DERM therapeutics Flashcards
epidermis features/function
- outer barrier
- keratin
- melanin
- touch
dermis features/function
- supports epidermis and protects from injury
- connective tissue
- nerves
- blood vessels
- hair follicles
- immune response
- oil, sweat glands
hypodermis features/function
- adipose tissue
- larger blood vessels
- regulation of temperature
pediatric skin anatomy
- more water
- thinner
- enhanced drug absorption
elderly skin anatomy
- drier
- thinner
- slower healing
- enhanced drug absorption
macule
- flat, non-palpable
- different color
macule example
freckles
drug eruption
papule
solid
elevated
can palpate
no visible fluid
papule example
wart
insect bite
nodule
firm papule that extends into the dermis or subcutaneous tissue
nodule example
severe acne
vesicle
small, elevated, fluid filled blisters
vesicle example
contact dermatits
burns
bulla
a larger vesicle
pustule
vesicles that contain pus
pustule example
acne
folliculitis
wheals
- elevated and transient plaque or papule caused by localized edema
- almost always itches
other names for a wheal
hive
urticaria
wheal example
hypersensitivity to drugs, bee sting
topical formulations to use on hairy skin
solutions lotions gels aerosols foams
topical formulations to avoid on hairy skin
ointments
patches
topical formualtions to us for moist area between skin folds
solutions
lotions
creams
powders
topical formulations to avoid for moist area between skin folds
ointments
how many grams to cover the whole body once
30g
dermatitis is synonymous with what
eczema
atopic dermatitis is most common in
young children
areas of body most commonly affected by atopic dermatitis in infants
- face/cheeks
- trunk
- neck
- arms/legs
areas of body most commonly affected by atopic dermatitis in children/adults
antecubital and popliteal fossa
hands
face
atopic triad
IgE mediated diseases
- dermatitis
- allergic rhinitis
- asthma
factors with increased prevalence of atopic dermatitis
- air polluted areas
- industrialization
- urban
- dietary changes
- higher socioeconomic status
hygiene hypothesis
having less exposure to infectious agents at a younger age can make you more susceptible later in life
symptoms of atopic dermatitis
- chronic with flares and remissions
- intense itch
- dry, flaky
- inflamed/red
- weepy
atopic dermatitis nonpharm treatment
reduce the following:
- allergens
- stress
- excessive bathing
- detergents
- sun exposure
- itching the rash
first line treatments for atopic dermatitis
-skin hydration with thick creams or ointments twice daily
or
-topical corticosteroids
what dosage form to avoid in treating atopic dermatitis
lotions
topical corticosteroids use duration
- for very high or high potency use 7-14 days then switch to lower potency
- medium or low potency can be used longer safely
corticosteroid adverse effects
skin atrophy hypopigmentation bruising stretch marks rash
corticosteroid affect on HPA axis
suppresses production of cortisol
suppression of HPA axis causes what side effects
growth retardation adrenal insufficiency Cushings secondary infections mood changes
benefit of using bid dosing over QD in high potency steroids
none
HPA side effect risk is low if used less than 2 weeks
dosage form absorption comparison
ointment > cream > lotion
atopic dermatits second line treatment
calcineurin inhibtors
UV light therapy
calcineurin inhibitor drugs
tacrolimus
pimecrolimus
calcineurin inhibitors use features
do not cause skin atrophy and can be used on the face
calcineurin inhibitors are equivalent in effectiveness to what strength steroids
low-moderate
atopic dermatitis third line treatment
oral immunosuppressive drugs
things to avoid in atopic dermatitis
- all antihistamines
- systemic antibiotics
- probiotics
- immunotherapy
- food elimination based only on allergy tests
- special laundry products
drug induced skin reactions presentation
- hives, vomiting, diarrhea, anaphylaxis
- occurs minutes to hours after drug exposure
DRESS acronym
Drug Reaction with Eosinophilia and Systemic Symptoms
DRESS features
- rash, fever, hematologic effects
- occurs 1-4 weeks after starting drug
- can be fatal if not treated
common drugs that cause DRESS
allopurinol
sulfa
anticonvulsants
stevens-johnson syndrome features
- severe blistering
- fever, HA, respiratory distress
- acute onset
drugs that cause stevens-johnson syndrome
sulfa drugs penicillins anticonvulsants NSAIDS allopurinol
toxic epidermal necrolysis
SJS when over 30% of the body is involved or reaction is even more severe
pseudoallergic reaction characterized by
direct mast cell activation
example of pseudoallergic reaction
vancomycin causing red man syndrome
fixed drug eruption features
- pruritic, red raised lesions
- occur in same area when drug is given
- appears quickly
drugs that cause fixed drug eruptions
tetracycline
sulfonamides
codeine
which medication can cause purple toe syndrome
warfarin
which medication causes blue skin
amiodarone
colloidal silver
which drug can cause hypertrichosis
minoxidil
cyclosporine
which medication can cause permanent tooth discoloration
tetracyclines
comedone
obstructed sebaceous follicle
pathophysiology of acne
- obstructed follicle
- increased sebum production
- colonizaiton by propionibacterium acnes
- hyperproliferation of ductal epidermis
- inflammation at acne sites
blackhead
open comedone
non-inflammatory
white head
close comedone
non-inflammatory
mild acne definition
<20 comedones
<15 inflammatory lesions
<30 total lesions
moderate acne definition
20-100 comedones
15-20 inflammatory lesions
30-125 lesions total
severe acne definition
> 5 cysts
100 comedones
50 inflammatory lesions
125 total lesions
exacerbating factors of acne
- heat and humidity
- pimple popping
- excessive scrubbing or washing
- sunlight exposure
- stress
- dietary changes
medications that can worsen acne
phenytoin isoniazid rifampin phenobarbital lithium steroids B vitamins
first line treatment for mild acne
benzoyl peroxide or topical retinoid or topical combo with antibiotic
first line treatment for moderate acne
combo therapy
using any combination of BP, retinoid, topical antibiotic and oral antibiotic
first line treatment for severe acne
oral antibiotic + any two of BP, retinoid, topicl antibiotic
OR
oral isotretinoin
gels tend to be
drying
creams and lotions tend to be
moisturizing
solutions tend to do what to the skin
drying
preferred dosage form for patients with oily skin
gels
benzoyl peroxide used for
first line option for acne
benzoyl peroxide directions
wash face and apply bid
when using with retinoids separate timing
benzoyl peroxide adverse effects
irritation
can bleach or discolor fabric
salicylic acid use
- for keratolytic and comedolytic acne
- useful if retinoids cannot be tolerate
salicylic acid adverse effects
- erythema
- peeling
- scaling
retinoids use
- first line option for acne
- for comedolytic, karatolytic and anti-inflammatory
retinoids directions
wash face and apply in evening
retinoid adverse effects
photosensitivity
dryness/flaking
specific retinoid to not use with benzoyl peroxide
tretinoin, breaks down when used at the same time
topical antimicrobials place in acne treatment
first line option when used in conjunction with BP or a retinoids
clindamycin foam (Evoclin) unique use instructions
dispense foam onto cool surface, not had and apply small amounts with fingertips
dapasone co-administration with BP causes
orange-brown skin discoloration
best topical antibiotics
clindamycin
erythromycin
dapsone
oral antibiotics use in acne
- mod-severe for a limited course
- don’t use at the same time as topicals
oral antibiotic options for acne
minocyclin > doxycycline > tetracycline
Macrolides
side effects of tetracyclines
phototoxicity
tooth discoloration
oral isotretinoin use in acne
severe cases
potential for long term improvement
oral isotretinoin MoA
decreases sebum production and shrinks sebaceous glands
oral isotretinoin directions for use
qd or bid with meals
oral isotretinoin max duration of use
20 weeks
oral isotretinoin adverse effects
hepatotoxicity
hypertriglyceridemia
highly teratogenic
secondary options for acne
oral contraceptives (estrogen dominant ones) spironolactone
how long to typically see improvement in acne
8 weeks
psoriasis cause
pathogenic T-cell production
factors that improve psoriasis
warmth
sunlight
factors that worsen psoriasis
cold stress alcohol smoking obesity
medications that trigger psoriasis flares
NSAIDs ACEI antimalarials beta blockers lithium salicylates steroid withdrawal
non pharm treatment for psoriasis
UV A or B
smoking cessation
balneotherapy?
emollients in psoriasis
avoids dryness
apply multiple times per day
keratolytics in psoriasis
removes scales and decreases hyperkeratosis
can increase penetration of other agents
corticosteroids in psoriasis
apply 1-4 times per day and taper
vitamin D analogs in psoriasis
inhibit keratinocyte proliferation
apply BID
retinoids in psoriasis
use with steroids
apply in evening
second line agents for psoriasis
topical calcineurin inhibitors
methotrexate
