Dermatology: Wk 2 Flashcards
Acne vulgaris, a disorder of:
Pilosebaceous follicles
4 factors involved in formation of acne lesions
Inc in sebum
Keratin and sebum plug hair follicle
C. acnes proliferates in follicle
Inflammatory response
Tx for moderate comedonal and inflammatory acne
without scarring
Benzoy peroxide + Topical retinoid cream
Refer pts to derm if:
Cystic, Scarring, or difficult to control
Adapalene, Tazarotene, and Tretinoin are all forms of
Topical Retinoids
Which topical retinoid is category X and contra-indicated in pregnancy?
Tazarotene
Topical Abx in the treatment of acne
Erythromycin 2%
Clindamycin 1%
How do topical Abx work in the treatment of ACne
Reduce number of C. acnes and reduce inflammation
What needs to be added when the acne is moderate- severe
Oral abx
SE of Minocycline (an oral abx for acne)
Dizziness, ataxia, nausea, vomiting
1st line Oral Abx tx for acne
Tetracycylines:
Tetra, Doxy, and Mino
2nd line Oral Abx tx for acne
Macrolides
“mycins”
Adverse effects to Tetracycline Abx
- tetracycline
- doxycycline
- minocycline
GI upset
Photosensitivity
Minocycline can cause vertigo, dizzy, and hyperpigmentation (GI upset and photosens are less common with Mino)
Tetracyclines are CONTRA in who
Pregnant
Children younger than 8
If pt has not responded after 3 mo of oral abx
Increase dose
Change abx
Refer to Derm
Minocycline and pigmentation
CAUTION
brown or blue/gray
may occur in scars
may not fade after stopping med
if on long term Minocycline, screen. If see on gums or sclerae, stop med
Oral Isotretinoin
For severe, nodulocystic acne failing other therapies
SE: xerosis, chelitis, elevated liver enzymes, hypertriglyceridemia
Isotretinoin is NEVER used with what?
Tetracycline (tetra, mino, or doxy)
because both have small risk of developing pseudotumor cerebri
Tx for acne in post-teen women
possibly associated with PCOS
Spironolactone
Commonly used meds to treat hormonal acne- other than Spironolactone
Yaz
Ortho Tri-cyclen
Estrostep
Acne Rosacea
looks similar to Vulgaris, but ABSENCE of comedones
Red swollen distorted skin
Easy flushing, redness, telangiectasias, papules, pustules
Acne Rosacea
Triggers to Acne Rosacea
Alcohol Sun Hot beverage Spicy food Emotional stress
NOT related to hormones
Acne Rosacea often also affects the
EYES
Tx for Acne Rosacea
Topical and Oral tx improve the papules and pustules
BUT
will not reverse the underlying redness and flushing
Periorificial Dermatitis Tx
around the mouth
- Topical steroid taper
- Oral Tetracycline (older) or Oral Erythromycin (younger)
- Topical Metronidazole, Erythromycin, and Pimecrolimus
Periorificial Dermatitis
No comedones
Papules and pustules with scaling
Around the mouth, nose, eyes
Itching or burning
Pts with Periorificial Dermatitis often have history of
Steroid use
this acne often flares when steroids are stopped
Spreading redness
Non fluctuant
Streaks of lymphangitis spreading from affected area –> lymph nodes
Cellulitis
Stasis Dermatitis
acute flare of chronic venous insufficiency
Dryness in a net like pattern
lower legs, not hot, can be oozing, crusting, fissuring
Asteatotic Eczema
Cellulitis is most often caused by
Group A Strep
Tx for Cellulitis that is Non purulent
covering for strep
Keflex
Amoxicillin
Augmentin
Clindamycin
Tx for Cellulitis that is Purulent, IVDU, or penetrating trauma
Cover for MRSA: “B,C,D”
Bactrim
Clinda
Doxy
+
Amoxicillin
How long for course of Abx to treat cellulitis?
5 days
if not better after this, need to possibly revise treatment
Abx that treat MRSA
“B,C,D,
L, V”
Bactrim Clinda Doxy Linezolid Vanco
Clinda has what associated risk
C-DIFF!!!
“Linda is a bish”
Bactrim to treat MRSA
need to combine with Amoxicillin
Macrolide to treat MRSA (Doxy or Mino)
need to combine with Amoxicillin
Linezolid to treat MRSA
Expensive medication $$
Vancomycin to treat MRSA
Parenteral DOC to treat severe infections
Erysipelas
superficial cellulitis
legs and face
pain, bright red, plaque like edema- sharply defined margin
high WBC
chills, fever, HA, vomiting, joint pain
SHARPLY DEMARCATED BORDERS
Erysipelas
Erysipelas tx
Empiric Abx therapy
cover Strep
Pen C, Amoxicillin, Clinda, Macrolide
Abx tx for Abscesses
“B,C,D” covering for MRSA
Bactrim
Clinda
Doxy
Most common affects kids age 2-5
contagious, easily spread
most cases d/t Staph aureus
Impetigo
Lesions start as papules surrounded by erythema–> pustules that enlarge and break down to form thick, adherent crusts w “HONEY CRUSTED APPEARANCE”
Non bullous Impetigo
Bullous Impetigo
flaccid bullae with clear/ yellow fluid that later becomes purulent
ruptured bullae leave thick, brown crust
face, arms/legs, diaper area
Ecthyma
goes DEEPER
plaque that extendes into dermis
“PUNCHED OUT” ulcers covered w yellow crust surrounded by raised margins
heals slowly, may scar
PUNCHED OUT ulcers
Ecthyma
Tx for Impetigo
“honey crusted”
Topical
Mupirocin or Retapamulin ointment
as long as localized infection and pt is otherwise healthy
Oral Abx need to be used to treat Impetigo when multiple close contact (like family members) affected or if it’s extensive
Dicloxacillin Keflex Erythromycin Clindamycin*** safe choice Augmentin
If MRSA: Clinda, Bactrim, or Doxy
Rapidly progressing redness, edema, fever, systemic sx, crepitus, skin necrosis
local anesthesia over plaque but over PAIN OUT OF PROPORTION in some cases
Necrotizing Fasciitis
If you suspect Necrotizing Fasciitis
consult Surgery immediately
Tx for Necrotizing fasciitis
Widespread debridement and broad spectrum Abx
deeper form of impetigo that results in ulcers
Ecthyma
Expanding, dusky, red plaque with blue discoloration and assoc anesthesia
Necrotizing Fasciitis
