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Dermatology > Dermatitis and Eczematous Eruptions > Flashcards

Dermatitis and Eczematous Eruptions Flashcards

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1
Q

Acute, subacute, and chronic, relapsing pruritic condition often associated with allergic rhinitis and/or asthma

A

Atopic dermatitis

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2
Q

What mediates atopic dermatitis

A

IgE

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3
Q

What is the epidemiology of atopic dermatitis? Where is it most commonlys een?

A
  • Infants and children most often affected
  • MC face, scalp, torso, and extensors, flexor folds
  • Follicular patterns of atopic dermatitis in persons with darker skin phenotypes
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4
Q

Atopic Triad

A
  • Eczema (atopic dermatitis)
  • Asthma
  • Hay fever
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5
Q

What are the primary characteristics of atopic dermatitis?

A
  • Dry skin and pruritis
  • Consequent rubbing –> increased inflammation and lichenification –> further itching and scratching –> itch-scratch cycle
  • Itch scratch cycle: itching/scratching –> disrupted skin barrier function–> penetration of allergens and irritants –> inflammation –> itching/scratching
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6
Q

Pathophys of atopic dermatitis

A
  • Decrease in barrier function due to impaired filagrin production
  • Reduced ceramide levels
  • Increased transepidermal water loss
  • Dehydration of skin
  • Acute inflammation associated with IL4 and IL13 expression
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7
Q

How can atopic dermatitis be categorized?

A
  • Acute - erythema, vesicles, bullae, weeping, crusting
  • Subacute - scaly plaques, papules, round erosions, crusts
  • Chronic eczema - lichenification, scaling, hyper- and hypopigmentation (depending on Fitzpatrick)
  • Itch that rashes
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8
Q

Etiology of atopic dermatitis

A
  • Genetic and environmental predisposing factors
  • Family history increases risk
  • Relationship between atopic dermatitis and development of aspirin-related respiratory disease
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9
Q

Environmental triggers of atopic dermatitis

A
  • Heat
  • Humidity
  • Detergent
  • Soaps
  • Abrasive clothing
  • Chemicals
  • Smoke
  • Stress
  • Allergy to eggs, cow’s milk, peanuts
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10
Q

Hallmark of atopic dermatitis

A
  • Intense pruritis
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11
Q

Clinical manifestations of atopic derm

A
  • Intense pruritis
  • Scratching –> lichenification
  • Impaired barrier function –> increased water loss and cutaneous infections
  • Worry about impetiginization with Staph aureus, secondary HSV, Coxsackie viruses, or vaccinia virus
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12
Q

Look for this in atopic derm

A
  • scaly, erythematous papules and plaques involving flexural surfaces, particularly antecubital fossae and popliteal fossae, face, neck, and extremities
  • Chronic cases –> lichenification, scaling, dyspigmentation
  • Facial findings (chronic) = periorbital scaly plaques and thinning of lateral eyebrows
  • Periorbital hyperpigmentation
  • Hyperlinear palms
  • Keratosis pilaris
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13
Q

Clinical presenation pearls for AD

A

Adequate history of child and family history of allergies, asthma, and skin disorders

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14
Q

Tests for atopic dermatitis

A
  • Family and personal history key to diagnosis
  • Serum IgE (not necessary but can be done)
  • Culture suspected infection
  • Skin biopsy can help
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15
Q

Management of atopic dermatitis

A
  • Avoid triggers
  • Appropriate skin care with gentle cleansers (cerave, cetaphil, vanicream fragrance free) and moisturizer on damp skin or under occlusive dressing
  • Clearance with lowest strength steroid
  • Avoid soap except in body folds
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16
Q

Side effects of long term topical steroid usage

A
  • Atrophy
  • Hypopigmentation
  • Striae
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17
Q

What localized medications can be used for atopic derm?

A

Steroids 2 weeks out of month
Medium potency:
* triamcinolone cream or ointment BID
* Mometasone cream or ointment BID
* Fluocinolone cream or ointment BID

Low potency:
* Desonide BID

Non steroidal (not recommended in <2 years old):
* Tacrolimus ointment BID
* Pimecrolimus cream BID
* Crisaborole ointment BID

Systemic: dupilumab start 600 mg SC divided into then 300 mg SC q 2 weeks

Medium: TMF (triamcinolone, mometasone, fluocinolone)

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18
Q

What can be used for pruritis in atopic dermatitis?

A

Antihistamines!
* Diphenhydramine hydrochloride nightly or every 6 hours as needed
* Hydroxyzine every 6 hours as needed
* Cetirizine hydrochloride 5-10 mg/day
* Loratadine 10 mg tablet or reditab once daily

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19
Q

What is contact dermatitis

A
  • Acute or chronic inflammatory reactions to substances that come in contact with the skin
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20
Q

What is irritant contact dermatitis?

A
  • Single exposure to offending agent that is toxic to skin
  • Confined to area of exposure and always sharply marginated and never spreads
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21
Q

What is allergic contact dermatitis?

A
  • Antigen (allergen) elicits type IV hypersensitivity reaction
  • Immunologic reaction involves surrounding skin and may spread beyond affected sites
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22
Q

Presentation of irritant contact dermatitis?

A
  • One exposure to offending agent
  • Well demarcated suggestive of outside job or external contact
  • Can also present as systemic contact reaction with widespread lesions ie ingested or implanted device
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23
Q

Presentation of allergic contact dermatitis

A
  • Delayed type (type IV) hypersensitivity reaction = allergens activate antigen-specific T cells in a sensitized individual
  • Repeat exposures
  • 24-48 hours post exposure
  • Topical agents, ingested, implanted devices, airborne
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24
Q

Look for what with acute contact dermatitis?

A
  • Erythema
  • Vesicles
  • Bullae
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25
Q

Look for what with chronic contact dermatitis?

A
  • Scaling
  • Lichenification
  • Fissures
  • Cracks
  • Geometric shapes with well-demarcated borders may be seen
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26
Q

What can airborne contact dermatitis affect?

A
  • Face (particularly upper eyelids)
  • Neck (including submandibular region)
  • Upper chest
  • Forearms
  • Hands (especially palmar surfaces)
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27
Q

What happens with repetitive exposure to the same irritant?

A

Cumulative contact dermatitis

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28
Q

What substances can cause contact dermatitis?

A
  • Soaps, detergents, waterless hand cleaners
  • Acids and alkalis 3: hydrofluoric acid, cement, chromic acid, phosphorus, ethylene oxide, phenol, metal salts
  • Industrial solvents: coal tar solvents, petroleum, chlorinated hydrocarbons, alcohol solvents, ethylene glycol, ether, turpentine, ethyl ether, acetone, carbon dioxide, DMSO, dioxane, styrene
  • Plants: euphorbiaceae (spurges, crotons, poinsettias, manchineel tree), ranunculaceae (buttercup), cruciferae (black mustard), urticaceae (nettles), solanaceae (pepper, capsaicin), opuntia (prickly pear)
  • Others: fiberglass, wool, rough synthetic clothing, fire-retardant fabrics, “NCR” paper
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29
Q

Diagnostic pearls for contact dermatitis

A
  • Occupational ACD should be considered, particularly in health care professionals, machinists, and construction workers
  • Consider allergy adhesive, wound dressings, and/or antimicrobial treatments in patients with chronic wounds including stromas
  • Implanted biomedical devices such as pacemakers, orthopedic implants, and endovascular stents can cause
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30
Q

Best tests for contact dermatitis

A
  • History and physical exam
  • Conduct patch testing to verify allergen (if necessary) –> allergy referral
    -positive test does not always equate to diagnosis of ACD and clinical correlation is key
    Skin prick tests used to diagnose type I hypersensitivity reactions and are not used for testing for contact dermatitis
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31
Q

What defines allergy contact dermatitis?

A
  • Hapten T cell-mediated inflammation
  • Reexposure to substance patient has been sensitized to
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32
Q

What are possible allergens that can cause allergic contact dermatitis?

A
  • Metal salts to antibiotics
  • Dyes to plant products
  • Jewelry
  • Personal care products
  • Topical medications
  • Plants
  • House remedies
  • Chemicals individual may come in contact with at work
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33
Q

What is the progression of lesions in allergic contact dermatitis?

A

Erythema –> papules –> vesicles –> erosions –> crusts –> scaling

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34
Q

Management of contact dermatitis?

A
  • Review of medications: OTC/RX/homeopathic
  • reduce hot water usage
  • Humidifier can be beneficial
  • Antihistamines (hydroxyzine vs benadryl)
  • do they have animals?
  • Avoid offending agents
  • Topical steroids (max 2 weeks on, 2 weeks off, repeat)
  • Oral steroids
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35
Q

What are low potency steroids for contact dermatitis?

A
  • Hydrocortisone 1% cream, ointment
  • Hydrocortisone 2.5% cream, ointment
  • Desonide ointment twice daily
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36
Q

What are medium potency steroids for contact dermatitis?

A
  • Triamcinolone cream, ointment
  • Mometasone cream, ointment
  • Fluocinolone cream, ointment
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37
Q

What are high potency steroids for contact dermatitis?

A
  • Clobetasol cream, ointment
  • Halobetasol cream, ointment
  • Betamethasone dipropionate cream, ointment
  • Fluocinonide cream, ointment
  • Desoximetasone cream, ointment
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38
Q

What treatment can be used for contact dermatitis that is not medication?

A

Phototherapy: PUVA

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39
Q

What is diaper dermatitis?

A
  • Rash in buttocks region
  • Caused by cutaneous candidiasis, ICD, and miliaria (blocked sweat ducts)
  • Combination of wet, dark, friction, urine, feces, and microorganisms
  • MC in infants 3 weeks old to 2 years old
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40
Q

Presentation of diaper dermatitis

A
  • Fussiness
  • Crying during diaper changes
  • Diarrhea typically multiple (acid in diarrhea can irritate)
  • Shiny erythema with dull margins
  • +/- papules/vesicles/erosions: candidiasis can be present
  • Miliaria: multiple papulovesicular lesions/pruritis
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41
Q

Management of diaper dermatitis

A
  • Frequent diaper changes with disposable appropriate fitting diapers
  • Keep area dry with blow drier after bathing
  • Barrier creams: zinc oxide/petroleum jelly
  • If candidiasis: nystatin x 2 weeks
  • Clotrimazole x 2 weeks
  • Econazole x 2 weeks
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42
Q

What is nummular eczema?

A
  • Dermatitis characterized by pruritic, coin shaped, scaly plaques
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43
Q

What is nummular eczema associated with?

A
  • Frequent bathing
  • Low humidity
  • Irritating and drying soaps
  • Skin trauma
  • Interferon therapy for hepatitis C
  • Exposure to irritating fabrics such as wool
  • Venous stasis = predisposing factor to developing lesions on legs
  • MC in men 50-65 years old
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44
Q

Look for what in nummular eczema

A
  • Round or coin-shaped erythematous scaly plaques often with minute fissures, round erosions, or crusts within
  • erythema may be less prominent in patients with darker skin phototypes
  • Plaques may begin as papules or vesicles which then coalesce
  • Trunk and extremities MC
  • May involve hands and feet, but not face and scalp
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45
Q

Diagnostic pearls for nummular eczema?

A
  • Coin shaped
  • Post inflammatory hyperpigmentation
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46
Q

Best tests for nummular eczema

A
  • Culture if bacteria suspected
  • Skin scraping if fungus suspected
  • Biopsy if necessary
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47
Q

Treatment for nummular eczema

A

Same as atopic dermatitis: proper hygiene, lowest strength steroid, avoid triggers

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48
Q

What is seborrheic dermatitis?

A
  • Common inflammatory papulosquamous condition
  • Affects sebum-rich areas of the body
  • Face, scalp, neck, upper chest, and back
  • Pityrosporum yeast, a common skin flora
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49
Q

Clinical presentation of seborrheic dermatitis

A
  • Simple dandruff fulminant rash
  • Dryness
  • pruritis
  • erythema
  • fine greasy scaling
  • Scalp, eyebrows, glabella, nasolabial folds, beard area, upper chest, external ear canal, posterior ears, eyelid margins, and intertriginous areas common
  • Anogenital involvement also reported
  • Darker skin hypo or hyperpigmentation
  • Stress can exacerbate
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50
Q

What patients may more commonly have seborrheic dermatitis?

A
  • Immunocompromised patients
  • HIV = more common
  • Parkinsons
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51
Q

Look for what in seborrheic dermatitis?

A
  • Erythematous plaques with loose, bran-like, or greasy scale
  • Often involving scalp, eyebrows, glabella, beard area, ears, and skin folds, especially nasolabial folds
  • Occasionally, crusted plaques are seek
  • Lighter skin yellow to red to pink
  • Darker skin hypo or hyperpigmentation
  • Asymptomatic or may complain of pruritis or burning in affected areas
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52
Q

Diagnostic pearls for seborrheic dermatitis

A
  • Facial seborrheic dermatitis may be associated with rosacea
  • Psoriasis frequently co-exist
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53
Q

Best tests for seborrheic dermatitis

A
  • CLinical diagnosis
  • Biopsy may help
  • KOH if thinking fungal
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54
Q

Management of seborrheic dermatitis

A
  • No cure
  • Waxes and wanes
    Shampoos
  • Salicylic acid
  • Selenium sulfide
  • Tar shampoos
  • Pyrithicone zinc
  • ketoconazole shampoo (1st line)
  • Vanicream zbar

Steroids
* Clobetasol solution
* Betamethasone
* Fluocinolone scalp oil
* Face hydrocortisone/desonide

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55
Q

What is stasis dermatitis

A
  • Inflammatory skin condition occurring on lower extremities caused by chronic venous insufficiency
56
Q

Symptoms of stasis dermatitis

A
  • Pruritis
  • Heaviness
  • Edema
57
Q

Skin findings in stasis dermatitis

A
  • Erythematous
  • Scaling
  • Patches
  • Weeping
  • Crusing
  • MC area medial ankle
  • Hyperpigmentation late
  • Lichenification
  • Loss of hair –> shiny skin
58
Q

Management of stasis dermatitis

A
  • Treat underlying VI
  • Weeping lesions = wet compresses, clean water and burrows
  • Topical steroids: triamcinolone, clobetasol
  • Consult vascular
59
Q

Complications of stasis dermatitis

A
  • Cellulitis
  • Non healing wounds
60
Q

What is lichen simplex chronicus?

A
  • Lichenified plaques from excessive rubbing and scratching
61
Q

Predisposing factors to lichen simplex chronicus

A
  • Chronic skin conditions
  • MC = atopic dermatitis
  • Emotional stress
  • Habit forming scratching (anxiety)
62
Q

Findings in lichen simplex chronicus

A
  • Thick skin
  • Plaques
  • Lichenified
  • Small papules, hyperpigmentation
  • Excoriations
  • MC areas: scalp, ankles, lower legs, upper thighs, forearms, vulva, pubis, anal region, scrotum, groin
63
Q

Tretment in lichen simplex chronicus

A
  • Difficult to stop chronic patients from itching
  • Stop itch scratch cycle
  • Antihistamines?
  • Patient education on avoiding scratching
  • Trim nails/pressure
  • Occlusive dressings/gloves
  • Topical steroids: TAC (triamcinolone)
  • ILK (intralesional kenalog injections)
  • Emollients
64
Q

What is perioral dermatitis?

A
  • Localized inflammatory disorder
  • Erythematous papular and pustular eruption
  • Involving nasolabial folds, upper and lower cutaneous lip, and chin
  • Lip margin and immediate circumoral area typically spared
  • Periorbital involvement, predominantly lower and lateral eyelids may occur
  • Fine scaling may be seen
  • Eruption may be asymptomatic, or burning or itch
  • MC women aged between 18 and 40
65
Q

What should be looked for in perioral dermatitis?

A
  • Red papules, both grouped and individually, on the chin, cutaneous lips, and nasolabial folds
  • May be pinpoint pustules, may be associated with scaling and erythema
  • On occasion, lesions are periocular
  • May complain of burning and/or pruritis
66
Q

Best tests for perioral dermatitis

A
  • Clinical diagnosis
  • Biopsy can help
67
Q

Management pearls for perioral dermatitis

A
  • If perioral dermatitis triggered by use of mid- or high-potency topical steroids, then use low-potency to taper because will flare if CS discontinued abruptly
  • Warn that will likely flare before they improve after steroid stopped
68
Q

Therapy for perioral dermatitis

A
  • DC topical steroids (taper)
  • Topical pimecrolimus 1% every 12 hours
  • Topical and oral antibiotics, avoid use of gels, solutions, or lotions on eyelid –> erythromycin every 12 hours or metronidazole every 12 hours or clindamycin every 12 hours
  • Topical azelaic acid every 12 hours
  • Doxycycline if necessary
69
Q

What is dyshidrotic eczema?

A
  • Common on hands and feet
  • Pruritic vesicular rash
  • Typically history of atopic dermatitis
  • MC between 20-40 years old

Tapioca like vesicles on lateral aspects of digits

70
Q

Symptoms of dyshidrotic eczema

A
  • Itching
  • Burning
  • Pain
71
Q

Tests for dyshidrotic eczema

A
  • C&S if unsure if infection or not
  • Patch testing (not always necessary)
  • Biopsy - diagnostic
72
Q

Treatment of dyshidrotic eczema

A
  • Topical steroids
  • Under occlusion x 2 weeks
  • Severe = high dose PO prednisone 2 week taper
  • PUVA therapy

can use norwegian neutrogena with gloves

73
Q

How is a secondary bacterial infection due to dyshidrotic eczema treated?

A
  • PO ABX vs topical
74
Q

What is the course of dyshidrotic eczema?

A
  • Course chronic, relapsing
  • Spotaneous remission (clinically not usually true)
  • Improves with age
75
Q

Patient education for dyshidrotic eczema

A
  • Avoid allergens/irritants
  • Excessive hand washing
76
Q

What are emollients?

A
  • Non-cosmetic moisturizers
  • Increase skin moisture, flexibility, and prevent cracking/fissures
  • Use unscented and without anti-aging ingredients
77
Q

How should emollients be applied?

A
  • Immediately after bathing and frequently throughout day (3x/d)
  • Apply in direction of hair growth
  • Avoid excessive rubbing
  • Continue use after flare up is controlled
78
Q

What are benefits of cream emollients?

A
  • Best option for most dermatoses
  • Mixture of fat and water
  • Cooling effect on skin
  • Moderate moisturizing effect
79
Q

What are characteristics of lotion emollients?

A
  • More water, less fat than cream
  • Less effective at moisturizing skin
  • Useful for hair covered areas
80
Q

What are characteristics of ointment emollients?

A
  • Greasy; avoid on weeping eczema
  • Preferable for dry/thickened skin
81
Q

MOA of topical corticosteroids (glucocorticoids)

A
  • Decreases immune response by 4 different processes
  • Stabilizes leukocyte/macrophage/histamine activity
  • Constriction of the capillaries and reduced capillary wall permeability- improving and preventing edema formation
  • Decreases activation of complement cascade
  • Reduces fibroblast proliferation and collagen deposition which leads to reduced scar formation
82
Q

Indications for topical corticosteroids

A
  • Atopic/seborrheic, contact dermatitis
  • Lichen simplex
  • Pruritis ani
  • Nummular eczema
  • Stasis dermatitis
  • Psoriasis
83
Q

Contraindications for topical corticosteroids

A
  • Underlying bacterial infections
  • Hypersensitivity
  • Ophthalmic use
84
Q

Cautions for topical corticosteroids

A
  • Chronic use may inhibit growth in children
  • Chronic use induced Cushing syndrome, Kaposi sarcoma
85
Q

Pregnancy category of topical corticosteroids

A

C

86
Q

Classification of potency of corticosteroids

A
  • Class I-VII
  • I: highest
  • VII: lowest
87
Q

When are side effects of topical corticosteroids more likely to be seen

A
  • Continuous long term use
  • High potency steroids/vehicles
  • Facial, intertriginous, genital dermatoses
88
Q

Side effects of topical corticosteroid

A
  • Skin atrophy
  • Striae
  • Easy bruising
  • Telangiectasias
  • Change in skin pigmentation
  • Corticoid rosacea
  • Steroid acne
  • Adrenal suppression
  • Glaucoma (periorbital use)
89
Q

Characteristics of ointment as a topical corticosteroid vehicle

A
  • Semi-occlusive
  • Petroleum based
  • Most potent
  • Benefits: superior lubrication, prevention of moisture loss, increase active ingredient absorption
  • Disadvantages: greasy, avoid hairy areas
90
Q

Characteristics of creams as topical corticosteroid vehicle

A
  • Semisolid emulsions of oil in 20-50% water
  • Less potent vehicle
  • Benefits: cosmetic absorption
91
Q

Characteristics of lotion as corticosteroid vehicle

A
  • Powder in water - requires shaking of container prior to use
  • Least potent vehicle
  • Benefits: minimal residue, cooling/soothing to skin, covers large area, good for thick hair bearing areas
92
Q

Characteristics of gels as corticosteroid vehicle

A
  • Mixture of oil in water with alcohol base
  • Drying effect with minimal residue
  • Great for scalp dermatitis or acne
  • No residue
93
Q

Characteristics of powders as corticosteroid vehicles

A
  • Absorb excess moisture
  • Protect skin-skin chafing
  • Covers large area
94
Q

Characteristics of foam as corticosteroid vehicle

A
  • Gaseous bubbles of matrix of liquid film
  • Easy to spread, w/o residue
  • More expensive
95
Q

Characteristics of solution as topical corticosteroid vehicle

A
  • Low viscosity
  • Powder in water/alcohol
  • Alcohol - drying effect
96
Q

What is the lowest potency topical corticosteroid (class VII)

A

hydrocortisone

97
Q

what is the low potency topical steroid (class VI)?

A

triamcinolone .025%

98
Q

what are the med/low potency topical corticosteroids (Class V)

A
  • Hydrocortisone valerate .2%
  • Triamcinolone .1% or .025%
  • Betamethasone valerate .1% c, l
  • Betamethasone dipropionate .05% l
99
Q

what are the medium potency topical steroids

A
  • hydrocortisone valerate .2% o
  • triamcinolone .1% o
  • betamethasone valerate .12% f
100
Q

What are the medium high potency corticosteroids (class III)

A
  • triamcinolon .5% c
  • betamethasone valerate .1% o
  • betamethasone dipropionate .05% c
101
Q

what are the class II (high potency) topical corticosteroids

A
  • triamcinolone .5% O
  • betamethasone dipropionate .05% o
  • fluocinonide acetonide .05% cogs
102
Q

what is the class I topical corticosteroid

A

fluocinonide acetonide .1% c

103
Q

dosing of corticosteroids

A

qd-bid

104
Q

tapering treatment of topical corticosteroids

A
  • gradual reduction in potency and frequency of application
  • 1-2 week intervals between each reduction in dose
105
Q

Maximum duration of treatment

A
  • Class I = <3 wk
  • Class II - IV = <6-8 wk
  • Class V-VII = chronic intermittent therapy, but face, intertriginous, genital limit to 1-2 wk intervals of therapy
106
Q

Maintenance therapy with topical corticosteroids

A
  • Lowest dose/regimen possible while maintaining control
  • Switch to less potent agent for long term therapy
107
Q

What is tachyphylaxis

A
  • Progressive decrease in clinical response to same dose
  • Results fro repetitive use of same drug
  • Prevented by drug free intervals “holidays” and switching to alternative agent
108
Q

Calcineurin inhibitors

A
  • Pimecrolimus 1% cream
  • Tacrolimus .03%, .1% ointment
109
Q

MOA of calcineurin inhibitors

A
  • Inhibits t lymphocyte activation via calcineurin inhibition
  • Prevents release of inflammatory cytokines/mediators
110
Q

Dosing of calcineurin inhibitors

A

BID until clearing is noted

111
Q

Indications for calcineurin inhibitors

A
  • Atopic dermatitis
  • Off label- intertriginous and facial psoriasis, oral lichen planus; vitiligo
112
Q

Maximum duration of therapy of calcineurinn inhibitors

A
  • Pimecrolimus- 2 years
  • Tacrolimus - 4 years
113
Q

Black box warning for pimecrolimus and tacrolimus

A
  • Rare case of lymphoma and skin malignancy
  • Avoid long term use
  • Limit to areas of AD, with minimal application to maintain control
114
Q

Contraindications for immunomodulators

A
  • Hypersensitivity
  • <2 yo
115
Q

Cautions with pimecrolimus/tacrolimus

A
  • Do not use with occlusive dressing
  • Reassess if no improvement in 6 weeks
  • Pregnancy category C
116
Q

SE of immunomodulators

A
  • Burning sensation (MC) resolves with continued use
  • HA
  • URI symptoms, fever
117
Q

Pros of immunomodulators

A
  • No skin atrophy/striae
  • Safe for use on face/eyelids
118
Q

Cons of immunomodulators

A
  • More expensive
  • Black box - tumorigenicity
119
Q

What is selenium sulfide found in?

A
  • Head and shoulders
  • Selsun
120
Q

MOA of selenium sulfide

A
  • Not fully known
  • Reduction in corneocyte production
121
Q

Indications for selenium sulfide

A
  • Seborrheic dermatitis
  • Tinea versicolor
122
Q

Contraindications for selenium sulfide

A
  • Hypersensitivity
  • Oral, opthalmic, anal, or intravaginal use
123
Q

Vehicles of selenium sulfide

A
  • Shampoo
  • Lotion
  • Foam
124
Q

Dosing of selenium sulfide

A
  • Seborrheic dermatitis: apply to affected area for 2-3 mins, rinse thoroughly, repeat 2x/wk initially; maintenance therapy once q 1-2 weeks
  • Tinea versicolor: shampoo/lotion: apply to affected area, lather, leave for 10 mins, rinse thoroughly; apply QD for 7 days
  • Foam: rub into affected area q 12 h x 7 days
125
Q

SE of selenium sulfide

A

Transient burning, stinging

126
Q

What contains pyrithione zinc?

A
  • Head and Shoulders
  • Selsun
  • T/Gel
127
Q

MOA of pyrithione zinc

A

Binds to hair/skin and reduces cell turnover

128
Q

Vehicle of pyrithione zinc

A

Shampoo, lotion, cream, soap bar

129
Q

Indications for pyrithione zinc

A

Seborrheic dermatitis

130
Q

Contraindications for pyrithione zinc

A

Hypersensitivity

131
Q

Side effects of pyrithione zinc

A
  • Transient stinging/burning
  • Desquamation
132
Q

Dosing of pyrithione zinc

A
  • Shampoo: apply to wet hair/scalp, lather, rinse thoroughly
  • Bar: massage into wet area, rinse
133
Q

A 75 year old with a history of Parkinson’s disease presents with minimally pruritic facial lesions presenting for 1 week. Exam reveals scattered discrete macules approximately 1 cm in size, with an orage-red greasy scale on the cheeks and nasolabial folds. What is the most appropriate treatment?

A
  • Hydrocortisone cream
134
Q

A 47 year old male presents with worsening irritation of his hand that started as dryness and progressed to chapping and erythema and now has fissuring. He works as a janitor inn the local hospital cleaning the operating rooms. His symptoms become less severe on his days off. What advice should be offered?

A

Wear appropriate protective clothing and equipment

135
Q

A 22 year old female is complaining of a rash around her mouth. She describes a feeling of mild burning or tension but denies pruritis. Exam reveals papulospustules on erythematous bases, the vermillion border is spared. A culture is negative. What is the recommended management?

A

Topical metronidazole (could also use topical erythromycin)

Dermatology (12 decks)

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