Drugs for the skin

Question 1

4 potency groups of topical glucocorticoids

Answer 1

low, medium, high and super high

Prolonged use can cause atrophy of the dermis and epidermis

Question 2

topical glucocorticoids

Answer 2

can be absorbed in amounts sufficient to cause sytemic toxicity. Growth retardation and adrenal suppression

Question 3

Use of topical steroids

Answer 3

Children 1 week Adults 2 weeks

Fluorintaed agents are stronger than non-fluorinated used to relieve itching and inflammation

Question 4

If drying is needed

Answer 4

Use gels or lotions

Question 5

If area is already dry

Answer 5

use ointments or creams

Question 6

Occlusive dressings increase penetration

Answer 6

avoid permeable areas such as the face, groin, or axillae

Question 7

apply topicals sparingly

Answer 7

Can lead to skin thinning and can casue straie and telangiectasia

Question 8

First line treatment of Acne

Answer 8

wash face 2-3 times daily with mild soap.
Avoid oil-based facial products
change pillow cases regularly

Question 9

Acne First line Tx

Answer 9

Topical treatment-benzoyl peroxide, clindamycin, erythromycin suppress growth of propionibacterium acnes

Question 10

Topical retinoids-tretinoin, adapalene, and tazarotene- help clear mild acne by normalizing hyperproliferating of epithelial cells in hair follicles

Answer 10

These are not absorbed systemically

Question 11

Acne first line-start low, go slow

Answer 11

Benzoyl peroxide needs to be used for 6 weeks to see if it is effective.

Question 12

Moderate to severe acne

Answer 12

Initiate oral antx- Tetracyclines- Doxycycline (Vibramycine) and minocycline (minocin, Dynacin, Solodyn) are most common.

Question 13

Erythromycin

Answer 13

used is tetracycline is ineffective or if pregnancy is a possibility. Tetracycline may cause discoloration of the teeth.

Question 14

Retin A is used for moderate

Answer 14

Is not systemic

Question 15

Isotretinoin (Accutane)

Answer 15

severe acne. adverse effects. nosebleeds, inflammation of the lips and eyes, pain, tenderness or stiffness in joints, bones, muscles
highly teratogenic. Providers of such must participate in risk-management program designed to ensure it is not used in pregnancy
Should be used under dermatologist referral

Question 16

Second line acne tx can include combined oral contraceptives

Answer 16

YAZ, Estrostep, and Ortho-tri-cyclen have FDA approval, all COC formulations with imporve inflammatory and noninflammatory acne

Question 17

second line oral contraceptives

Answer 17

estrogen and progesterone diminish testosterone and increase SHBG in the liver reducing sebum production. Takes 4-6 months to work

Question 18

Acne Rosacea

Answer 18

Initially treat with metronidazole. It that fails, other topical or oral antbx can be included. No alcohol with oral Flagyl

Question 19

Clindamycin safe “B” for pregnancy

Answer 19

Not safe during lactation.

Question 20

Topical erythromycin

Answer 20

first line in pregnancy and lactation

Question 21

Resesarch on Benzoyl and salcylic acid is limited

Answer 21

Systemic absorption is low so could be used in lactation.

Question 22

Retin A (tretinoins)

Answer 22

risk for teratogenesis. Topical may have limited fetal exposure, but cannot exclude. Do not use in lactating mother

Question 23

Tetracycline

Answer 23

discolors teeth in pregnancy and cause bone deformation and growth restriction
Not always contraindicated in lactating mother. Infant can be exposed if used longer than 3 weeks

Question 24

Pruritus

Answer 24

local histamine reaction.

Question 25

Tx of pruritus

Answer 25

topical or oral histamines, or steroid depending on severity

Question 26

Uticaria (hives)

Answer 26

Treat with oral histamine or steroid depending on severity. like Zyrtec

Question 27

Angioedema

Answer 27

emergency -send to ED

Question 28

Bacterial infections

Answer 28

Topic or sytemic agents to treat. Many develop sensitivity to neomycin, use something different.

Question 29

Impetigo

Answer 29

honey crusted lesions. Tx with Bacitracin or Bactroban if lesions are few. Severe may need oral and topical medication

Question 30

Psoriasis

Answer 30

Treat with topical drugs, systemic drugs or phototherapy. Suppress proliferation of keratinocytes Autoimmune process. papules and plaques surrounded with silvery white scales.

Question 31

If less than 10% involvement of skin tx

Answer 31

Emollients, glucocorticoids, Tar perparations at bedtime, vitamin A derivitives, elidel,

Question 32

Eczema

Answer 32

topical immunosuppressants that work against inflammatory process. Used long-term. atopic dermatitis

Question 33

sunscreen

Answer 33

water resistant not waterproof. Lasts 40-80- minutes Use a sunscreen with UVA and UVB protection Use if outside more than 20 minutes
use 20 minutes before and every two hours
SPF of time no protection

Question 34

Protection from UVA

Answer 34

Mexoryl, Prsol 1789, titanium dioxided, zinc oxide, avobenzone block. SPF is for UVB exposure

Question 35

Skin cancer

Answer 35

Basal cell and squamous are the two most common and curable.

Question 36

Melanoma

Answer 36

most dangerous skin cancer
caused by UV lights, thanning beds, sun lamps
60,000 cases in 2008 and 8700 died.

Question 37

ABCs of skin cancer

Answer 37

A Asymmetry=asymmetrical
B borders=uneven
C=brown or black patches, tan, white, red, blue
D=Diameter. larger than 6mm pencil eraser
E=Evolutionchanging appearance