Derm Therapies Flashcards
Drug delivery is dependent on
skin type skin condition lipid vs. water-based vehicle charge concentration gradient
The __________ provides a “bricks and mortar” barrier for the skin. It is the rate-limiting step to topical therapy absorption.
The stratum corneum provides a “bricks and mortar” barrier for the skin. It is the rate-limiting step to topical therapy absorption.
__________ of the skin increases absorption by making the SC more penetrable
hydration
Actions : Anti-inflammatory Immunosuppressive Anti-proliferative Vasoconstrictive Uses: Eczema, contact dermatitis, psoriasis, itch, LP
Corticosteroids
AE of Corticosteroids
SKIN ATROPHY, striae, acne, suppression of the HPA axis.
How is strength of corticosteroids based?
standardized laboratory vasoconstriction assay.
Chemical vs. % (higher % does not mean stronger)
Vitamin A analogs which work through nuclear receptors on DNA causing alteration of gene transcription.
Retinoids
tretinoin(Retin-A), tazarotene(Tazorac),
adapalene(Differin).
Retinoids examples
Actions: Regulate cell growth, inhibit carcinogenesis, alter enzymes involved with cellular differentiation
Retinoids
Uses: acne, psoriasis, cosmetic skin improvement.
Retinoids
AE of Retinoids
dryness, irritation, sun sensitivity
A vitamin D analog that acts through DNA receptors to alter skin differentiation
Calcipotriene (i.e. Dovonex)
Uses of calcipotriene
Psoriasis, eczema?
AE of Calcipotriene
irritation, increased serum calcium.
Examples of Topical Antimicrobials
clindamycin or erythromycin gels benzoyl peroxide gel or wash terbinafine, oxiconazole…..creams metronidazole gel or lotion bacitracin or mupirocin ointment
Wounds, acne, fungal inf., rosacea
Topical antimicrobials
Work through calcineurin to alter T cell activation
Topical Calcineurin Inhibitors “nonsteroidal antiinflammatories”
tacrolimus(Protopic) pimicrolimus(Elidel)
AE TCIs
limited, local irritation/burning
Controversy of TCIs
The FDA added a ‘black-box’ warning to the drug information label on these products.
Based on animal studies with systemic forms of these meds…risk of lymphoma?
The AAD and other patient advocate groups DON’T agree based on current data.
TCI use
Eczema (around eyes), dermatitis
second-line, follow dx
3 kinds of UV light and how sunscreen blocks then
Traditionally - UVB
Newer ones with avobenzone/helioplex - UVA
Titanium Oxide + Zinc oxide - block
SPF
SPF=sun protection factor.
A number based on a standardized application. Indicates relative sun protection from a given product against UVB.
SPF 2 blocks 50% of sun’s UV rays.
SPF 15 blocks 93% of sun’s UV rays.
SPF 30 blocks 97% of sun’s UV rays.
New sunscreen labeling
Can’t say “water proof”.
Indicate water resistant 40 mins or 80 mins.
Have to be SPF 15 to claim they decrease the risk of skin cancer or aging effects.
Look for “broad spectrum” to cover all wave lengths
“Immune response modifier”
Increases local immune activity through Toll receptors (i.e. INF, TNF, NK cells, T cells).
Imiquimod (Aldara)
Uses for Imiquimod
Condyloma, now Actinic keratosis, BCC, common warts, molluscum, in sit Cancer
inhibits thymidylate synthase resulting in reduced DNA synthesis.
Acts selectively in actinic damaged skin cells
5-Fluorouracil (topical)
Wound care
New research»»keep it covered with a nonstick dressing to allow natural cytokines to facilitate healing.
Monitor for infection.
“Airing out” wounds slows healing and increases likelihood of scarring.
Uses for systemic retinoids
Uses: acne, psoriasis, ichthyosis, Darier’s disease, chemoprophylaxis of skin ca…
(repair disordered keratinization).
Ex of systemic retinoids
isotretinoin (Accutane, Sotret, Amnesteem, Claravis)
acitretin (Soriatane)
AE of systemic retinoids
Dryness
Hyperlipidemia
Teratogenicity
Hepatitis
Hair loss
Arthralgias
Pseudotumor cerebri
Headaches
DISH
Depression?Monitoring labs for Systemic retinoids
Lipids, LFT, HCG
Inhibits myeloperoxidase in PMNs.
Affect on CD11a/CD18.
* Neutrophils
Dapsone (systemic)
- a sulfone
Uses of dapsone
dermatitis herpetiformis, linear IgA disease, bullous lupus, Sweet’s syndrome, spider bite….(neutrophilic skin dz)
AE Dapsone
Hemolysis (esp. G6PD deficiency),
Methemaglobinemia, Motor neuropathy
Labs for Dapsone
G6PD, CBC
Dihydrofolate reductase inhibitor that disrupts DNA synthesis to block cell division. Immunosuppressive
Methotrexate (systemic)
Uses of methotrexate
psoriasis, CTCL, lupus, others
AE of methotrexate
hepatotoxicity, myelosuppression, pneumonitis
Labs for methotrexate
CBC, LFT, Liver biopsy
Biological therapy uses
psoriasis, psoriatic arthritis, (RA).
Biogenetically engineered proteins which disrupt/inhibit focused portions of the immune system involved in psoriasis
Biological therapy, ie.
Amevive-inhibits T memory cells.
Enbrel-binds to TNF making it inactive.
Raptiva-removed from the market
Remicade-binds TNF, inhibits some cytokines.
Humira-binds TNF.
Stelara-binds to p40 subunit of IL-12 and IL-23
AE of bio therapy
Injection site irritation. Risk of Infection? Exacerbate CHF? Reactivate TB? Risk for cancer? Others?
Uses for oral antimicrobials
Antibiotics: acne, folliculitis, cellulitis, rosacea, wound infection……
Anti-virals: HSV infection, cold sores, zoster……
Anti-fungals: ‘ring worm’, ‘athletes foot’, infected nails…..
Forms pyrimidine dimers in DNA and reduces langerhans cell and leukocytes
UV light therapy
Types of UV light therapy
UVB (290-320 nm)
Narrow band UVB (311 nm)
PUVA (psoralen +UVA) 320-400nm
Actions of UV light therapy
Anti-inflammatory
Immunosuppressive
Uses UV light therapy
Psoriasis, pruritis, eczema, CTCL
AE of UV Light therapy
burns, carcinogenic, photoaging
Minoxidil
Rogaine
vasodilatation and direct stimulation of hair shaft growth
Minoxidil
Uses of minoxidil
Alopecia
Blocks 5-alpha reductase enzyme in follicles to inhibit the conversion of testosterone to dihydrotestosterone.
Finasteride (i.e. Propecia)
Uses of finasteride
androgenetic alopecia
Freezes tissue (-196 C)
Liquid nitrogen
Uses of Liquid N
warts, AK, skin cancer, others
Moisturizers (kinds)
Occlusives-trap moisture in.
Humectants-bind water.
Emollients-give skin a smooth feel.
Suggestions for moisturizers
Suggest: fragrance-free, dye-free (Cetaphil, Vanicream, Eucerin…)
Suggestions for soap
Minimizing their use. Try non-soap cleansers like Cetaphil, Purpose, Basis.
Exfoliate.
Thicken epidermis.
Stimulate collagen growth.
Increase skin profusion.
Alpha hydroxy acids
Overall goal of AHA
fewer wrinkles, more pliable skin, with better hydration
Uses for corticosteroids
eczema, contact dermatitis, psoriasis, itch, lichen planus…
Uses for retinoids
acne, psoriasis, cosmetic skin improvement
Uses for calcipotriene
psoriasis, eczema
Uses for topical antimicrobials
wounds, acne, fungal infections, rosacea
TCIs uses
Eczema, second line
Immune response modifier
Imiquimod - Aldara cream
Increases local immune activity through Toll Receptors
Imiquimod uses
condyloma, actinic keratosis, BCC, common warts, molluscum, in sit Cancer…
Repair ordered keratinization
Retinoids (vitamin A analogs that bind to nuclear retinoid receptors to alter cell differnetiation)
Uses for systemic retinoids
Acne, psoriasis, ichthyosis, darier’s disease, chemoprophylaxis of skin cancer
Dapsone is a _____
Sulfone
Dapsone uses
dermatitis herpetiformis, linear IgA disease, bullous lupus, Sweet’s syndrome, spider bite
Dapsone acts on
polymorphonuclear luekocytes
Immunosuppressive
Dihydrofolate reductase inhibitor that disrupts DNA synthesis to block cell division
Methotrexate
Methotrexate uses
psoriasis, CTCL, lupus, others.
