Derm Treatments

Question 1

mild acne vulgaris

Answer 1

TOPICAL

1. antiseptics
   * azelaic acid
   * salicylic acid
   * benzoyl peroxide
   * retinoids
   * tretinoin or topical ABX (clindamycin or erythromycin)

Question 2

moderate acne vulgaris

Answer 2

topical tx with:

1. antiseptics
   * azelaic acid
   * salicylic acid
   * benzoyl peroxide
   * retinoids
   * tretinoin (retinoid)** or topical ABX (clindamycin or erythromycin)

PLUS

ORAL ABX
1. minocycline or doxycycline

+/- spironolactone

Question 3

Severe Acne vulgaris or refractory

Answer 3

PO isotretnoin aka Acutane

Question 4

Rosacea

• first line for papulopustules
• mild-mod
• mod-severe
• refractory
• facial erythema s/s ONLY tx

Answer 4

first line: life style modifications–>sunscreen, avoid irritants (toners, astringents, menthols, camphor)

mild-moderate:

• topical metronidazole** first line if papulopustules
• Azelaic acid and Ivermectin also considered first line

Mod-severe:
*PO ABX–>tetracycline, doxy, mino

refratory–>PO isotretinoin

facial erythema s/s ONLY–>topical Brimonidine**, laser or intesnse pulsed light

Question 5

folliculitis

• mild first line
• severe/refractory
• gram negative infection
• MRSA infection

Answer 5

MILD
1. topical mupirocin*** can also use clindamycin, erythromycin or Bezoyl peroxide

SEVERE/REFRACTORY

1. PO ABX: Cephalexin or Dicloxacillin
   * if MRSA suspected–Trimethoprim/sulfamethoxazole**, clindamycin or erythromycin

GRAM -

1. daily acetic acid or topical Benzoyl Peroxide
   * *MC resolves w/o treatment

Question 6

erythema multiforme

• symptomatic tx
• severe

Answer 6

Symptomatic:

1. discontinue ofending drug, skin care etc
   - ->tx with corticosteroid + Lidocaine + diphenydramine mouth wash for oral lesions
2. Severe:
   * systemic corticos
3. Mycoplasma related
   * abx
4. HSV related
   * PO acyclovir

Question 7

SJS or TEN

Answer 7

1. PROMPT discontinuation of causative agent
2. Supportive tx:
   * tx is like severe burns–>burn unit admin, pain control, prompt withdrawl of offending med, fluid + electrolyte replacement, woundcare (gauze + petroleum)

Question 8

Alopecia Areata

• local
• extensive
• prognosis

Answer 8

LOCAL
*intralesional corticosteroids

EXTENSIVE
*topical corticos

PROGNOSIS
*may spontaneoulsy resolve or progress to alopecia totalis (compl scalp hair loss) or alopecia universalis (hair loss on scalp + body)

*relapse is common

Question 9

androgenetic alopecia

Answer 9

1. Topical minoxidil
   * best used if recnt onset in a smaller area
   * 4-6 MO trial b4 improvement
2. PO Fineasteride
3. hair transplant is effective

Question 10

Onychomycosis

• most effective tx?
• 1st line for dermatophytes
• candida?

Answer 10

Systemic antifungals=MOST effective

1. Terbinafine is 1st line for dermatophytes
2. Iconazole for dermatophyte + Candida

TOPICAL antifungals

1. efinaconazole or tavaborole
   * *use topical if PO are contraindicated or not desired

Question 11

Paronychia

1. w/o abscess–mild, mod, assoc with nail biting
2. with abscess
3. MRSA

Answer 11

W/O ABSCESS

1. MILD: warm water or antiseptic soaks for 10-15 mins–>topical abx (triple antibitoics or mupirocin)
2. MOD: PO ABX: cephalexin or Dicloxacillin first lines
3. nail biting: amoxicillin-clavulanic acid or clindamycin

WITH ABSCESS
*i/d

MRSA

• Trimethoprim-sulfamethoxazole
• clindamycin
• doxycycline