Dermatology Flashcards
What are the 3 kinds of inflammatory acne?
- ) Papulopustular Acne
- ) Nodulocystic Acne
- ) Acne Congloblata
Acne Facts
- most common in age 18-19 and in males
- no cure, treat to control condition
- 2 months to form, 2 months for treatment to work
- treat entire affected area
- pick and pop leads to inflammation and scarring
- cleans twice a day
- inflammation, not an infection
Benzoyl peroxide
- seen in many OTC cleansers
- helps to open pores
- helps prevent against antibiotic resistance
- SE’s of dryness, itching, redness, BLEACHING
the 2 topical antibiotics used are…
clindamycin and erythromycin
combo product of topical BP and antibiotic
BenzaClin gel
When are topical retinoids used?
- to combat comedonal acne
- can cause dryness and peeling
topical retinoid that is FDA approved to treat acne and wrinkles
Retin-A (tretinoin)
Finaca Gel
FDA approved for inflammatory acne and rosacea
works well for women acne (nodular along jaw and neck)
topical agents that are indicated for mild to moderate inflammatory acne and comedonal ance
Epiduo gel
Ziana gel
Oral antibiotics are used in acne for…
moderate to severe inflammatory acne
Doxycycline
- most common of tetracyclines
- if you go brand you get less GI upset and sun sensitivity
- take with food and NOT before bedtime
Tetracycline
-take an hour before or two hours after meals
Minocycline
- grey pigmentation, pseudotumor cerebri, SLE like syndrome
* no GI upset
SE’s of all of the tetracyclines
- yeast infections
- decrease effectiveness of OCPs
- tetratogenic
- avoid in children under 8
oral Erythromycin
- write enteric coated if possible
- GI upset
- effective option for patients under 14
Don’t treat acne with oral antibiotics alone. Discontinue abx once a patient is controlled and only treat topically
.
Isotretinoin (Accutane)
- indicated for severe inflammatory nodular acne resistant to maximal conventional treatment
- 20-24 week course
- weight based medication
- SE’s: dryness, pseudotumor cerebri, joint aches, elevated LFT’s and lipids, depression, tetratogenicity
- monthly labs
- ALL women must be on 2 forms of birth control
- must be in iPledge prescriber
What labs must be ordered with Isotretinoin?
All patients: CBC, CMP, lipids
Women: HcG
Yaz
good for acne that is hormonally driven
FDA approved for moderate acne
Topical Rosacea Medications
- ) Metronidazole
- ) Finacea Gel
- ) Mirvaso Gel
- ) Soolantra Cream
- ) Sulfa Cleansers
- ) OTC Redness Relief
How long does it typically take to notice an improvement with topical rosacea therapies?
- 12 weeks
- treatment is long term because the condition is considered to be chronic
only FDA approved rosacea medication
- Oracea (low dose doxycycline)
- low dose is proven to control inflammation w/o SE’s of bacterial resistance, GI upset, or sunsensitivity
What are the 3 oral Rosacea medications?
- ) Oracea
- ) Tetracycline
- ) Erythromycin
Ocular rosacea
- Patient’s will c/o dry, gritty, sensation in their eyes
* oral antibiotic is required to treat this
4 Rules of Topical Corticosteroids
- ) Lower number class = higher potency
- ) Higher potency = more SE’s
- ) If you step up, you must step back down
- ) Always apply BID
TAR SE’s of topical corticosteroid use
Telangiectasia fromation
Atrophy of skin (don’t apply to face)
Rebound Flaring
*HPA suppression
How do you taper a patient on topical corticosteroids?
- in days (spread out same med over greater course of time)
- or in strength (taper down in class to give them lower potency of steroid)
good for severely dry or irritated skin bc it creates a barrier, oil based on not asthetically pleasing
ointments
most common topical vehicle, water based with oil soluble ingredients
creams
convenient for large surface areas as it spreads easily
lotion
mainly water and evaporate quickly, leave minimal residue
gels
absorb quickly, good for hairy regions of the body
foams
liquid with water or alcohol base, may sting, good for scalp
solution
When do we use high dose steroids
- ) Thickened Skin
2. ) Severe flares
When do we NOT use high dose steroids
- face
- intertriginous areas
- areas of occlusion (stockings or bra line)
When do we use moderate/low dose steroids
- face, intertriginous areas, occlusive areas
- mild to moderate flares
When do we NOT use mild to moderate steroids
- thickened skin
- severe flares
Steroid Exceptions to the rules
- ) Elocon Cream/Ointment = don’t thin the skin
2. ) thickened skin on the face
SE’s of a 1cc triamcinolone acetonide injection are…
NON-REVERSIBLE
-infection, bleeding, pain, high steroid glucose intolerance
Calcineurin Inhibitors
non-steroidal immunosuppressants which help to decrease inflammation and itching w/o suppressing the entire immune system
- NOT APPROVED for children under 2
- Black Box warning for cancer, not proven cause
- Elidel or Protopic
Topical Keratolytics
help to soften and shed the epidermal skin layer
commonly used for calluses, ichthyosis and keratosis pilaris
BID for 2 months if you want good results
if its scaly, consider it to be……..
FUNGUS!
capable of invading the skin, hair, and nails
molds
dermatophytes (most skin, hair, and nail infections)
non-dermatophytic molds
yeasts
Candida
Pityrosporum
Fungal infections of the epidermis are typically localized and treated topically BID for 14 days
.
Topical Antifungal
Nizoral (ketokonazole)
covered well by insurance, FDA approved for dermatophytes and Candida
Nystatin
works well for Candida but NOT for dermatophytes
Oral antifungals are rarely used for skin infections unless…..
extensive infection
patient is immunocompromised
*if so use Lamisil
What is the gold standard therapy for tinea capitis?
Lamisil
approved for adults and children 4 and over
dosed based on weight
When do you suspect tinea unguium/onychomycosis?
when nails are thickened and there is underlying nail debris
You cannot look at the nail and diagnose fungus! You NEED to culture it
.
Oral Onychomycosis Therapy
Lamisil
6 weeks for hands, 12 weeks for feet
SE’s: metallic taste, rash, liver dysfunction
*check LFT’s one month into treatment!
nail won’t be clear at end of treatment (6 to 12 months for regrowth)
nail fungus with liver disease
Penlac
apply daily for 1 year
Topical steroids will fertilize fungal infections. If you treat a rash with a steroid and it becomes worse, it could be a fungal infection
.
Use Lotrisone = need to taper
betamethasone diproponate has a steroid in it
if not, rebound flare
Hives
use antihistamines!
what works for one person may not work for another
need certain level in blood stream, take QD for 5 days to start
only helps itching related to hives
Drowsy Antihistamines
Benadryl
Atarax
Non-drowsy Antihistamines
Claritin
Zyrtec
Xyzal
Allegra
Topical Treatment for Uricaria
OTC Sarna Lotion
only provides short term relief on top of the skin, not treating the underlying problem
Tell all urticaria patients that if they develop SOB, they need to go immediately to the ER. They are in anaphylaxis and need a shot of epinephrine
.
Scabies
parasitic infection that only affects humans
very itchy and contagious
easily treated
Scabies treatment
elimite (permethrin) cream- apply neck down and leave on for 8-10 hours, it can be drying so moisturize after if needed
topical corticosteroids- short term itch relief, patients may itch for 1 week after treatment
Household Cleaning- wash clothes with warm soapy water, tie off pillows and stuffed animals for 48 hours (mites die in 24 w/o human contact)
