)
- teratogenic
- monitor LFTs
- must use birth control
- decreases inflammation
- normalizes the abnormal keratinocytic proliferation
- teratogenic
Atopic dermatitis (eczema) is chronic and characterized by ___
- high amount of IgE
- onset frequently at an early age
- commonly associated with other atopy such as asthma and seasonal allergies
Name the cutaneous vascular disorder of increased reaction of capillaries to heat
- present for at least 3 months
- causes “flushing”
- usually starts between 30-50 years old
Acne Rosacea
- What are two options for 1st line treatment of psoriasis
- What would be 2nd line treatment?
- Emollients- ointments help with penetration
- Topical steroids
- high or very high potency when used with emollients- can help absorb better
- 2nd line- 3-4 rounds of high potency topical steroids then maintenance application
- add vitamin D analog- Calcipotrene (Dovonex)
What is the core (1st line) of topical treatment for acne and what is its MOA
- Topical Retinoids - comedolytic (keratylitic)
- reverses abnormal keratinization
- decreases cohesion of the follicular cells
Systemic antibiotic options for community acquired MRSA
- Trimethoprim-sulfamethoxazole (bactrim)
- Minocycline/doxycycline
- Clindamycin
- Linezolid (Zyvox)
- Serious infections require IV vancomycin
Guttate psoriasis is caused by _____
Beta hemolytic strep
- do throat culture and if positive can treat and will go away
Superficial bacterial infection with erythematous papules primarily caused by Staph aureus… name of condition and treatment options
- in groin could be caused by candidiasis
- swimming pool/hot tub exposure:
- pseudomonas
Folliculitis
- Topical bactroban
- clindamycin gel
- severe/diffuse
- cephalexin or augmentin
Cautions of antifungals and oral azoles
- high risk for hepatotoxicity
- monitor LFTs
- can cause significant hypoglycemia when on hypoglycemia drugs
- can increase statins
- can incrase levels of rhabdomyolysis
1st line oral abx for acne– and possible side effects
Tetracycline –doxycycline or minocycline
- **especially careful when combined with a retinoid
- greater increase for photosensitivity
- *vaginal yeast infection, allergic reaction
Systemic treatment options for eczema
- Oral antihistamines (helps with puritis)
- benadryl
- atarax
- zyrtec
- Derm referral
- oral steroids- can do a burst but may cause rebound exacerbation
- immunomodulators
- oral antibiotics
- phototherapy
Which antifungal is very effective in cutaneous infections, has affinity for keratin and is lipophililc, long half-life
Used for onychomycosis- tinea infection of the nails
Itraconazole (Sporanox)
Which topical antibiotic is effective against S. aureus and used to decolonize carriers of MRSA
Mupirocin (Bactroban)
- *for carriers of pts who get infections often can use bactroban intranasally
- BID x 5-10 days
- safe in peds greater than 1 year
1st line pharm treatment for abscess/infection
- topical abx for MINOR infections
- oral abx: 7-10 days
- broad spectrum penicillin (dicloxacillin)
- first generation cephalosporin (cephalexin)
2nd and 3rd line oral abx treatment for acne
- Erythromycin- good alternative to tetracycline
- (pregnancy cat B)
- Bactrim: TMP/SMX- bacteriostatic
If you treat a fungus with a steroid cream it will _____
If you treat a dermatitis with an antifungal, it will ______
Get worse
Most likely will not improve
Which OTC acne treatment is
- considered an antibacterial
- mildly comedolytic
- is also available by script
- can see results in 5 days
- S/E: skin irritation/dryness
- bleaches fabrics
Benzoyl peroxide
Fungal infections- which treatment is fungicidal causing leakage of the cellular components and cellular death. is only effective against candidiasis, not against tenia
Nystatin (Mycostatin)
In fungal infections, which treatments can be used for either tinea or candida, are considered fungicidal.
They impair the ergosterol in the cell membrane causing leakage of cell contents and cell death
- Topical azoles
- Clotrimazole (Lotrimin) OTC
- Ketoconazole (Nizoral)
- Miconazole (Monistat)
- Oxiconazole (Oxistat)
- imidazole
Systemic Antibiotics for rosacea
- use for 4-6 weeks
- used for anti-inflammatory properties
- Tetracycline 250-500mg po BID
- minocycline 50-100 mg po QD
- Erthromycin
**want to taper oral abx as you start topical metrogel
In relation to psoriasis, when using vitamin D derivatives- what are some precautions to educate patient about
- Calcipotriene- reduce cell proliferation so it willdecrease topical plaques
- Dovonex, Sorilux
- cannot be used on face
- its frequently combined with a steroid cream - more effective
- Alefacept (amevive)
- Etanercept (enbrel)
- Infliximab (remicade)
- Adalimumab (Humira)
- Ustekinumab (Stelera)
- Methotrexate
- Cyclosporine
These are _______ that are used for which disease process and what do you need to avoid when taking these?
These are biologic agents, tumor necrosis factor inhibitors for moderate to severe psoriasis mangaged by DERM.
- Must avoid vaccines while on these
Name the dermititis types:
- acute inflammatory reaction
- acute reaction to incontinence with an occlusive garment
- allergic dermatits
- Contact
- Diaper dermatitis
- atopic dermatitis
In regards to psoriasis, when prescribing keratolytics such as salicylic acid what do you need to edcuate pt on
- Concentration needs to be 3%-6%
- higher concentrations are destructive to tissues
- toxic if applied too frequently or in too large a quantity
- Must be cautious on use of extremities in diabetics- dont want to damage skin
- If toxicity occurs, could require hemodialysis
Treatment for community acquired MRSA
- 1st line option
- I&D
- If there is surrounding inflammation/induration consider systemic antibiotics
Which OTC acne treatment comes in two different strengths but has limited effectiveness
Salicylic acid
2nd line treatment for abscess/infection
- different antibiotic for 7-10 days
- second generation cephalosporin (ceclor)
- 3rd generation cephalosporin (Rocephin)
- Fluoroquinolones (Cipro)
- good for pseudomonas
2nd line pharm treatment for eczema
- Topical Calcineurin Inhibitors
- Elidel (Pimecrolimus)
- use for infant and up
- Protopic (Tacrolimus)
- 0.1%- over age 15
- .03%- over age 2
- inhibits phosphatase activity of calcineurin, results in inhibition of T-cell activation; inhibits inflammation
- Elidel (Pimecrolimus)
How do oral contraceptives help with acne
- whats the MOA
- they’re anti-inflammatory
- help decrease the number of comedones
- anti-androgenic
Which antifungal inhibits the enzyme that is the cornerstone of the fungus biosynthesis
Terbinafine (Lamisil)
Which topical antibiotic is effective against Group A strep, S. aureus, and pseudomonas
Gentamycin
Cautions and side effects of topical retinoids
- causes drying and peeling of skin
- erythema
- photosensitivity - avoid prolonged sun exposure
- Preg cat C
Nonpharmacological care for skin infection
- good hygiene
- warm compresses
- elevation of lower extremity if appropriate
- If severe infection:
- I&D w/ culture
Treatment for furuncle/carbuncle
- abscesses requiring I&D if it has a raised pustular center (pointing) with some fluctuance
- you cannot drain something that is hard
- clear pus and debris then probe entire cavity
- after I&D possible antibiotics
Which OTC acne treatment
- interferes with the DNA synthesis of P.acnes
- can cause pigment changes in dark skinned pts
- is antibacterial and anti-inflammatory
- pregnancy cat. B
Azelaic acid
Treatments for an abrasion
clean it, use bacitracin or triple antibiotic ointment then cover until healed
1st line treatment options for rosacea
Topical:
- Metronidazole gel, cream, or lotion
- anti-inflammatory
- calms down redness
- take for 3-9 week
- Sodium sulfacetamide with sulfur (sulfacet-R)-
- anti-inflammatory
- contraindicated in renal dies
- pregnancy cat C
- can cause local irritation/allergic dermatitis
- Azelaic acid
- used for treating papules
Name the 3 OTC acne treatments
- Benzoyl peroxide
- azelaic acid
- salicylic acid
What are possible treatment options for psoriasis in the primary care setting?
- Emollients
- moisturizes- increase hydration
- Topical steroids* one of the cornerstones of care**
- decreases puritis, itching, scaling
- Topical immunosuppresive
- Elidel, Protopic
- Vitamin D derivatives- reduces cell proliferation
- Calcipotriene (Dovonex, Sorilux)
- Keratolytic agent
- Salicyclic acid- reduces scaling, softens plaques
Oral antibiotics for acne MOA
- active against P.acnes
- typically used for moderate to severe acne
- prevents further lesions
- anti-inflammatory effect
In fungal infections, which treatment are:
- toxic to fungi
- prevent synthesis of fungal cell membrane
- have limited use against yeast
- highly effective aginst dermatophytes
- preg cat C
Allylamine antifungals
- Butenafine (mentex)
- Naftifine (Naftin)
- Terbinafine (Lamisil)
bacterial infections are usually caused by which pathogens
- Staphylococcus aureus (MRSA)
- Streptococcus pyogenes (Group A strep)
- less commonly:
- Haemophilus influenza
- P. Aeruginosa, E.coli
Systemic retinoid
(managed by dermatology)
name, uses, cautions
- Soriatane (acitretin)- metabolite of retinoid
- decreases hyperproliferaization and inflammation
- can cause elevated triglycerides, cholesterol in LFTs
- want to avoid in renal pts
- iS TERATOGENIC
- cannot get pregnant for THREE years after use
- cannot DONATE BLOOD
Treatment options for Onychomycosis (very common)
- Topicals may not penetrate into nail bed
- Turbinafine
- 250mg qd x 6 weeks
- Itraconazole- **First line treatment
- 200mg PO daily X 8 weeks
Nonpharm treatment of exzema
- avoid perfumes, irritants-smoke, detergent, soaps, bubble bath
- decrease frequency of bathing
- keep skin hydrated
- wear loose cotton clothes- avoid synthetics and wool
- Prevention is KEY
- Bleach bath for SEVERE cases
When should low potency topical steroids be used for eczema?
- when using on eyelids, face, mucous membranes, genitalia
- use on infants and children
Oral and topical antibiotics are best used in combination with ________ if used alone can cause resistance
a comedolytic (Benzoyl peroxide)
Patho of acne
- follicular hyperkeratinization- abnormality of the pilosebaceous gland
- > then becomes colonized with P.acnes
- then theres an increase in sebum production
Side effects of topical corticosteroids
- HPA access suppression*
- why you don’t use steroids long term
- Systemic absorption
- Skin atrophy corticoid rosacea
- steroid-induced acne
- hypopigmentation
- increased intraocular pressure
- cataracts
- contact dermatitis
- Pregnancy cat C
Which antifungal is the preferred agent of tinea capitis and tinea corpus if oral treatment is needed
Griseofulvin (Grifulvin)
Tinea Capitis→
Ciclopirox (Pen-Lac, Loprox) is an alternative to systemic treatment for ______
Onychomycosis can also be used for other dermatomycosese, candidiasis, tinea
What are some nonprescription treatment options for fungal areas?
- Vinegar soaks
- Vicks VapoRub
- dry ares most likely to be infected with fungus thoroughly- want to ameks ure there is no moist dark areas
- anti-fungal powders
- Tinactin
- Monistat
What are the 3 groups of viruses producing skin lesions?
- Herpes viruses
- replicate their own polymerase, along with several of their own enzymes
- Papilloma viruses
- contribute to the initiation of DNA replication
- Pox viruses
- replicate entirely in the cytoplasm
First line therapy for Varicella-zoster virus (chicken pox)
- 1st line- topical therapy
- acyclovir, zovirax, genovir
- treat at earliest sign of outbreak
- if patient is highrisk
- systemic acyclovir for 7 days
Systemic antivirals are contraindicated in which patients
What are adverse events of systemic antivirals
Patients with renal disease
Headache, vertigo, depression, tremors
first line therapy for herpes zoster (shingles)
Systemic antivirals
**Must be within 72 hours of initial outbreak to be effective
acyclovir, valacyclovir, famcicyclovir
first line therapy for warts
prescribe salicyclic acid for 8 weeks
if not resolved then cryosurgery
* caution in diabetics and pts with peripheral vascular disease
Drug that is a prodrug of acyclovir that is converted rapidly with 55-70% bioavailibility and very effective
Valacyclovir (valtrex)
