Dermatology: Clinical Therapeutics Flashcards
How is ‘hot spot’ treated?
- Clip and clean with topical antiseptic/antimicrobial
- Systemic/topical anti-inflammatory
- Look for underlying disease- FAD, pruritic trigger
Pyotraumatic dermatitis- surface overgrowth
How is ‘hot spot’ treated?
- Clip and clean with topical antiseptic/antimicrobial
- Systemic/topical anti-inflammatory
- Look for underlying disease- FAD, pruritic trigger
Pyotraumatic dermatitis- surface overgrowth
How is fold dermatitis treated?
- Topical antiseptics/anti-microbial and topical/systemic antiinflammatories
- Look for underlying cause- obese
May progress to superficial or deep infection
What are these lesions?
Superficial pyoderma lesions
How are superficial pyodermas treated?
- Underlying cause- identify/treat/manage
- Topical treatment
- Systemic ABs- if proven infection and/or no response to above
When it topical therapy the only therapy indicated?
- Surface infections
- Otitis externa
- Most cases of superficial pyoderma
How is malassezia dermatitis treated?
Shampoo first line
* Chlorohexidine and minconazole
Other topical preperations for skin/ears
* clotrimazole, miconazole, nystatin, terbinafine, selenium sulfide
Systemic antifungals- if chronic or severe
Allergy vax- atopic dermatitis and is hypersensitive
What are the different antiseptics for the skin?
Chlorhexidine
* Shampoo
* Conditioner
* Spray
* Gels
* Wet wipes
Hypochlorous acid- spray/rinse
How should deep pyoderma be treated?
Localised- topical antiseptics and ABs
Severe- systemic ABs on C&S- mixed infection usually
How long should ABs be used for in superficial and deep pyodermas?
Superficial- 2-3 weeks
Deep- 4+ weeks
- Past clinical, cytological cure
How long should ABs be used for in superficial and deep pyodermas?
Superficial- 2-3 weeks
Deep- 4+ weeks
- Past clinical, cytological cure
What are suitable first line antibiotics for pyoderma?
- Amoxicillin ± clavulanate
- Tetracycline/doxycycline
- Clindamycin
- Metronidazole
What are the phases of treatment of immune mediated skin disease?
Removal or treatment of any external triggers and control of the immune response
Induction of remission
* Days to weeks
* Aggressive therapy
* May need to add/change treatments
* Acoid severe adverse effects
* Regulat treatment monitoring
Transition
* Weeks to months
* Taper to lowest effective dose
* Taper drugs with most risk of adverse effects
* Treatment monitoring frequency reduces
* If no relapse with advanced dose tapering, stop treatment to determine cures
Maintenance
* Months to years
* Cases where relapses have occured in transition phase
* Lowest effective dose and monitor for adverse effects
* Treatment monitoring as determined by treatment and dose
What is commonly the approach to IMSD primary treatment?
- Steroids until stable then gradually taper every 1-2 weeks until minimal effective dose- side effects
- Depending on disease alternative or additional medication- cytotoxics, ciclosporing, oclacitinib
What are the effects of steroids at low, intermediate and high dose?
Low- physiological dosing
* replace glucocorticoids that are absent- adrenal insufficiency
Medium dose- anti-inflammatory dosing
* reduce inflammation and pruritus
Immunosuppressive- high dose
