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Clinical Medicine Jeff > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What is the tx for herpes zoster (shingles)?

A

Antivirals (within 72 hours of onset)

  • Valacyclovir*, PO Q8h x 7 days
  • Famciclovir PO TID x 7 days
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2
Q

What is the tx for atopic dermatitis (eczema)?

A

-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

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3
Q

What is the tx for stasis dermatitis?

A
  • 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
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4
Q

What is the tx for lichen simplex chronicus?

A

Topical steroids, behavioral modification, anti-anxiety meds

  • Anti-anxiety meds (Doxepin, Hydroxyzine HCl), SSRIs
  • pregabalin* (Lyrica), olanzapine* (Zyprexa)
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5
Q

What is the tx for seborrheic dermatitis?

A

Antidandruff shampoos: Selsun blue, Ketoconazole 2% cream, Ciclopirox (especially for kids),
Topical steroids: hydrocortisone (sparing/pulsed on face), Clobetasol scalp solution

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6
Q

What is the tx for acne vulgaris?

A

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)

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7
Q

What is the tx for rosacea?

A
  • Topical abx: (metronidazole* gel/cream, sodium sulfacetamide)
  • Oral abx (doxycycline*, minocycline)
  • Intense pulsed light/laser
  • NO topical steroids
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8
Q

What is the tx for perioral dermatitis?

A
  • 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
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9
Q

What is the tx for hidradenitis suppurativa (HS)?

A

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

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10
Q

What is the tx for psoriasis?

A
  • 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
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11
Q

What medications exacerbate psoriasis?

A
  • beta-blockers
  • calcium channel blockers
  • lithium
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12
Q

What is the tx for guttate psoriasis?

A
  • topical steroids (same rule of thumb as psoriasis or atopic derm)
  • treat underlying infection
  • NBUVB = Narrowband UVB, a type of phototherapy
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13
Q

What conditions are well-known risk factors for guttate psoriasis?

A

-Hx of preceding A beta-hemolytic streptococci (ex. Streptococcus pyogenes) or acute strep pharyngitis in adults

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14
Q

What is the tx for exanthematous (morbilliform) drug eruption?

A
  • D/C medications
  • Antihistamine
  • topical steroids
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15
Q

What drugs cause exanthematous (morbilliform) drug eruptions?

A
  • Sulfas
  • NSAIDS
  • ACE inhibitors
  • Allopurinal
  • Penicillins
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16
Q

What is the tx for drug-induced acute urticaria?

A
  • D/C medications
  • Antihistamine
  • systemic steroids (prednisone*)
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17
Q

What drugs cause drug-induced acute urticaria?

A
  • Penicillins
  • NSAIDS
  • Radioactive contrast
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18
Q

What is the tx for Stevens-Johnson syndrome & toxic epidermal necrolysis?

A
  • 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
19
Q

What drugs cause SJS/TEN?

A
  • Sulfas
  • Allopurinal
  • Carbamezapine
  • Ibuprofen
  • Cephalosporins
  • Fluroquinolines
20
Q

What is the tx for angioedema?

A
  • 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

21
Q

What is the tx for urticaria?

A

-H1 antihistamines (2nd generation preferred)
→ Cetirizine, Loratidine, Fexofenidine
-oral steroids may have benefit
-topical steroids for itch

22
Q

What is the tx for scabies?

A
  • Permethrin, Apply once before bed and wash off in morning, repeat after 1 week
  • Lindane, Quell
  • treat everyone, cleanse everything
23
Q

What is the tx for tinea versicolor?

A
  • Topical antifungals: ketoconazole, spectazole, selenium sulfide lotion, QD x 4 weeks
  • Fluconazole (Diflucan), Q1wk x4 weeks
  • Oral like terbinafine (Lamisil) = not so helpful
24
Q

What pathogen causes tinea versicolor?

A

malassezia furfur (overgrowth of yeast)

25
Q

What is the tx for pityriasis rosea?

A

let it run its course, steroids, anti-itching pills and creams

26
Q

What is the tx for lichen planus?

A

topical high steroids, oral antihistamines;

self-limiting in most cases

27
Q

What is the tx for erythema multiforme?

A

if herpetic treat w/ anti-virals (valtex);
topical steroids;
lidocaine if painful;
oral prednisone if extensive or refractory

28
Q

What is the tx for erythema multiforme major?

A

oral prednisone;

refer to opthalmology, derm, or ER

29
Q

What is the tx for musculosum contagiosum?

A

usually resolves within 6-12 months, but can take up to 4 years;
liquid nitrogen if symptomatic

30
Q

What is the tx for verruca vulgaris?

A

(warts on skin);
depends on location, age of pt, compliance;
most go away eventually, but they can spread;
cryotherapy

31
Q

What is the tx for condylomata acuminate?

A

(genital warts);
associated with cervical cancer, must treat;
cryotherapy

32
Q

What is the tx for impetigo?

A 
topical abx (mupirocin) & warm soaks;
oral abx if required (rare)
33
Q

What pathogens cause impetigo?

A

staphylococcus & group A streptococcus

34
Q

What is the tx for cellulitis?

A 
oral abx (cephalosporin);
warm abx soaps/washes
35
Q

What pathogens cause cellulitis?

A

Haemophilus influenzae, streptococcus, and staphylococcus

36
Q

What is the tx for a furuncle?

A

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

37
Q

What is the tx for a carbuncle?

A

I&D;
culture to R/O MRSA;
if associated cellulitis, tx w/ dicloxacillin (assume MSSA);
if MRSA, tx w/ doxycycline

38
Q

What pathogen causes erysipelas?

A

Group A Beta-hemolytic streptococci

39
Q

What pathogen causes folliculitis?

A

Staphylococcus aureus;

hot tub folliculitis: Pseudomonas aeruginosa

40
Q

What is the tx for folliculitis?

A

abx, soaps, preventative counseling

41
Q

What is the management for felon?

A

US to confirm dx;

fish mouth incision: drain thru an incision on side of finger

42
Q

What pathogen causes lymphangitis?

A

Group A beta-hemolytic streptococci (GABHS)

43
Q

What is the tx for lymphangioma?

A

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

Clinical Medicine Jeff (7 decks)

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