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239B > dermatology > Flashcards

dermatology Flashcards

1
Q

Ointments

A

consist mainly of water suspended in oil and exellent lube, most potent vehicles, occulsive effect, not hairy areas to to greasiness-
use: dry, lichenified lesions

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2
Q

creams

A

less potent than ointments but stronger than lotions, semisolid emulsion of oil in water, washed off with water, nonhairy areas such as palms and soles

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3
Q

lotions

A

powder in water preparation, less potent vehicle

use: moist areas, dermatoses, pruritius, hairy areas, lg areas, cooling effect on skin

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4
Q

solutions

A

water in combo with various meds/substances
coolness and aid in drying of exudative lesions
use: closed dsg, infected dermatoses or hairy areas

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5
Q

gel

A

oil in water, semisolid emulsion with alcohol in the base, transparent and colorless and liquefies on contact with the skin
use: hairy body areas and combine the advt of ointments with cosmetic adv of creams

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6
Q

corticosteroids GROUP 1 (most potent)

A 
Clobetasol propionate (Temovate; cream, ointment 0.05%)
 Betamethasone dipropionate (Diprolene; ointment 0.05%)
Halobetasol propionate (Ultravate; cream, ointment 0.05%)
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7
Q

corticosteroids GROUP 2

A 
Fluocinonide (Lidex; cream, ointment, gel, solution 0.05%)
Mometasone furoate (Elocon; ointment 0.1%)
Betamethasone dipropionate (Maxivate; ointment 0.05%)
Amcinonide (Cyclocort; ointment 0.1%)
Desoximetasone (Topicort; cream, ointment 0.25%; gel 0.5%)
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8
Q

corticosteroids GROUP 3

A 
Triamcinolone acetonide (Kenalog, Aristocort; ointment 0.1%) 
Amcinonide (Cyclocort; cream, lotion 0.1%)
Betamethasone dipropionate (Diprosone; cream 0.05%)
Betamethasone valerate (Valisone; ointment 0.1%)
Fluticasone propionate (Cutivate; ointment 0.005%)
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9
Q

corticosteroids GROUP 4

A 
Mometasone furoate (Elocon; cream, lotion 0.1%)
Triamcinolone acetonide (Kenalog, Aristocort; cream 0.1%)
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10
Q

corticosteroids GROUP 5

A 
Fluticasone propionate (Cutivate; cream 0.05%)
Fluticasone acetonide (Synalar; cream 0.025%)
Betamethasone valerate (Valisone; cream 0.1%)
Hydrocortisone valerate (Westcort; cream 0.2%)
Betamethasone dipropionate (lotion 0.05%)
Prednicarbate (Dermatop; cream 0.1%)
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11
Q

corticosteroids GROUP 6

A 
Fluocinolone acetonide (Synalar; solution 0.01%)
Betamethasone valerate (Diprolene lotion 0.05%)
Triamicinolone acetonide (Aristocort, Kenalong; cream 0.1%)
Desonide (DesOwen; cream, ointment, lotion 0.05%, Tridesion; ointment 0.05%)
Alclometasone dipropionate (Aclovate; cream, ointment 0.05%)
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12
Q

corticosteroids GROUP 7 (least potent)

A 
Hydrocortisone (Hytone; cream, ointment, lotion 2.5%, generic cream 0.1%, 2.5%
Pramoxine hydrochloride (HC Pramoxine; cream 0.1%, 2.5%)
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13
Q

group 1 and II used for

A

Groups 1-2 (severe): psoriasis, discoid lupus, severe eczema, resistant adult atopic dermatitis

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14
Q

group III- V used for

A

Groups 3-5 (intermediate): atopic derm, eczema, seborrheic derm, intertrigo, tinea, scabies (after scabicide), severe dermatitis of face

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15
Q

group VI- VII used for

A

Groups 6-7 (mild): derm of eyelids, diaper area, face, mild intertrigo.

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16
Q

group I-II use these to tx

A

Groups 1-2 (severe): psoriasis, discoid lupus, severe eczema, resistant adult atopic dermatitis

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17
Q

group 3-5 use these to tx

A

Groups 3-5 (intermediate): atopic derm, eczema, seborrheic derm, intertrigo, tinea, scabies (after scabicide), severe dermatitis of face

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18
Q

group 6-7 use these to tx

A

Groups 6-7 (mild): derm of eyelids, diaper area, face, mild intertrigo.

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19
Q

psoriasis s&s

A

Scaly plaques & papules
well demarcated, elevated, erythematous, silvery white plaques
pitting on nail beds
most psoriatic lesions are asymptomatic, but can be pruritic. Picking & scratching can worsen lesions (produce Koebner’s response?)
Skinfold lesions more likely to itch (axilla, groin, genitals = inverse proriasis)

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20
Q

differential dx of psoriasis

A 
gout
pseudogout
reactive arthritis
syphilis
squamous cell CA
nummular eczema
lichen simplex chronicus
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21
Q

management of psoriasis

A

meds = Oral retinoids i.e. methotrexate, Cyclosporine
phototherapy- uvb
topical- reduce epidermal proliferation and decrease inflammation wiht steroids (ointments pref), shampoo help, coal tar prep or vit D prep

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22
Q

methotrexate

A

oral retinoids for psoriasis
use with caution of childbearing age
effective in treating severe, recalcitrant psoriasis involving a large body area
CI: pregnancy, liver/kidney disease, anemia, colitis or debility

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23
Q

cyclosporine

A

oral retinoids for psoriasis
limited because of its potential nephrotoxicity
monitor BP, and serum creat.
Dermatologist should manage/co-manage

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24
Q

referral of psoriasis

A

medication management, pt with re-calcitrant or unresponsive psoriasis

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25
Q

education to pt on psoriasis

A

understand chronic nature, adherence with meds/ointments, avoid injury sunburn/trauma, triggers BB ASA chloroquines

26
Q

Acne Vulgaris patho

A

before puberty- androgenic stimulation which increases sebaceous gland production, abd adherent keratinization (plugged follicles)

27
Q

acne vulgaris management

A

tx comedone (retinoids), topical keratolytics (retin A) salicylic acid, inflam/bacteria with benozyl peroxide & ABX for severe acne i.e. doxy/minocycline or estrogen/spironolactone suppress the androgenic stimualtion of sebum

28
Q

acne vulgaris s&s

A

primary lesion (comedone)
open- blackhead closed- whitehead
inflam rx to sebum, fatty acids, and gm + propionibacerium acnes (cytokines causing papules and pustules)

29
Q

acne vulgaris referral

A 
cystic acne unresponsive to std therapy
systemic isotretinoin (accutane)
30
Q

contact dermatitis overview

A

eczematous dermatitis- irritant or allergic type

hands and ACD most common

31
Q

ICD vs ACD

A

irritant CD- acute- well demarcated area of erythema, scaling or crusting at site of exposure
cumulative ICD- weak irritants (cosemetics)
occurs months after continual exposure (not as ACD)
ACD_ typically acute with itch, inflam, vesicles

32
Q

differential dx of CD

A 
atopic derm
dyshidrotic eczema
bacterial or candida infection
phytophotodermatitis
herpes zoster
33
Q

distribution dx - for CD

A

scalp/ears: shampoo, hair dyes, eyeglasses
eyelid- nail polish, contact lens
face- airborne allergens, cosmetics, sunscreen
neck- necklace, airborne allergen, perfumes
trunk- meds, sunscreen , plants, clothing
axillae- deodorant, clothing
arms- same as hands, watch
hands- soap detergents, foods, plants, metal, gloves
genitals- poison ivy, rubber condoms
anal region- hemorrhoid prepartions, nystatin,
lower legs- topical meds, socks
feet - shoes

34
Q

CD patient education

A

avoid offending agent- dont use personal product until healed, domeboros solition for soothing inflammed/crusted lesions, reduce handwashing, liberal use of emollinets, anithistamines to help sleep not ithc, urushiol resin( poison oak) remains on clothing/tools for months

35
Q

CD referral

A

refractory cases, dx in ??, patch test to determine allergy

36
Q

CD tx

A

topical medium to high potency corticosteroids( group 1-5) ointments pref (less preservative)- steroid allergy use topical calcineurin inhibitors
oral prednisone- when periorbital/gential regions or >20% body SA involved

37
Q

atopic dermatitis

A

chronic DO c/o exacerbation and remissions of dry, itchy, red skin
can start in infancy (a/w asthma, allergic rhinitis, urticaria, acute reactions to foods)
FH
itch and rash develops rash followed by lichenification if untreated
pruritic, erythematous, dry patches of skin, often w/ scale. linear excoriations. ill defined borders, crusting and oozing are common
Infants: cheeks, scalp, forehead, extensor extremities
Adults: generalized typically on face, neck, flexural folds, wrists, and dorsa of feet.

38
Q

atopic dermatitis triggers

A

Aggravating factors
dry skin, sweating, heat, dry environments, occlusion(athletic equipment, dressings, gloves)
topical agents (soap, laundry detergents) and wool make it worse
exacerbated by infections, stress, allergies

39
Q

atopic dermatitis differential dx

A 
seborrheic derm: 
psoriasis: 
Scabies: 
Molluscum contagiousum: 
tinea:
40
Q

atopic dermatitis tx

A

moisturize for dryness
antihistamines for itching and sleep aid.
hydration w/ tepid water bath immediately followed by emollient like petrolatum
Topical mild corticosteroid ointment for inflam
discontinue once inflam has reduced but continue lubricants and emollients
Nonsteroidal calcineurin inhibitors (tacrolimus and pimecrolimus) for chronic mod to severe AD
Treat secondary bacterial, fungal, or viral infection
Systemic corticosteroids reserved for extreme cases.

41
Q

atopic dermatitis education

A

Must avoid rubbing and scratching
Avoid known triggers; continuous use of lubricants and emollients to decrease need for topical corticosteroids.
use mild soaps and laundry detergents

42
Q

scabies s&S

A

itching, (esp at night)
lesions at site of infestation & lesions secondary to hypersensitivity to mite
intraepidermal burrows are linear or serpiginousNOT “typical”
common sites: interdigital spaces (web spaces), wrist, arms, genitals, feet, buttucks, axillae

43
Q

scabies differential dx

A 
contact dermatitis
asteatotic dermatitis
insect bites
animal scabies
seborrheic dermatitis
psoriasis
44
Q

scabies tx

A

Apply Permethrin 5% head (neck) to toe (sparing face); leave on for 8-12 hrs; and then wash off
May use antihistamines & corticosteroids after permethrin for itching
Ivermectin off-label is PO med used as well

45
Q

patient education on scabies

A

all household contacts must be identified and treated
all clothing & bedding must be washed in hot water and dried on hot cycle
stuffed sofas & chairs should be vacuumed
materials that cannot be washed should be placed in a plastic bag for 1 week

46
Q

seborrheic dermatitis s&S

A

dry, flaky scales
greasy, erythematous, sharply marginated plaques
FYI: (this is Cam’s two cents) often in adults nasolabial folds & eyebrows. Golden dry flaky hue & on scalp (aka dandruff & in infants = cradle cap)
Unknown cause, over reaction to normal yeast on skin ?? (hence use anti-fungal cream to treat yeast, and then stop over reaction)

47
Q

seborrheic dermatitis differential dx

A 
dandruff
scabies
asteatotic eczema
psoriasis ** in particular this is hard 
candidal infection
intertrigo
48
Q

seborrheic dermatits tx

A

topical 2% ketoconazole
10% sodium sulfacetamide wash daily
if above doesn’t work, topical steroid
shampoo = Nizoral 1% OTC

49
Q

patient education on seborrheic dermatitis

A

this is chronic & recurrent

monitor for early flares (and Cam’s two cents: avoid triggers - sun, ETOH etc)

50
Q

fungal infections

A 
dermatophytes most common fungi
tinea capitis
tinea corporis 
tinea cruris 
tinea pedis 
tinea manus
tinea unguium
51
Q

tinea capitis

A

head/scalp - patchy, scaly, nonscarring areas of hair loss

52
Q

tinea corporis

A

body-erythematous plaques and papules in annular or arciform pattern=elevated borders w/ central clearing

53
Q

tinea cruris

A

jock itch- groin and upper thigh, gluteal folds: erythematous scaling patches w/ raised borders. often spares scrotum.

54
Q

tinea pedis

A

athletes foot- interdigital scaling, maceration, and fissuring, also scaling eruption on sole and sides of foot

55
Q

tinea manus

A

hand- dry, diffuse, scaly eruption of palms, w/ shrp marginated plaques on dorsum.

56
Q

tinea unguium

A

nail aka onychomycosis

begins in distal nail bed and spreads to infect nail plate=thickened/yellowed nail

57
Q

patient education on fungal infections

A

caution use of OTC steroid creams for long-term use (causes skin thinning and striae)
absorbent powders help reduce moisture and prevent reinfection.
Tinea capitis: clean combs, towels and bedding; don’t share
refer if start ORAL ANTIFUNGALS

58
Q

canidiadisis

A

appearance depends on location
thrush (oral cavity): white or gray membranous plaques w/ base-macerated and brightly erythematous
lesions can extend down esophagus, lips.
skin: axillary, gluteal, interdigital, perianal/diaper region, panniculus foldes, shaved areas (folliculitis of beard), vagina, glans penus.
Treatment: powders, vaginal douches, oral suspensions, creams and tablets

59
Q

tinea versicolor

A

chronic, asymptomatic, superficial lesions
white or light pink in hypopigmented version or tan and brown in hyperpigmented version; pigment returns w/ treatment.
slightly scaly, round/oval coalescing papules and plaques.
sternum, sides of chest, abdomen, or back, pubis, intertriginous areas.
Treatment
antifungal creams (imidazoles), shampoos w/ selenium sulfide or pyrithione zinc x 7-14 days consecutively

60
Q

management of most tinea

A

Acute, exudative lesions - drying agent like aluminum 1)sulfate (Domeboro) soaks
2) topical antifungal solutions and creams
3) keratolytic agents remove thick scales on hands and feet allowing topical antifungal agent to penetrate.
4) Oral antifungals: for widespread tinea or infections involving scalp and nails. consult
Onychomycosis: terbinafine 250mg daily x 6wks for fingernail and 12wks for toenail
**monitor liver fx and CBC for SE of neutropenia

61
Q

most fungal infections application of steroids

A

BID- tx for 2 weeks , tinea pedis, tinea unguium and tinea capitis require 6 weeks or more of tx

239B (14 decks)

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