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Treatments > Dermatology - Acne, Rosacea, Psoriasis > Flashcards

Dermatology - Acne, Rosacea, Psoriasis Flashcards

1
Q

What do you treat mild acne?

A

topicals

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2
Q

What do you treat moderate acne?

A

topical and or oral ABX

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3
Q

What do you treat severe acne with?

A

oral isotretinoin

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4
Q

What are acne topicals for oily to normal skin type?

A

gels, solutions, lotions

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5
Q

What are acne topicals for normal skin?

A

gels, solutions, lotions, creams

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6
Q

What are acne topicals for normal to dry skin?

A

lotions, creams

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7
Q

What are pt issues for topicals?

A

bleaching, odor, irritation

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8
Q

What is the most common trigger for acne in females?

A

Hormonal - androgens

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9
Q

What are environmental issues for acne?

A

diet, location, mechanical pressure, season, stress

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10
Q

What is salicyclic acid useful for?

A

self-treatment of small blackheads

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11
Q

Why do pt use salicyclic acid first when not first line treatment?

A

available OTC

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12
Q

What does salicylic acid do?

A

increases sloughing of skin, mildly irritating

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13
Q

What is benzoyl peroxide useful for?

A

superficial inflammatory acne

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14
Q

What does benzoyl peroxide do?

A

increases sloughing of epithelium and loosens follicular plug
NOT an antibiotic

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15
Q

What is the process of acne?

A

hyperproliferation of ductal epidermis, increased sebum, propionibacterium acne, inflammatory

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16
Q

What are the different forms of benzoyl peroxide?

A

soaps, washes, creams, gels, lotions

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17
Q

What products work against abnormal kertinization of follicle in acne?

A

salicylic acid, benzo peroxide, topical retinoidsm isotretinoin

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18
Q

What product works for abnormal sebum in acne?

A

antiandrogens, isotretinonsm, oral or topical ABX

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19
Q

What are the adverse effects of benzoyl peroxide?

A

dryness, redness, peeling

may bleach hair and clothing

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20
Q

What is the starting dose for benzoyl peroxide?

A

2.5 or 5% and every other day

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21
Q

What are retinoids?

A

vit A derivities

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22
Q

What do retinoids do?

A

epithelial differentiation dependent on vit A, increases cell turnover

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23
Q

What are the formations of retinoids?

A

gel or cream

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24
Q

What are the adverse effects of retinoids?

A

burning, stinging, scaling, photosensitivity

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25
Q

What are the retinoid products?

A

tretinoin, adapalene, tazarotene

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26
Q

What does tretinoin do?

A

decrease layers of stratum corneum from 14 to 5, lessens wrinkles and scars

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27
Q

What is the first line retinoid?

A

adapalene

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28
Q

What is the most effective retinoid and what is bad about this?

A

tazarotene - preg cat X

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29
Q

What is azelaic acid?

A

antibacterial against P acnes and s epidermis, anti-inflammatory

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30
Q

What does azelac acid helpful for?

A

hyperpigmentation due to inflammation

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31
Q

What are the formulations of azelaic acid?

A

cream, gel, foam

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32
Q

What are the adverse effects of azelaic acid?

A

burning, itching, stinging

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33
Q

Why is oral abx not first line for acne?

A

issues with resistance as well as long-term exposure

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34
Q

What are the oral abx used for acne?

A

tetracycline, doxycycline, minocycline

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35
Q

What are the problems with ABX with acne?

A

cannot use under age 8
photosensitivity
tetracycline must be taken on empty stomach
minocycline - hyperpigmentation, toxic hep, drug induced lupus
give with lots of fluids because cause esophageal irritation

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36
Q

What is isotretinoin?

A

vit A metabolite

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37
Q

What does isotretinoin cause?

A

decreased sebum production, inhibit growth of p acne, decrease inflammation

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38
Q

What is the preg cat for isotretinoin?

A

preg cat X, requires IPledge program

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39
Q

What are the side effects of isotretinoin?

A 
Depression
Drying of mouth, eyes, skin, nasal mucosa
Inflammation of lips
Hypertriglyceridemia
Alopecia
Muscle and joint pain
Photosensitivity
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40
Q

What is the only isotretinoin that does require to be given with food?

A

Absorica

41
Q

How long is isotretinoin given?

A

5 months

42
Q

What is first line for comedonal, noninflammatory?

A

something that will induce exfolitation

  • retinoids
  • BPO
  • azelaic acid
43
Q

What are first line tx for mild to moderate papulopustular inflammatory acne?

A

decrease p acnes in follicle

  • adapalene + BPO
  • oral abx + adapalene
44
Q

What is the first line for severe papulopustular, nodular acne or conglobate?

A

oral isotretinoin

45
Q

What are the types of rosacea?

A

erythematotelangiectatic
papulopustular
phymatous
ocular

46
Q

What is rosacea that has flushing and spider viens?

A

erythematotelangiectaticc

47
Q

What are rosacea with thickening of skin and overgrowth of blood vessel?

A

phymatous

48
Q

What is roseacea with redness with bumps and pimple-type lesions?

A

papulopustular

49
Q

What is rosacea with redness of eye with dryness, tearing, burning and swelling?

A

ocular

50
Q

What are the topical treatment options for rosacea?

A 
Sulfacetamide/sulfur
Metronidazole	
Azelaic acid
Ivermectin
Brimonidine
51
Q

What are the oral treatments for rosacea?

A

ABX and isotretinoin

52
Q

What is first line tx of papulopustular roacea?

A 
metronidazole (MetroGel)
applied once a day
anti-inflammatory effects 
Azelaic acid (Azelex)
bid, more expensive
53
Q

What are the adverse effects of?

A

facial burning, stinging, itching

54
Q

What is the efficacy of sulfacetamide or sulfur?

A

limited, cannot use with sulfa allergy

55
Q

What is ivermectin (soolantra) used for only?

A

papulopustular rosacea

56
Q

What is the features of ivermectin?

A

applied once a day, possibly more effective than other two, kills skin mites and anti-inflammatory, expensive

57
Q

What is the alpha 2 receptor agonist for rosacea?

A

brimonidine (Mirvaso), only good for erythema, expensive

58
Q

What are oral abx for papulopustular rosacea and erythema (but not spider veins) in erythematotelangiectatic rosacea?

A

Doxycycline, TMP/SMX, erythromycin, metronidazole, ampicillin, clindamycin, dapsone

59
Q

How long do you give oral ABX for rosacea?

A

12 weeks then switch to topical, give low dose

60
Q

What is the rate limiting step to topical absorption?

A

thickness of stratum corneum

61
Q

What factors affect topical absorption?

A

hydration, formulation, applying more does not increase how quick absorbed

62
Q

What is the formulations from most absorbative to lease?

A

gels> ointment > cream

63
Q

Why do gels have alcohol in them?

A

increase penetration, dry quickly, drying or stinging, drug is well dispersed

64
Q

What are most occlusive but also greasy?

A

ointments

65
Q

What is fingertip unit?

A

one fingertip = 500 mg, enough to cover front and back of hand

66
Q

How many fingertips are needed to cover trunk front and back?

A

15

67
Q

Where are low dose steroids used?

A

thin stratum corneum and for limited time

68
Q

What is mid and high potency used in adults?

A

average or thick stratum corneum

69
Q

How long do you use steroid?

A

2-4 wks then taper to prevent flare

70
Q

What are the adverse effects of steroids?

A

Skin: atrophy, telangiectasia, striae distensae, acne, folliculitis, and purpura
Exacerbation of rosacea, fungal infections
Rebound
Systemic effects rare but possible

71
Q

What are class 1 superpotent topical steroids?

A

betamethazone diproprionate 0.05%

Clobetasone propionate lotion/spray/cream/shampoo

72
Q

What are class 2 potent topical steroids?

A

betamethasone diproplionate 0.05
Desoximetazone0.25%
fluocinonide0.05%

73
Q

What are class 3 upper mid strength topical steroids?

A

betamethasone valerate
fluticasone propionate
mometasone furoate
triamcinolone acetonide

74
Q

What are some vit D analogs?

A

Calcipotriene (Dovonex)

Calcipotriene/betamethasone dip (Enstilar, Taclonex)

75
Q

What do vit D analogs do?

A

inhibit keratinocyte proliferation and improve differentiation

76
Q

What are the adverse effects of vit D analogs?

A

Burning, stinging, redness, itching, peeling, drying – diminish over time
Systemic absorption is a concern only in doses over 100 g per week
Calcipotriene inactivated by UVA

77
Q

What is the goeckerman regimen?

A

coal tar + UV light

78
Q

What does coal tar do?

A

suppress DNA synthesis, decrease cell division

79
Q

What are problems with coal tar?

A

otc varies quality
staining
odor
irritation

80
Q

What are calcineurin inhibitors and their characteristic?

A

Tacrolimus and pimecrolimus
good for thinner skin, must be occluded to work on thick plaques
stops activation of T cells
black box warning of malignancy

81
Q

What is anthralin?

A

tx for psoriasis
not as good as steroids or vit D
unknown patho
causes stinging, skin staining

82
Q

What is the mot effective when used along with topical steroids for psoriasis?

A

tazarotene

83
Q

Can you use salicylic acid on kids?

A

NO

84
Q

What is the best evidence treatment for psoriasis?

A

Monotherapy with topical corticosteroid, vitamin D analog, or tazarotene
Combinations
Topical corticosteroid + vitamin D analog
Topical corticosteroid + tazarotene

85
Q

What does steroids do?

A

itching, redness, inflammation reduction

86
Q

What are some other strategies of psoriasis treatment?

A

Monotherapy with tacrolimus, pimecrolimus, coal tar
Combinations
Topical corticosteroid + salicylic acid
Tacrolimus + salicylic acid

87
Q

When is phototherapy contraindicated?

A

pt with lupus or xeroderma pigmentosum

88
Q

What is the traditional systemic therapy for psoriasis?

A

methotrexate

89
Q

What is the most effective systmeic therapy for psoriasis?

A

cyclosporine

90
Q

What is the least effective systemic therapy and used with phototherapy?

A

acetretin

91
Q

What are the risks of methotrexate use?

A

hepatotoxicity, bone marrow suppression

92
Q

When is methotrexate contraindicated?

A

pregnancy, renal or hepatic impairment, presence of leukemia or thrombocytopenia

93
Q

What are the cyclosporines used for psoriasis?

A

Gengraf, neoral, sandimmune

94
Q

What do cyclosporines do?

A

inhibit production and rlease of IL 2, inhibit activation of resting T lymph

95
Q

What are the risks of cyclosporine?

A

HTN, lymphoma, cutanoeous malignancies, structural kidney disease

96
Q

What are the contraindications of cyclosporine?

A

uncontrolled HTN, renal dysfunction, concomitant tx with MTX, PUVA, UVB, coal tar, radiation or immunosuppressant

97
Q

What are the contraindications for acetretin (soriatane)?

A 
females who are pregnant who might become preg in 3 years
severe liver or kidney disease
uncontrolled dyslipidemia
use of MTX or tetracycline
ETOH use
98
Q

What are the other biologics used for psoriasis?

A 
Adalimumab (Humira)
Certolizumab pegol (Cimzia)
Etanercept (Enbrel)
Golimumab (Simponi)
Infliximab (Remicade)
Ixekizumab (Taltz)
Secukinumab (Cosentyx)
Ustekinumab (Stelara)
Apremilast (Otelza)

Treatments (10 decks)

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