Dermatology Flashcards
dry skin with severe pruritis
eczema (AD)
categories of eczema
mild- infrequent itching, little effect on life
mod- frequent itching, mod effect on life, disturbed sleep
seve- incessant itch, widespread, affects life, lose sleep
first line for mild eczema
low potency topical steroid BID 2-4 weeks
first line for mod eczema
high potency topical steroid 1-2 weeks tapered to low potency
first line for eczema on face or flexures
low potency steroids x5-7 days
alternative topical CIs used for >2years and older with mild/mod eczema or in face/flexures
tacrolimus, pimecrolimus
alternative for mild/mod eczema in 3 months and older when steroids cannot be tolerated
crisaborole ointment (eucrisa) BID
alternative for >12 years in mild/mod eczema when other therapies ineffective
ruloxitinib cream (opzelura)
maximum amount of ruloxitinib cream (opzelura) that can be used in a week
60g/week
100g/2weeks
oral option for mod/sev eczema in those >12 years when other systemic therapies do not work or cannot be ussed
abrocitinib (cibinqo)
upacitinib (rinvoq)
BBW for abrocitinib/cibinqo and upacitinib/rinvoq
serious infection, mortality, malignancy, MACE, thrombosis
SC MoAbs used for mod/sev eczema when topicals do not work/not advised
dupilumab (dupixent)
tralokinumab (adbry)
immunosuppressive options for mod/sev eczema
cyclosporine, methotrexate, azathioprine
this class blocks cytokine transcription and inhibits T-cell activation
topical calcineurin inhibitors
PDE-4 inhibitor oinment for eczema
crisaborole (eucrisa)
JAK inhibitors for eczema
ruloxitinib cream (opzelura)
abrocitinib tabs (cibinqo)
upacitinib tabs (rinvoq)
erythematous, indurated, scaly plaques caused by contact with an allergen
allergic contact dermatitis
type of allergic contact dermatitis with redness, itching, swelling, and blisters 4 hours-4days after exposure to urushiol oil
toxicodendron dermatitis
first line treatment for ACD
topical corticosteroids up to 2 weeks
high or medium potency depending on whether on face/flexures
alternative for ACD that is localized or involves the face/intertriginous areas
topical calcineurin inhibitors
topical calcineurin inhibitors do not work for what type of ACD
urushiol rash
alternative for ACD >20% of BSA or on face/hands/feet/genitalia
systemic corticosteroids
drying and soothing agents for ACD/ToxicoDerm
dry- aluminum acetate soak
sooth- oatmeal bath, calamine
preventative option for toxicodendron dermatitis
bentoquatam
what does not help toxicodendron dermatitis
antihistamines do not help itch
TCIs not effective
2 treatment options for toxicodendron dermatitis
high potency topical corticosteroids
systemic corticosteroids if severe, or face/genitals (prednisone taper 2-3 weeks, medrol not long enough)
chronic relapsing condition with well-demarcated erythematous plaques, greasy/yellow scales, usually distributed in areas rich in sebaceous glands
seborrheic dermatitis
asymptomatic accumulation of greasy scales that are dark/yellow on infants between 2 weeks and 12 months old
cradle cap
topical antifungals than can be used for seborrheic dermatitis (4)
selenium sulfide
zinc pyrithione
ketoconazole
ciclopirox
AEs of selenium sulfide
discoloration of blonde, gray, or dyed hair
application of selenium sulfide
BIW to wet hair, leave for 10 mins, rinse
if using RX strength, decrease to once a week after 2 weeks of use
what ages can use selenium sulfide and zinc pyrithione
2 and older
application of ketoconazole
BIW x 4 weeks with at least 3 days between each treatment, leave in hair for 3 mins, once controlled use once a week for maintenance
AEs of ketoconazole
hair loss, skin irritation, abnormal hair texture, and dry skin
AEs of ciclopirox
ventricular tachycardia, contact derm, hair discoloration
application of ciclopirox shampoo and gel
shampoo: BIW x 4 weeks with at least 3 days between each treatment, leave in hair for 3 mins
gel: BID x 4 weeks
alternative options for treating seborrheic dermatitis
coal tar, topical steroids, topical CIs, systemic antifungals (severe cases)
AEs of coal tar
stains hair, skin, linens, photosensitivity, irritant contact derm
application of coal tar
QD at bedtime, bath in morning to remove tar and loosen scales
treatment of cradle cap
baby shampoo, soft brush to remove scales
chronic autoimmune disorder with lesions that may be itchy and/or sore and may bleed
psoriasis
most common type of psoriasis, irregular red plaques , lesions covered in scales, Auspitz sign with bleeding after scale removal
plaque psoriasis
categories of plaque psoriasis
mild: BSA <3-5%
mod: BSA 3-10%
sev: >10%, affects emotion, hands, feet, scalp, or genitals
3 first line options for MILD plaque psoriasis
topical corticosteroids- match potency to severity
calcipotriene (dovonex)
calcitriol (vectical)
dosing & max of calcipotriene for plaque psoriasis
BID, max of 100g/week to avoid hypercalcemia
alternative options for plaque psoriasis (5)
tazarotene (tazorac), TCIs, anthralin, coal tar, salicylic acid
1st line option for mod/sev plaque psoriasis dosed once weekly
methotrexate
PDE4i used as an alternative in mod/sev plaque psoriasis for those who prefer oral without risk of immunosuppression
apremilast (otezla)
vit A derivative used as an alternative in mod/sev plaque psoriasis in combo with other agents, effect takes 3-6 mos
acitretin (soritane)
IL-12/23 inhibitors (2) MoAbs used as an alternative in mod/sev plaque psoriasis, not most effective
risankizumab (skyrizi)
guselkumab (tremfya)
IL-17A inhibitors (2) MoAbs used as an alternative in mod/sev plaque psoriasis, most effective biologic options
brodalumab (siliq)
ixekizumab (taltz)
tnf-a blocker MoAb with least efficacy used as an alternative in mod/sev plaque psoriasis
adalimumab (humira)
conjunctivitis type with morning crusting and thick pus in eyes
bacterial
treatment for bacterial conjunctivitis (2)
erythromycin 5mg/g ointment 1/2 inch QID x 5-7 days
trimethoprim/polymyxin B 0.1%-10,000 U/g drops 1-2 drops QID x 5-7 days
conjunctivitis type with burning/sandy/gritty feeling, watery discharge
viral
treatment option for both viral and allergic conjunctivitis
-vasoconstrictor/antihistamine: naphazoline/pheniramine
-mast stabilizing antihist: azelastine (optivar), ketotifen (zaditor), olopatadine (patanol)
conjunctivitis type with itching, hyperemia, tearing, chemosis, eyelid edema
allergic
conjunctivitis type with direct damage to ocular tissue causing redness, edema, mucous discharge, swollen/thickened eyelids
toxic
treatment for toxic conjunctivitis
loteprednol or other minimally preserved topical steroid for short course BID to QID
treatment for fleas
calamine, oral antihistamines, topical corticosteroids, ice packs, wash area, avoid scratching
treatment for bedbugs
low/med potency topical steroids, systemic antihistamines, avoid scratching
how to use nix (permethrin)
2 months and older
wash hair, towel dry so damp
apply and leave for 10 minutes
only retreat if needed
how to use rid
2 years and older
apply to dry hair, leave for 10 mins
second treatment must be done in 7-10 days
AEs of lindane (alternative for lice)
neurotoxicity, human carcinogen
alternative for resistant cases of lice
oral bactrim + topical permethrin
treatment for pubic lice
topical permethrin or pyrethrins/piperonyl butoxide
non medication option for lice
wet combing
main treatment option for scabies
permethrin (elmite) cream
application of permethrin for scabies
apply to body onto skin from neck to soles of feet including finger and toenails
remove by washing after 8-14 hours
reapply 1-2 weeks later
treatment for resistant scabies
ivermectin x 1 then repeat in 14 days
alternative for scabies, treatment failure common
crotamiton (crotan) cream or lotion
treatment for chiggers
topical antipruritic, topical steroids, oral antihistamines, repel with DEET
treatment for mosquito bites
antihistamine, topical or oral glucocorticoid
how old to use DEET
2 months and older
AEs of DEET
rare dermatitis, allergic reaction, neurotoxicity
what to use/application for bites
local anesthetics or counterirritants TID-QID up to 7 days if 2 years and older
oral treatment for alopecia
finasteride 1 mg
AEs of finasteride
orthostatic hypotension, dizziness, decreased libido, breast tenderness, impotence
hazardous for females of childbearing age
topical treatment for alopecia and application
minoxidil- apply 2 hours prior to sleep
solution 1 mL to bald area BID
foam 1/2 cap BID for males, QD for females
AEs of minoxidil
hypotension, dizziness, tachycardia, HA
pH of healthy skin
4.7-5.7
common drugs that cause acne
lithium, valproic acid, phenytoin, isoniazid, GCs, OCs, cyclosporine, azathioprine, disulfiram, phentermine, iodides, bromides, androgens, danazol, high dose B and D vitamins
names of topical retinoids
tretinoin, adapalene (differin), tazarotene
AEs of topical retinoids
irritation, dryness, flaking, transient worsening of acne, photosensitivity
how long to see improvement with topical retinoids
8-12 weeks
topical antimicrobials
benzoyl peroxide, clindamycin, erythromycin, dapsone, minocycline
topical antimicrobials are most effective in combination with
a topical retinoid
AE of topical clindamycin
risk of pseudomembranous colitis
AE of benzoyl peroxide
bleaching of hair/clothing, erythema, scaling, xerosis, stinging
when are benefits seen with benzoyl peroxide
minimum 3 weeks
maximum 12 weeks
oral antibiotics used for acne
tetracycline, doxycycline, minocycline, sarecycline, erythromycin, bactrim, azithromycin
which hormonal agents can and cannot be used for acne treatment
CHC- ethinyl estradiol + progestin
CANNOT USE PROGESTIN ONLY
inhibit androgen binding, used for acne treatment
spironolactone, drosperinone
dosing of isotretinoin
duration of course
0.5 - 1 mg/kg/day in divided doses with food
increase to 2 mg/kg/day BID
course given 15-20 weeks
micronized isotretinoin dosing
0.4-0.8 mg/kg/day in divided doses with or without food
contraception requirements for isotretinoin
2 forms simultaneously for 1 month before, during, and 30 days after treatment
abstinence acceptable if for religious reasons
dispensing of isotretinoin according to ipledge must be
not later than the do not dispense date before being reversed
-30 days for men
-7 days for women
AEs of isotretinoin
night blindness, PSYCHIATRIC, skin photosensitivity, eczema-like rash, dry lips, dry eyes, HA, etc…
contraindications to isotretinoin
pregnancy
underlying psychiatric conditions
concomitant use w/ tetracyclines, doxycycline, or minocycline (pseudotumor cerebri risk)
AEs of azelaic acid
burning, itching, redness, hives
storage of clascoterone cream
2-8C before dispensing
patients store at room temp
discard 180 days after dispensing or 30 days after opening
which medications work for post-inflammatory hyperpigmentation
hydroquinone cream, retinoids, azelaic acid, chemical peels
treatment for acne conglobata
isotretinoin, systemic antibiotics, intralesional steroids
types of exanthematous drug reactions
maculopapular rash, DRESS
drugs that cause maculopapular rash
penicillins/cephalosporins, sulfonamides, anticonvulsants
onset of maculopapular rash
7-10 days after drug
onset of DRESS
1-6 weeks after drug
drugs that cause DRESS
allopurinol, sulfonamides, anticonvulsants, dapsone
signs of DRESS
FEVER, exanthematous eruption, eosinophilia, organ involvement (esp. liver)
treatment of dress given organ involvement
yes–> systemic corticosteroids for 8-12 weeks
no –> high potency topical steroid BID-TID x1 week
types of urticarial drug reactions
urticaria
serum sickness-like
onset of urticaria
minutes to hours, minor
drugs causing urticaria
penicillins & related, sulfonamides,, aspirin, opiates, latex
onset of serum sickness-like reaction
1-3 weeks after drug
drugs causing serum sickness-like reaction
penicillins/cephalosporins, sulfonamides
types of blistering drug reactions
fixed drug eruption
SJS/TEN
onset of fixed drug eruption reaction
minutes to days, minor
drugs causing fixed drug eruption
tetracyclines, barbiturates, sulfonamides, codeine, phenolphthalein, APAP, NSAIDs
onset & presentation of SJS/TEN
within 7-14 days
fever, bullous formation, mucous membrane involvement, epidermal necrosis & sloughing
risk factors for SJS/TEN
HIV INFECTION, lupus (SLE), malignancy, UV light or radiation therapy, genetic
drugs causing SJS/TEN
sulfonamides, penicillins, anticonvulsants, NSAIDS (oxicams), allopurinol
topical antiseptic wound options for SJS/TEN
chlorhexidine, silver nitrate, silver SULFAdiazine, gentamicin
treatment options for SJS/TEN
which is preferred?
which is absolutely contraindicated
steroids
IVIG – preferred
cyclosporine
thalidomide – CI
drugs that cause skin photosensitivity
sulfonamides, tetracyclines, amiodarone, coal tar
drugs that cause skin hyperpigmentation
phenytoin, tetracyclines, silver, mercury, antimalarials, amiodarone
aminopenicillins (amoxicillin, ampicillin) have higher cross reactivity with…
cefadroxil, cephalexin, cefaclor, and cefprozil
