Dermatology Flashcards
What is the tx for herpes zoster (shingles)?
Antivirals (within 72 hours of onset)
- Valacyclovir*, PO Q8h x 7 days
- Famciclovir PO TID x 7 days
What is the tx for atopic dermatitis (eczema)?
-Corticosteroids: low potency (face, neck, groin), high potency (sparingly, pulses) on body
Potencies:
High (betamethasone dipropionate x 2 wks (only to body)
Mid (Triamcinolone 0.1% cream/oint)
Low
(hydrocortisone 2.5%/Desonide cream)
-OTC moisturizers (reduces flares) (ex. ceraVe and cetaphil)
-Pimecrolimus* (elidel), Tacrolimus* (protopic), Crisaborole* (eucrisa)
-anti itch medications
-biologic injection medications
What is the tx for stasis dermatitis?
- Leg elevation, exercise, weight reduction
- support stockings
- moisturizers: Lachydrin cream, OTC ceraVe
- If dry, itching, eczematous skin, tx w/ topical corticosteroids: Triamcinolone acetonide 0.5% or Fluocinolone acetonide 0.025% pulsed
What is the tx for lichen simplex chronicus?
Topical steroids, behavioral modification, anti-anxiety meds
- Anti-anxiety meds (Doxepin, Hydroxyzine HCl), SSRIs
- pregabalin* (Lyrica), olanzapine* (Zyprexa)
What is the tx for seborrheic dermatitis?
Antidandruff shampoos: Selsun blue, Ketoconazole 2% cream, Ciclopirox (especially for kids),
Topical steroids: hydrocortisone (sparing/pulsed on face), Clobetasol scalp solution
What is the tx for acne vulgaris?
Mild: benzoyl peroxide* (1), topical erythromycin, clindamycin, and topical retinoids* (2) (differin, adapalene, retin A, tretinoin)
-gentle OTC cleanser (ex. Cetaphil)
-topical creams such as Benzaclin +/- Differin Gel (which contains adapalene, a mild retinoid)
Moderate - Severe: topicals (Benzaclin, Differin Gel) + oral abx (doxycycline or minocycline)
Severe or cystic: Isotretinoin (Accutane)
-routine lab work required, provider must register with FDA to prescribe
For females: hormonal therapies (BCP or spironolactone)
What is the tx for rosacea?
- Topical abx: (metronidazole* gel/cream, sodium sulfacetamide)
- Oral abx (doxycycline*, minocycline)
- Intense pulsed light/laser
- NO topical steroids
What is the tx for perioral dermatitis?
- 1st: topical tx (metronidazole cream*, erythromycin, pimecrolimus (Elidel))
- topical sulfa lotions (Klaron, Avar green)
- 2nd: Systemic tx (doxycycline*, macrolides (similar to erythromycin)
- NO topical steroids
What is the tx for hidradenitis suppurativa (HS)?
Mild: topical clindamycin, oral abx: doxycycline/minocycline/clindamycin (if disease resistant), intralesional corticosteroids (triamcinolone or kenalog), surgery
Moderate: oral abx: 1st line: tetracycline; For refractory cases: clindamycin/rifampin
-Adalimumab (Humira): Day 1: 4-40mg injections*; 2 weeks later, 2-40 mg injections; then 1-40mg injection every week for life
What is the tx for psoriasis?
- heavy ointments
- topical steroids (betamethasone diprop* oint. QHS x 2 weeks to body, desonide* cream QHS x 2 weeks to face/folds)
- topical vitamin D/A analogs
- anti-histamines
- coal tar preparations
- phototherapy
- methotrexate, cyclosporin
- biologic injections
- NO Prednisone
What medications exacerbate psoriasis?
- beta-blockers
- calcium channel blockers
- lithium
What is the tx for guttate psoriasis?
- topical steroids (same rule of thumb as psoriasis or atopic derm)
- treat underlying infection
- NBUVB = Narrowband UVB, a type of phototherapy
What conditions are well-known risk factors for guttate psoriasis?
-Hx of preceding A beta-hemolytic streptococci (ex. Streptococcus pyogenes) or acute strep pharyngitis in adults
What is the tx for exanthematous (morbilliform) drug eruption?
- D/C medications
- Antihistamine
- topical steroids
What drugs cause exanthematous (morbilliform) drug eruptions?
- Sulfas
- NSAIDS
- ACE inhibitors
- Allopurinal
- Penicillins
What is the tx for drug-induced acute urticaria?
- D/C medications
- Antihistamine
- systemic steroids (prednisone*)
What drugs cause drug-induced acute urticaria?
- Penicillins
- NSAIDS
- Radioactive contrast
What is the tx for Stevens-Johnson syndrome & toxic epidermal necrolysis?
- admit to ICU or burn unit
- stop any suspected meds
- ? IV systemic corticosteroids probably not helpful unless in high doses and early
- high dose IV immunoglobulins may be helpful in early TEN
- replacement of fluids & electrolytes
- debride frankly necrotic skin only
- conjunctival erythromycin ung
What drugs cause SJS/TEN?
- Sulfas
- Allopurinal
- Carbamezapine
- Ibuprofen
- Cephalosporins
- Fluroquinolines
What is the tx for angioedema?
- D/C offending agent
- Airway management (epinephrine if airway obstruction/anaphylaxis) and intubation PRN
- H1/H2 antihistamines
- glucocorticoids
-diagnostic tests (only needed if trigger is not identifiable):
→ CBC, ESR, CRP, C4 level
What is the tx for urticaria?
-H1 antihistamines (2nd generation preferred)
→ Cetirizine, Loratidine, Fexofenidine
-oral steroids may have benefit
-topical steroids for itch
What is the tx for scabies?
- Permethrin, Apply once before bed and wash off in morning, repeat after 1 week
- Lindane, Quell
- treat everyone, cleanse everything
What is the tx for tinea versicolor?
- Topical antifungals: ketoconazole, spectazole, selenium sulfide lotion, QD x 4 weeks
- Fluconazole (Diflucan), Q1wk x4 weeks
- Oral like terbinafine (Lamisil) = not so helpful
What pathogen causes tinea versicolor?
malassezia furfur (overgrowth of yeast)
What is the tx for pityriasis rosea?
let it run its course, steroids, anti-itching pills and creams
What is the tx for lichen planus?
topical high steroids, oral antihistamines;
self-limiting in most cases
What is the tx for erythema multiforme?
if herpetic treat w/ anti-virals (valtex);
topical steroids;
lidocaine if painful;
oral prednisone if extensive or refractory
What is the tx for erythema multiforme major?
oral prednisone;
refer to opthalmology, derm, or ER
What is the tx for musculosum contagiosum?
usually resolves within 6-12 months, but can take up to 4 years;
liquid nitrogen if symptomatic
What is the tx for verruca vulgaris?
(warts on skin);
depends on location, age of pt, compliance;
most go away eventually, but they can spread;
cryotherapy
What is the tx for condylomata acuminate?
(genital warts);
associated with cervical cancer, must treat;
cryotherapy
What is the tx for impetigo?
topical abx (mupirocin) & warm soaks; oral abx if required (rare)
What pathogens cause impetigo?
staphylococcus & group A streptococcus
What is the tx for cellulitis?
oral abx (cephalosporin); warm abx soaps/washes
What pathogens cause cellulitis?
Haemophilus influenzae, streptococcus, and staphylococcus
What is the tx for a furuncle?
I&D (numb with lidocaine, sometimes pack after draining, culture to determine MIC);
culture to R/O MRSA;
if MRSA +, consider trimethoprim-sulfa or doxycycline;
nasal carriage: mupirocin
What is the tx for a carbuncle?
I&D;
culture to R/O MRSA;
if associated cellulitis, tx w/ dicloxacillin (assume MSSA);
if MRSA, tx w/ doxycycline
What pathogen causes erysipelas?
Group A Beta-hemolytic streptococci
What pathogen causes folliculitis?
Staphylococcus aureus;
hot tub folliculitis: Pseudomonas aeruginosa
What is the tx for folliculitis?
abx, soaps, preventative counseling
What is the management for felon?
US to confirm dx;
fish mouth incision: drain thru an incision on side of finger
What pathogen causes lymphangitis?
Group A beta-hemolytic streptococci (GABHS)
What is the tx for lymphangioma?
Tx for stable adult/ kids 3+ that are nontoxemic (peeing drinking and well hydrated) → broad spectrum oral antibiotic until cultures are complete
(dicloxacillin, cephalexin)
analgesics, hot compress
3 and under/ systemically ill pts (fever chills myalgia enlarged lymph nodes)→ Parenteral antibiotics
analgesics, hot compress
Any children who do not improve within 48hrs → IV antistaph/antistrep therapy
