Derm Therapeutics Flashcards
What acne treatments target follicular hyperkeritiniazation?
topical retinoids and isotretinoin
azeliac acid
salicylic acid
What do you need to warn patients abour when using benzol peroxide?
bleaching of clothes
What is the strongest retinoid?
tazorac
What acne treatments target increased sebum production?
isotertinoin
hormonal therapies-ocp, aldactone
What acne treatments target P. acnes?
BPO
topical antimicrobials
oral abx-doxy or minocycline
azelaic acid
What acne treatments target inflammation?
isotretinoin
oral abx
topical retinoids
azelaic acid
What are SE of actuate?
dry skin and lips and photosensitivity
How do you treat hyperpigmented skin?
hydroquinone
How do you treat atrophic scars?
laser resurfacing
How do you treat keloids or hypertrophic skin?
corticosteroid injection
What topical vasoconstrictor meds can you use for redness of rosacea?
brimonidine and oxymetazoline
What are possible treatments of rosacea?
Metronidazole Azelaic acid Sulfacetamide Acne meds Retinoids Topical/oral abx Ivermectin
Acne treatments
Isotretinoin (accutane)
Topical retinoids (tretinoin, adapalene, tazorac-strongest)
Oral abx limit for 3 mo (doxycycline, minocycline)
topical antimicrobials (clindamycin, benzol peroxide-bleaches clothes, sulfacetamide, dapsone)
Azeliac acid
Hormonal therapy (OCP, spironolactone)
Hidradenitis Suppurativa tx
Prevention-loose clothes, don’t pick, avoid dairy
Treat new lesions
Mild-clindamycin, punch surgery, kenalog inj, short course abx (doxy or minocycline)
Mod- above plus spironolactone
Severe-prednisone, Humiera (TNF α inhibitor), accutane, surgery
NO cure
Alopecia Areata tx
Intralesional corticosteroid inj (kenalog 2.5-5 mg/mL)
Topical steroids
Topical immunotherapy
Telogen Effluvium tx
Treat underlying cause
Minoxidil (rogaine)
Self-limited (6-12 mo)
Androgenic Alopecia in Men tx
Minoxidil (rogaine) ↑ anagen phase and enlarges miniaturized follicles takes 6-12 mo
Finasteride (propecia) ↓ scalp DHT-better results from younger age and longer time on drug
Surgery
Androgenic Alopecia in Women tx
“Minoxidil (rogaine)
Spironolactone
Surgery”
Trichotillomania
Psych referral
Psychotherapy
Pityriasis (tinea) Versicolor tx
Topicals Selenium sulfide Zinc pyrithione Azole antifungals Terbinafine Ciclopirox
Orals
Itraconazole and fluconazole
Tinea Capitis tx
Oral antifungals
Griseofulvin, terbinafine, fluconazole, itraconazole
Do not share hats, helmets or hair products
Tinea Corporis
ringworm tx
Topicals
azoles, allyamines, butenafine, ciclopirox, tolnsftate
Oral
terbinafine, itraconazole, fluconazole, griseofulvin
Tinea Cruris
jock itch tx
Topicals
azoles, allyamines, butenafine, ciclopirox, tolnsftate
Oral
terbinafine, itraconazole, fluconazole, griseofulvin
OTC zeasorb powder and avoid tight clothing
Tinea Pedis
athletes foot tx
Topicals
azoles, allyamines, butenafine, ciclopirox, tolnsftate
Oral
terbinafine, itraconazole, fluconazole, griseofulvin
Onychomycosis tx
Topical-can take a year
efinazonazole, amorolfine, tavaborle, ciclopirox
Oral-can take 3 mo
terbinafine
Candidiasis tx
Topical clotrimazole, miconazole, nystatin
Oral fluconazole
MRSA oral therapy
Trimethoprim- Sulfamethoxazole (Bactrim DS)
Doxycycline
Clindamycin
Linezolid
MRSA IV therapy
Clindamycin
Linezolid
Vancomycin
Daptomycin
Treatment for recurrent erythema multiforme
oral acyclovir or valtrex MC
Other: dapsone, antimalarials, azathioprine, cyclosporine, thalidomide
Describe ointments
consist primarily of water suspended in oil
strongest moisturizer
best for dry, non-hairy skin
Describe creams
mix of water in oil
less potent than ointments
easy to wash off
contain preservatives which can cause SE
Describe Gels
oil in water with alcohol
drying effect
transparent
Describe lotions
powder in water-must shake first, may also contain alcohol
good for large surface area and hairy area
cooling effect
What class is hydrocortisone in?
Class 7-least potent
What class is betametasone dipropinate G, O, L, clobetasol and diflorasone diacetate in?
Class 1-super potent
What steroid class is safest for LT use?
Class 6 and 7 for 1-2 wk intervals
What steroid class is most appropriate for non-facial and intertriginous areas with mild to mod disease?
Class 2-5 for <6-8 wks
What steroid class is best for thick skinned areas and hyperkeratotic lesions?
class 1 for < 3 wks
What is the most common side effect of steroids?
skin atrophy
What are adverse effects of kenalog injections?
local txn, systemic absorption, atrophy, hypopigmentation, telangiectasias
Tx for Seborrheic Dermatitis
corticosteroids, selenium sulfide 2.5% shampoo
Folliculitis tx
Mupirocin Ointment TID (covers MRSA*) Altabax BID
Clindamycin Gel or lotion BID
Keflex q6h Dicloxacillin 250-500mg q6h Augmentin 500-875mg q12h
Bactrim DS* q12h
Doxycycline* 100mg q12h
Clindamycin* 300-450mg q6h
Gram neg: Cipro 250-750 BID Bactrim DS * BID
Tx for Impetigo
Mupirocin (bactroban) ointment TID x 10 d
Keflex 250-500 q6h Dicloxacillin 250-500 q6h
Augmentin 500-875 q12h
Erysipelas tx
Oral
Penicillin 500 q6h Amoxicillin 500 q8h Keflex 250-500 q6h
IV
Cefazolin (Ancef) Ceftriazone (Rocephin)
Cellulitis tx
Keflex 250-500mg q6h
Amoxicillin-Clavulanate (Augmentin) 500-875mg q12h *bites
Clindamycin 300-450mg q6h *MRSA coverage
Cipro 500-750mg q12h *puncture wounds
IV: Cefazolin, cetriazone, nafcillin, clindamycin
Elevate head or affected extremity, warm compress, tylenol or ibuprofen for fever and pain
Head Lice tx
Permethrin 1% (Nix)
Pyrethrin/piperonyl butoxide (Rid) Malathion 0.5% (Ovide) -flammable Benzyl Alcohol 5%-used in pregnancy Topical/oral Ivermectin
Crab Lice tx
Permethrin 1% (Nix)
Pyrethrin/piperonyl butoxide (Rid) Malathion 0.5% (Ovide) -flammable Benzyl Alcohol 5%-used in pregnancy Topical/oral Ivermectin
Body Lice tx
Wash entire body
Topical/oral ivermectin
Wash clothing and bedding or dispose in plastic
sealed bags
Scabies tx
Permethrin 5% Cream (Elimite)
Bath before and 24 hr after last application
Could take weeks for ithching to subside
Bed Bugs tx
Bites resolve in 1-2 wks Topical/oral steroids Antihistamines Eradication
Brown Recluse Spider Bite tx
Rest, ice and elevation Tetanus shot Analgesics Wound cleaning and care Abx to ↓ 2° infections
Necrotic wounds heal slowly-may need excision
Pityriasis Rosea tx
Symptomatic management Antihistamines Calamine lotion Steroids-oral prednisone UVB phototherapy-caution with post-inflammatory hyperpigmentation Rash lasts 4-10 wks
Lichen Planus tx
Topical corticosteroids
Clobetaols (Temovate) Betamethasone Diproprionate (Diprolene) Kenalog injections
Oral prednisone 30-60 mg QD 4-6 wk Narrow band UVB
Phototherapy Retinoids- Acitertin (Soriatane) Cyclosporine 5mg/kg/day
Lichen Planus Oral Lesions tx
Kenalog paste (in orabase)
Erythema Multiforme tx
Resolves spontaneouslt in 3-5 wks Remove possible drug related cause Oral antihistamines Topical steroids Oral prednisone if severe Oral acyclovir if recurrnet EM (even if not due to HSV)
Erythema Multiforme tx if due to mycoplasma
Macrolide
Herpes Simplex tx
Primary tx 7-10 d
Acyclovir 400 mg TID Famcyclovie 250 mg TID Valtrex 1gm BID
Supressive (6+ episodes/yr)
Acyclovir 400 mg BID Famcyclovir250 mg BID Valtrex 500 mg QD or 1 gm QD
Recurrent
Acyclovir 400 mg tid or 800 mg bid X5 d Acycloviror 800 mg tid X2 days Famciclovir 125 mg bid X 5 d Famciclovir 1000 mg bid X 1 d Valtrex 500 mg bid X 3d Valacyclovir 1g qd X 5d
Herpes Zoster tx
Prevention with vaccine
Urgent opthalmic referral and antiviral within72 hrs
Acyclovir 800 mg po five times a day for 7-10 d Valacyclovir 1 g po tid x 7 d Famcyclovir 500 mg po tid x 7 d
Pain management
Molluscum Contagiosum tx
Self limited (~2 mo for single lesion) Cryotherapy NO steroids
Verruca Vulgaris (HPV)
Physical or chemical cautery
Cryotherapy
Phenol nitrate
Condylomata Acuminata (anogenital warts) tx
No tx is curative & relapses are common
Cryotherapy
Laser ablation
Podophyllin (smaller lesions use chemical to burn) Inter-lesional interferon
Imiquimod cream
5-flourouracil
QUIT smoking
Prevention: vaccine (guardasil)
Acne rosacea tx
Metronidazole Azelaic acid Sulfacetamide Acne meds Retinoids Topical/oral abx Ivermectin
Redness relief: brimonidine and oxymetazoline moisturize, clense, sunscreen, laser, avoid triggers
Hidradenitis Suppurativa tx
Prevention-loose clothes, don’t pick, avoid dairy Treat new lesions
Mild-clindamycin, punch surgery, kenalog inj, short course abx (doxy or minocycline)
Mod- above plus spironolactone Severe-prednisone, Humiera (TNF α inhibitor),
accutane, surgery NO cure
Atopic Dermatiti tx
Emollients
Creams- Cetaphil or Eucerin Ointments- Aquaphor, petroleum jelly
Topical Steroids
High potency (grade 1-III)-chronic eczema Moderate potency (Grade III-V) - flare ups on face
Mild potency (Grade V-VII)-persistent lesions on face, neck, axilla, groin, flexor surfaces
Topical Calcineurin Inhibitors- for severe cases not responding to steeroids (BBW of lymphomas and skin malignancies)
Abx if 2° infection Antihistamines-NOT recommended Phototherapy if refractory to topicals
Bleach baths if need to kill staph
Alopecia Areata tx
Intralesional corticosteroid inj (kenalog 2.5-5 mg/mL)
Topical steroids Topical immunotherapy
Telogen Effluvium tx
Treat underlying cause Minoxidil (rogaine)
Treat underlying cause Minoxidil (rogaine)
Androgenic Alopecia in Men tx
Minoxidil (rogaine) ↑ anagen phase and enlarges miniaturized follicles takes 6-12 mo
Finasterida (propecia) ↓ scalp DHT-better results from younger age and longer time on drug
Surgery
Androgenic Alopecia in Women tx
Minoxidil (rogaine) Spironolactone Surgery
Trichotillomania tx
Psych referral
Psychotherapy
Pityriasis (tinea) Versicolor tx
Selenium sulfide
Zinc pyrithione
Azole antifungals
Terbinafine Ciclopirox
PO Itraconazole and fluconazole
Tinea Capitis tx
PO Griseofulvin, terbinafine, fluconazole, itraconazole
Do not share hats, helmets or hair products
Tinea Corporis
ringworm tx
azoles, allyamines, butenafine, ciclopirox, tolnsftate
PO terbinafine, itraconazole, fluconazole, griseofulvin
Tinea Cruris
jock itch tx
azoles, allyamines, butenafine, ciclopirox, tolnsftate
PO terbinafine, itraconazole, fluconazole, griseofulvin
OTC zeasorb powder & avoid tight clothing
Tinea Pedis
athletes foot tx
azoles, allyamines, butenafine, ciclopirox, tolnsftate
PO terbinafine, itraconazole, fluconazole, griseofulvin
Onychomycosis (Tinea Unguium) tx
topical tx can take a year-efinazonazole, amorolfine, tavaborle, ciclopirox
Oral-can take 3 mo terbinafine
Candidiasis tx
Topical clotrimazole, miconazole, nystatin
Oral fluconazole
Exanthematous tx
Resolves in a few days to a week after medication stopped
Stop offending agent
±Topical Steroids,
Oral antihistamines and reassurance
Cold to help itch
Fixed Drug Eruption tx
Lesions resolve days to weeks after drug discontinues
Non-eroded- treated with potent topical glucocorticoid ointment
Eroded- treat with antimircobial ointment and dressing until sire reepithelialized
Address pain
Refer to derm
DIHS
or DRESS tx
Sx may persist for weeks ater cessation fo drug 10% fatality
STOP suspected medications & d/c non-essential meds
Topical/oral steroids
Systemic antihistamines
SJS and TENs tx
Consult derm, optho, burn, gyno
D/c non-life sustaining meds ASAP
Pain management
Consider AMT for corneal damage
Monitor fluids & electrolytes
2° infection
NO steroids
Do NOT use CHG-impregnated patched (can cause chemical burns
Staphlycoccal Scalded Skin Syndrome (SSSS) tx
Penicillinase resistant PCN (Naficillin, oxacilin)
Vancomycin for MRSA
Mupirocin ointment with xeroform
Monitor fluids and hemodynamic status
Pemphigus Vulgaris/Bullous Pemphigoid tx
Corticosteroids
Immunosupressive drugs (Retuximab, sulfasalazine, methotrexate)
Ig IgG
Caution: skin infections, mouth hygiene, ocular involvement, psych surrport
Necrotizing Fasciitis tx
Send to burn/trauma SICU
Broad spectrum abx: carbapenem, clindamycin (anaerobic coverage)
Vancomycin or linezolid for MRSA coverage
IV fluids
NPO
OR prep
Complications: sepsis, amputation, death Mortality: 20-35%
Fournier Gangrene tx
Complications: pan w/ erection, genital scarring, impotence, psych problems, extensive reconstruction
NSQIP mortality 10%
Purpura Fulminans tx
Fluid management Broad spectrum antibiotics DIC management Heparin vs FFP vs Protein C concentrate Prompt removal of dead tissues +/- amputations
Vitiligo tx
Sun protection-SPF 50 Steroids Betamethasone Fluocinonide Phototherapy Depigmentation- monobenzone 20% (benoquin) cream BID x 18 mo Surgical grafting Laser therapy
Albinism tx
Unable to manufacture melanin Prevent sun damage (SPF 50+) Frequent skin checks regular optho visits
Psych/social support
Solar Lentigos (liver spots) tx
Chemical peel Cryotherapy Laser therapy Hydroquinone Retinoids Prevention: sunscreen and ↓ sun exposure
Melasma tx
Hydroquinone glycolic or Azelaiz acid peel Retinoids
D/c OCP, sunscreen
Ephelides (freckles) tx
Can treat like lentigo if desired-caution for hyperpigmentation
Acanthosis Nigricans tx
Treat underlying condition
Post-Inflammatory Hyperpigmentation tx
Hydroquinone 3%
Azelaiz (finacea) acid peel 20%
Keloids tx
Topical steroids-gels, lotions, creams and ointments
Kenalog or 5-FU injections Surgical excision Cordran tape Recurrence is common
Epidermal Cyst tx
Kenalog Injection I & D Surgical excision
Lipoma tx
Surgical excision for cosmetic reasons
Dermatofibroma tx
Surgery for cosmetic
Acrochordons (skin tags)
Cosmetic removal (may also be irritating) Electrodessication or surgical excision
Hemangioma tx
None necessary
If bleeds-arterial embolization, surgery, laser, interferon
Actinic Keratosis tx
Cryotherapy Curettage Electrosurgery Topical chemotherapy Fluoroplex-5FU Effudex-5FU Zyclara-imiquimoid
Skin cancer tx
Mohs
Electrodessication & currettage (ED&C)
Cryotherapy
Erividge
