Dermatological Therapeutics 11.13.13

Question 1

Topical TherapyBasic Science

Answer 1

Drug delivery is dependant on:

• skin type (thin, thick)
• skin condition
• lipid vs. water-based vehicle
• charge
• concentration gradient

Question 2

Hydration does what?

Answer 2

Hydration of the skin increases absorption by making the SC more penetrable.
- Hydration spreads the cells a bit to get the medicine in

Question 3

Corticosteroids

Answer 3

Actions: Anti-inflammatory
Immunosuppressive
Anti-proliferative of cells
Vasoconstrictive

Uses: eczema, contact dermatitis,
psoriasis, itch, lichen planus

Adverse effects: SKIN ATROPHY (Thinned out and can see blood vessels)

Question 4

*Retinoids

Answer 4

Vitamin A analogs* which work through nuclear receptors on DNA causing alteration of gene transcription.

Actions: Regulate cell growth

Uses: acne, psoriasis, cosmetic skin improvement.

• can add antimicrobials to reduce inflammation

Question 5

*Calcipotriene

Answer 5

A vitamin D analog* that acts through DNA receptors to alter skin differentiation. . Normalize cell growth.

Question 6

Topical Calcineurin Inhibitors: TCIs“NONsteroidal anti-inflammatories”

Answer 6

tacrolimus(Protopic) pimicrolimus(Elidel)

Work through calcineurin to alter/inhibit T-cell activation.
A.E. : limited. Local irritation or burning.
ex. use on thin skin around the eye
Controversy about safety?!?!

Question 7

Avobenzone / Helioplex or

Mexoryl sunscreens do what?

Answer 7

are better against UVA. (400) uvB (300)
SPF is only about 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.

Question 8

*Imiquimod: Aldara cream

Answer 8

*“immune response modifier”. Increases local immune activity through *Toll receptors.

INCREASE inflammation to draw in the immune system

Question 9

*Topical 5-fluorouracil

Answer 9

5-FU* inhibits thymidylate synthase resulting in reduced DNA synthesis.
Acts selectively in actinic damaged skin cells.

Imiquimod and 5-FU Use-Actinic Keratosis-

Question 10

wound care

Answer 10

keep it covered/ wet reduce scaring

Question 11

*systemic Retinoids

Answer 11

Vitamin A analogs that bind to nuclear retinoid receptors to alter cell differentiation.
Uses: acne, psoriasis, ichthyosis, Darier’s disease, chemoprophylaxis of skin ca…..
*( repair disordered keratinization).
help slough off cells too
Teratogenicity. dont use for prego ppl

Question 12

Dapsone

Answer 12

Action: Inhibits myeloperoxidase in PMNs.
Affect on CD11a/CD18.
A Sulfone.

*(neutrophilic skin dz).

Question 13

*systemic Methotrexate

Answer 13

Action: *Dihydrofolate reductase inhibitor that disrupts DNA synthesis to block cell division. Immunosuppressive.

Uses: psoriasis (50% of body covered), lupus
A.E. :*hepatotoxicity

Question 14

Minoxidil

Answer 14

i.e. Rogaine
Action: vasodilatation and direct stimulation of hair shaft growth.

Uses: Alopecia

Question 15

Finasteride

Answer 15

i.e. Propecia
Action: Blocks 5-alpha reductase enzyme in follicles to inhibit the conversion of testosterone to dihydrotestosterone.

Uses: Androgenetic Alopecia

Question 16

Liquid Nitrogen

Answer 16

Action: Freezes tissue (-196 C)

Uses: warts, actinic keratoses, skin cancer,
others…..

Question 17

Alpha Hydroxy Acids

Answer 17

Exfoliate.
Thicken epidermis.
Stimulate collagen growth.
Increase skin profusion.

Result in fewer wrinkles, more pliable skin, with better hydration.

Question 18

Telogen Effluvium

Answer 18

“stress hair loss”.

Nonscarring.
Cause: Disrupted growth cycle of hairs causing premature shift from anagen to telogen.
Triggers: Pregnancy, Surgery, High Fever, Extreme diet,…..

Area: Diffuse scalp involvement.
“Coming out in Bunches”

Question 19

Alopecia Areata

Answer 19

Autoimmune.
-Can associate with other AI disease.

T-cells attack the hair bulb 
		(“Swarm of Bees”)
Area: Circular patches on scalp or beard.
		-A. Totalis=all scalp hair lost.
		-A. Universalis=all body hair lost.

Question 20

**Tinea Capitis

Answer 20

*Cause: Trichophyton tonsurans mostly.
Fungus growth on scalp and hair shafts.
African-American kids most common.
Possible Scarring!

‘Kerion’-intense inflammatory reaction due to zoophilic fungi.
Treatment: Griseofulvin is the standard.

Question 21

Paronychia

Answer 21

Def’n: inflammation of the nail folds.

Can be infectious or noninfectious.

Cause varies but often determines the clinical presentation.

Question 22

Onychomycosis

Answer 22

Fungal growth on or under the nail.
Common organism: Trichophyton
	rubrum or T. mentagrophytes.
Culture nail clippings.
Treat: terbinafine (Lamisil)
		     itraconazole (Sporonox)

Question 23

Androgenetic Alopecia

Answer 23

Three stages of normal hair cycle-
* Anagen->Catagen->Telogen

“Simple Baldness”, “Hereditary Alopecia”,
“Pattern Alopecia”.
Nonscarring.
Cause: Genetically determined miniaturization of follicles triggered by androgens.
Area: Top of Scalp.
Treatment: Minoxidil, Finasteride, Hair Transplants