Dermatitis, etc Flashcards
Atopic dermatitis
eczema
filaggrin deficiency
lichenification, dry, scaly
Atopic dermatitis nonpharm treatment
bath
maintain hydration – NO LOTION
oral antihistamine for pruritus
Mild-moderate atopic
low dose GC desonide BID 2-4 weeks
if face, 5-7 days
high GC triamcinolone 0.5 1-2 week tapered
Topical CNI, PDE4i
Mod-severe atopic
Soak and smear high potency steroid
jak stat if refractory = itinib
– monitor liver function
SQ IL- antagonist
Immunosupressants (CNI/MTX/AZA)
Allergic contact
urushiol or latex
mild-mod ACD
med-high potency GC x 2 weeks max
if chronic or face due: topical CNI (not for urushiol)
Severe ACD
systemic GC 3-4 weeks
taper 2-3 weeks
(DO NOT GIVE MEDROL DOSEPACK)
Do not use in ACD urushiol
antihistamines
topical CNI
Latex ACD
Steroids
Epi pen
Immunotherapy
anti-IgE therapy omalizumab
Seborrheic
due to malassezia yeast
infants - cradle cap
HIV, AIDs, Parkinsons patients
Cradle cap
often resolves
Baby shampoo, remove scales
emollient cream
AVOID steroids in baby
Seborrheic mild - mod tx
use twice a week
if <2 y/o ask ped
Ketoconazole - leave in 3 min
Selenium sulfide - discoloration
Zinc pyrithione -
Ciclopirox - V tach, contact derm
Severe seborrheic tx
systemic antifungals
Itraconazole
Ketoconazole
Fluconazole
Terbinafine
Seborrheic symptom relief
topical GC
not for baby or facial
Plaque Psoriasis
chronic inflammatory immune disorder
silvery white scale
auspitz sign = removal cause bleeding
risk factors for plaque psoriasis
FHx
infection
obesity
smoking
EtOH abuse
Comorbidities of plaque psoriasis
psoriatic arthritis
cardiometabolic disease
IBD
nonalcoholic fatty liver
mood disorder
cancer
osteoporosis
Triggers for psoriasis
Koebner phenomenom (injury)
- sunburn, infection, tattoo, vax
Infection, stress
Steroid withdrawal
Medications
- NSAID, lithium, BB, Quinidine, antimalarial
Psoriasis classification
based on BSA
mild <3-5
moderate 3-10
severe >10 or affects emotions/folds
Target response for psoriasis tx
BSA <1% plaque infolvement
Mild psoriasis
- topical GC +/- vitamin D analog
- Retinol (tazorac)
alternate
- topical CNI
- keratinolytics
Mod-severe psoriasis
- MTX (monitor liver)
- Cyclosporine
Alternate
- PDEI Apremilast
- Vitamin A (Soritane)
- IL inhibitors (risankizu, guselki, Brodalu, Ixekizu)
- TNFa inhibitors
- Psoralen +UV-A
FTU
0.5g
bacterial conjunctiva
crusting, purulent
S. aureus, S.pneumo, H.inf, M.cat
- gonorrhea eye rare, prophy
- chlamyida eye, no prophy
bacterial conjunctiva prophylaxis
Gonorrhea
- erythromycin
IM or IV ceftriaxone for sx
bacterial conjunctiva treatment
QID 5-7 days (if improve BID)
1. Erythromycin ointment
2. PolymyxinB/TMP 1-2 drops
if Chlamydia
- PO Erythromyycin QID 5-7 days
– Azithromycin x 3days
Contacts w/ bacterial conjunctivitis
Give Fluoroquinolone (pseudomonas risk)
bacterial conjunctiva avoid
aminoglycosides
sulfacetamine
azithromycin (expensive, resistant)
Viral conjunctivitis
pink eye, congagious
self limiting
sandy gritty morning crust
adenovirus
prodrome - fever, pharyngitis, URI
jumps from one eye to the other
Viral conjuncitivs tx
- Lubricating ointments
+ cold compress
Symptom relief
- naphazoline/phenriamine
- azelastine
- ketotifen
- olopatadine
Allergic conjunctivitis
IgE hypersensitivity
Allergic conjunctivitis tx
avoid rub eye, avoid allergen, avoid contacts
1. antihistamine/vasoconstrictor (naphazoline/phenriamine)
2. antihistamine/mast cell stabilizer
aka
- azelastine
- ketotifen
- olopatadine
Refractory - GC
PO antihstiamine for prophylaxis
Toxic conjunctivitis
Redness, edema, mucus discharge, swollen eyelids, thickened eyelids
TAKES YEARS TO DEVELOP
Cause of toxic conjunctivitis
aminoglycoside abx eyedrop
antiviral agents
glaucoma meds
topical anesthetics
contact lens solution
artificial tears
Toxic conjunctiva tx
use preservative free
short course LOTEPREDNOL QID
NONALLERGIC conjunctivitis
Transient chemica/mechanical causes
Resolves in 24 hrs usually
Similar sx to dry eye
Diagnosis of exclusion
No keratitis, iritiis, angle closure glaucoma, style, ulceration, or blepharitis
nonallergic conjuctivitis tx
Eye lubricants
Fleas
oral antihistamines
topical GC
Bed bugs
wash, dry, freeze, professional exterminator, silica
low potency GC
systemic antihistamine
Head lice
wet comb
Permethrin NIX - wet hair
Pyrethrin/pip Rid - dry hair + retreat 7-10 days
Lindane - BBW seizure/death/carcinogen
TMP/SMX + NIX == resistant cases (kill symbiotic bacteria in lice gut that prod vitaminB)
Body lice
hot water, dry clean, evaluate STD
Topical permetrin
Pyrethrins/pip
Cillaris
Scabies
Treat all fam/close contact
wash, store bag 3 days
SX: antihistamines max 2 weeks + MEDIUM potency topical GC
Mites:
1. permetrin
2. Ivermectin
3. Crotamiton
Crusted scabies
PERMETRIN + POIVERMECTIN
Chiggers
soap/water, mitigate with belt
REPEL with DEET
topical anti-itch (methol)
Topical GC
Oral sedating AH (benadryl)
Mosquitos
nonsedating AH
Topical GC 5-10 days
Oral GC 5-7 days
Ticks
DEET ≥20%
Things to avoid in bug bites
Dibucaine
Topical benadryl
Hydrocortisone
DEET use
2 months +
conc >30% children
10-35% for most
Ticks 20% or higher
