Dermatology

Question 1

Anatomy of human skin

Answer 1

Question 2

What are Keratinocytes ?

What happens to old keratinocytes as new ones are made?

Answer 2

• Cells that make up the basal layer of the epidermis
• old ones migrate to the surfaces and become squamous cells that no longer multiply

Question 3

What factors affect drug absorption and what can this lead to ?

Answer 3

• Hydration
  
  • increased hydration leads to increased absorption
• Damage to stratum corneum
  
  • more damage= increased absorption
• temp/friction
  
  • increased t/f= increased absorption
• Drug particle size
  
  • smaller, soluble drugs absorb better

Question 4

Ointments (water in oil)

• Pros vs. Cons?

Answer 4

• Pros
  
  • most occlusive
    
    • Occlusive agents increase moisture levels in skin by providing a physical barrier to epidermal water loss
  • most useful for chronic lesions
  • relieves dryness, brittleness and provides protection
• Cons
  
  • Greasy
  • cosmetically noticable
  • don’t apply to acute lesions
  • don’t apply to skin folds(intertriginous), burns, or hairy areas

Question 5

Creams (oil in water)

• Pros vs. Cons

Answer 5

• Pros
  
  • most widely used
  • easily vanish when rubbed into skin
  • provides lubrication
• Cons
  
  • more drying vs. ointment
  • Not occlusive
  • application mistakes
    
    • you apply to much
    • not rubbed in well

Question 6

Lotions and Gels

• Pros vs. Cons

Answer 6

• Pros
  
  • cooling
  • may be good for oozing lesions
    
    • posion ivy
  • good for hairy areas or scalp
• Cons
  
  • Drying
  • Not occlusive
  • Must be shaken well prior to use

Question 7

For Acute lesions that are oozing, weeping, edema, itchy, red what type of vehicle would you use?

Answer 7

• Solution
• Powders
• Lotions
• Sprays
• Bath/Soaks

Question 8

For subacute lesions that are crusting, less oozing, itchy you use?

Answer 8

• Creams
• Gels

Question 9

For Chronic inflammed lesions if its dry, red, itchy, scaling, thick you can use?

Answer 9

Ointment

Question 10

What type of conditions would you see at these areas?

1. Scalp
2. Face
3. Ears
4. Chest or Abdomen
5. Back
6. Genital area
7. Hands
8. Feet
9. Generalized

Answer 10

1. Scalp= dandruff, seborrheic dermatitis
2. Face=Acne, rosacea, seborrheic dermatitis, impetigo, herpes simplex, atopic dermatitis (eczema)
3. Ears=Seborrheic dermatitis
4. Chest or Abdomen =Tinea versicolor, tinea corporis, acne, herpes zoster
5. Back =Tinea versicolor(fungal infection of the skin), tinea corporis (ring worm)
6. Genital area =Scabies, warts, herpes simplex
7. Hands =Scabies, warts
8. Feet =Tinea pedis, contact dermatitis, onchomycosis
9. Generalized =Contact dermatitis, photosensitivity

Question 11

Explain the pathophysiology of acne ?

Answer 11

Question 12

• What medications do you give to normalize follicular keratinization ?
• What medications do you give to decrease sebum production?
• What medications do you give to suppress p.acnes?
• What medications do you give to reduce inflammtion?

Answer 12

Question 13

Topical Retinoids

1. MOA?
2. Agents available?
3. C/I’s?

Answer 13

1. Stimulate epidermal cell turnover and decrease cell cohesiveness (decrease kertinocytes stickiness)
   
   • Unplug follicles
   • Reduce inflammation
2. • Tretinoin (formed from vit. A)
   • Adapalene (greater anti-inflammation then tretinoin)
   • Tazarotene (poorly tolerated)
3. Pregnancy

Question 14

Topical Retinoids

1. ADR’s?
2. Other considerations?

Answer 14

1. irritated skin-dryness, peeling, redness, hyperpigmenation (T>A)
2. • Acne gets worse before better
   • Wear sunscreen and avoid UV lights

Question 15

Benzoyl peroxide (BPO)

• MOA?
• C/I?
• ADR’s?

Answer 15

• MOA: antimicrobial, anti-inflammatory, keratolytic effects
• C/I: avoid use with trentinoin or use at separate times
• ADR’s: dryness, peeling , bleaching

Question 16

Azelaic acid

1. ) MOA?
2. ) Indication?

Salicyclic acid

1. ) MOA?
2. ) Indication?

Answer 16

Azelaic acid

1. ) MOA-reduces p. acnes causing decreased inflammation and keratinization normalization
2. ) Indication- if pt. cant tolerate everything else

Salicyclic acid

1. ) MOA-keratolytic agent, lipid soluble (inc. absorption)
2. ) Indication- less effective vs. retinoids and BPO

Question 17

Pathophysiology of Atopic dermatitis? (3 things)

Answer 17

• epidermal and immune dysfunction
• excessive water loss
• IgE mediated hypersentivity rxn

Question 18

Emollients

1. Indication?
2. Agents available?
3. Used in combo with?

Answer 18

1. cornerstone of management for atopic dermatitis

• Lanolin
• Mineral Oil
• Shea butter
• Cocoa butter
  3. ) with topical steroids - apply emollient first then wait 5-15 mins then apply steroid

Question 19

Topical steroids

1. MOA?
2. Indication?
3. Categorized by…..? but no single agent has been proven?

Answer 19

1.) causes vasoconstriction to minimize redness and inflammation

2.)Used for acute flares of atopic dermatitis

3.) categorized by potency but no single agent proven better than another

Question 20

What agents are in what potentcy group ?

Answer 20

Question 21

• Considerations for High potency drugs
• Considerations for Medium potency drugs
• Considerations for Low potency drugs

Answer 21

Question 22

ADR’s of Topical Steroids?

Answer 22

• Skin atrophy
• Striae (stretch marks)
• Rosacea
• Hypopigmentation in darker skin tones
• Tolerance
• Systemic side effects
  
  • Adrenal supression
  • HTN
  • Hyperglycemia

Question 23

How do you apply topical steroids ?

Answer 23

Question 24

Crisaborole

1. MOA?
2. C/I?
3. ADE?
4. Vehicle?
5. Indication?

Answer 24

1. Non- steroid inhibitor of PDE-4 (non steroid- can be used long term)
2. Don’t use in kids less than 2 (CrisaboroLE you must be at least 3 )
3. buring/stinging
   
   1. rare: hives
4. Ointment
5. mild to moderate atopic dermatitis

Question 25

Pathophysiology of Psoriasis For smaller areas of psoriasis you should be taking ? For larger areas?

Answer 25

* immune mediated * t-cells cause hyperproliferation of keratinocytes * leads to plaque formation (dark, silver, scaly) * cytokines/TNF-alpha further inflammation * Small= topical * large=oral

Question 26

What are the pros and cons for each topical agent when treating psoriasis ? * Emollients * Keratolytics * Coal tar * Calcipotriene (synthetic vit D3 analong) * Topical steroids

Answer 26

Question 27

Calcipotriene 1. MOA:? 2. Can be comined with? 3. Can help improve? 4. ADR's?

Answer 27

1. inhibits epidermal keratinocyte hyperproliferation (synthetic vit. D3 analog b/c vit D3 deficiency leads to increase keratinocyte hyperproliferation) 2. Can be combined with other treatments including steroids (steroid sparing effect) 3. can help improve UVB light therapy (appply after not before) 4. hypercalcemia (rare in large areas only)

Question 28

Describe each * UV-A * UV-B * UV-C

Answer 28

* UV-A * most abudant- penetrate into deep layers of skin (wrinkles) * UV-B * absorbed into supericial layer of skin (causes suburn and inc. risk of skin cancer) * UV-C * doesnt reach eart surface

Question 29

* SPF stands for? * SPF 15 protects you against * SPF 45 protects you against * How do you apply it ?

Answer 29

Question 30

Active ingrediants in sunscreens

Answer 30

Question 31

Chemical sunscreen vs physical vs broad spectrum ?

Answer 31

Question 32

waterproof sunscreen vs sweatproof sunscreen?

Answer 32