Dermatology Flashcards
2 palm areas (2%) at 2 times a day requires ______ gm for 1 month
30
Two FTUs for corticosteroid are about the same as ___of topical steroid
2 FTU = 1g topical steroid
How many FTUs will cover a hand and fingers?
1 FTU
How many FTUs will cover face and neck?
2.5 FTUs
Class 1 steroid
- super high potency
- severe dermatoses
- scalp, palms, soles, thick plaques on extensor surfaces
Classes II-IV steroid
- medium to high potency
- can use on flexural surfaces for limited periods
Classes VI, VII
- Low potency
- large areas
- thinner skin (ex. face, eyelid, genitals)
Duration for super high potency
<3 weeks
Duration for medium to high potency
<6-8 weeks
Duration for low potency
Face and genitals: 1-2 weeks to avoid skin atrophy, telangiectasia, and acne
Examples of Class I super high potency
- Betamethasone 0.05% ointment
2. Clobetasol 0.05% cream or ointment
Examples of Class II high potency
- Betamethasone 0.05% cream
2. Fluocinonide 0.05% cream, gel, ointment, or solution
Examples of Class III medium potency
- Betamethasone 0.05% cream or lotion
- Betamethasone valerate 0.1% ointment
- Triamcinolone 0.1% ointment
Examples of Class IV
- Fluocinolone acetonide 0.025% ointment
2. Triamcinolone acetonide 0.1% cream or ointment
Examples of Class V
- Fluocinolone acetonide 0.025% cream
Example of Class VI
Triamcinolone acetonide 0.1% cream
Example of Class VII
Hydrocortisone 1% (or 2.5%) cream, lotion, or ointment
Systemic effects of topical glucocorticoid
- Cushing’s
- Pseudotumor cerebri
- Growth retardation
- Sodium retention and edema
Ocular effects of glucocorticoid
- cataract
- glaucoma
- retarded healing or corneal abrasion
- extension of herpetic infection
Bacitracin active against
gram-positive (strept, staph, pneumococci)
Of bacitracin, neomycin, and polymyxin B - which is most likely to give contact dermatitis?
neomycin
up to 30%
Mupirocin active against
gram-positive (MRSA)
Mupirocin ADE
stinging, burning, pruritis, headache
Polymyxin B active against
gram-negative
all gram positives are resistant
Neomycin active against
- aerobic gram-positive
- Gram-negative
4 factors of acne vulgaris
- Androgens influence increase in sebum production
- Hyperkeratosis (keratin and sebum plug hair follicle)
- P. acnes bacteria
- Inflammation
Comedone: tx
topical tretinoin
Mild inflammatory acne: tx
Topical tretinoin or benzoyl peroxide (and or topical clindamycin)
Moderate acne: tx
Topical tretinoin or benzoyl peroxide (+/- clindamycin)
-consider oral antibiotic and derm referral
Severe acne: tx
topicals AND oral antibiotic (doxycycline or minocycline)
(consider oral isotretinoin, derm referral and hormonal therapy for females
Cystic acne: tx
intralesional triamcinolone
Rosacea: Tx
- Sunscreen
- Topicals:
- Clindamycin 1% cream
- metronidazole
- sodium sulfacetamide - Doxycycline, minocycline
- Isotretinoin (Accutane) - stage III rosacea
Metronidazole: don’t use when?
pregnancy and nursing
What do patients taking sodium sulfacetamide need to be warned of?
photosensitivity
Retinoic acid (vitamin A)
Ex. tretinoin (retin A), adapalene (Differin), tazarotene (Tazorac)
Retinoic acids: ADE
photosensitivity
Which topical retinoid is category X in pregnancy
Tazarotene
Which medication can cause slate gray hyperpigmentation of skin?
Minocycline
also dizziness
Isotretinoin and pregnancy
- MUST be on 2 forms of contraception
- MUST have negative serum pregnancy test within 2 weeks before therapy
What labs are important to get for isoretinoin (besides pregnancy)?
LFTs, fasting lipid profile
-Hypertriglyceridemia
What does nystatin cover?
Candida only!
Seborrheic dermatitis: Tx
ketoconazole
Tacrolimus (Protopic) and Pimecrolimus (Elidel) use
atopic dermatitis
vitiligo
alopecia areata
Tacrolimus and pimecrolimus (calcineurin inhibitors) box warning
rare cases of malignancy
contraindication for kids under2
Most common ADE for Sklice (ivermectin topical)
conjunctivitis, ocular hyperemia, eye irritation
Lindane: ADE
- concentrated in fatty tissues including the brain
- Can lead to seizures***
What is the treatment for scabies or lice for pregnant women or infants (<6 months)
Sulfur precipitated in petrolatum
Monobenzone: effect
irreversible depigmentation**
(may cause hypopigmentation at sites distant to area of application
Drugs that reduce hyperpigmentation of the skin
- Hydroquinone
- Mequinol
- MBEH
Drugs for repigmentation in vitiligo are activated by what
UVA light
Drugs for repigmentation of depigmented macules of vitiligo
- Psoralens
- Trioxsalen
- Methoxypsoralen
Since SPF really only measures UVB protection, what 3 chemicals might you look for?
- Parsol 1789
- Avobenzone
- Mexoryl (Antheliose)
Major use of podophyllum resin
codyloma acuminatum (warts)
Podophyllum: contraindication
pregnancy
What is the best medication to use for actinic keratoses?
Fluorouracil
Healing lasts for 1-2 months after treatment
Imiquimod: uses
- warts (condylomate)
- actinic keratoses
- basal cell
- squamous cell carcinoma
- lentigo maligna melanoma
Bimatoprost (latisse) is a prostaglandin analogue that causes what adverse effect?
permanent brown pigmentation of the iris
Finasteride (Propecia): MOA
blocks production of dihydrotestosterone
- oral
- not for use in women of child bearing age
Eflornithine: effect
-affects the rate of hair growth
but, will come back 8 weeks after stopping
Dovonex (calcipotriene)
Vitamin D3 analog
Acitretin (Soriatane)
- Psoriasis
- systemic drug (inhibits IL-6)
- Pregnant women can’t use this, can get pregnant for 3 years after stopping treatment!**
- MUST avoid ethanol
- Can’t donate blood during treatment and for 3 years after medication is stopped
Methotrexate
-Folate antagonist contraindications: -Pregnancy -Nursing -Males not advised to father children for at least 3 months after stopping
