Exam 3 dermatological therapeutics Flashcards by Ben Harris

What is drug delivery dependent on?

Skin type, skin condition, lipid vs. water-based vehicle, charge, concentration gradient

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What is the rate limiting step of topical therapy absorption?

The stratum corneum

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What increases absorption of topical treatments through the skin?

Hydration of the skin

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What are the actions of corticosteroids?

Anti-inflammatory, immunosuppressive, anti-proliferative, vasoconstrictive

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What can corticosteroids be used for?

eczema, contact dermatitis, psoriasis, itch, lichen planus

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What are adverse side effects of corticosteroids

Skin atrophy (thinning), striae, acne, suppression of the HPA (hypothalamus, pituitary, adrenal) axis

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Explain the levels of corticosteroid strength

1 is for very thick skin, 7 is for very thin skin and babies

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What are retinoids in terms of their background?

vitamin A analoges

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How do retinoids work?

working through nuclear receptors on DNA causing alteration of gene transcription

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What is the action of retinoids?

regulate cell growth, inhibit carcinogenesis, alter enzymes involved with cellular differentiation

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What can retinoids be used for?

acne, psoriasis, cosmetic skin improvement (reduction of fine wrinkles and pigmentation)

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What are the side effects of retinoids?

dryness, irritation, sun sensitivity

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What is calcipotriene

Vitamin D analog that acts through DNA receptors to alter skin differentiation

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What are the uses for calcipotriene

psoriasis (localized), eczema

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What are side effects of calcipotriene?

irritation, increased serum calcium

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What are topical antimicrobials used for?

wounds, acne, fungal infections, rosacea

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What do non-steroidal anti-inflammatories (topical calcinuerin inhibitors) work through?

calcineurin to alter T-cell activation

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What are the uses for non-steroidal anti-inflammatories (topical calcinuerin inhibitors)

Eczema around the eyes, dermatitis

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What sun rays are the best to block for sunscreen?

UVA and UVB

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What new sunscreens help to block UVA rays?

avobenzone/helioplex or mexoryl

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What is so special about titanium and zinc oxide for blocking sun rays?

they stay on the skin and do not get absorbed so they block longer

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How does Imiquimod/aldara cream work?

increase local immune activity through toll receptors

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What is imiquimod used for?

condyloma, actinic keratosis, BCC, common warts, molluscum, in situ cancer

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what can topical 5-fluorouracil be used for?

actinic damaged skin cells; actinic keratosis,

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How does 5-flourouracil work?

inhibits thymidylate synthase resulting is reduced DNA synthesis

How do systemic retinoids work?

by repairing disordered keratinization

What can systemic retinoids be used for?

acne, psoriasis, ichthyosis, Darier's disease, chemoprophylaxis of skin cancer

What are two systemic retinoids?

isotretinoin, acitretin

What are side effects of systemic retinoids?

teratogenicity (don't use during pregnancy), depression, arthralgia, hair loss

What labs should be ordered with retinoids?

Lipids, LFT, HCG

What kind category is dapsone in?

Sulfones

What can dapsone be used for

Leprosy therapy, dermatitis herpetiformis, linear IgA disease, bullous lupus, Sweet's syndrome, spider bites

How does dapsone work?

inhibits myeloperoxidase in PMNs (affects CD11a/CD18)

What are the side effects of dapsone?

Hemolysis in people with G6PD deficiency

What labs should be done before Rx dapsone?

G6PD, CBC

What is the action of methotrexate?

Dihydrofolate reductase inhibitor that disrupts DNA synthesis to block cell division

What can methotrexate be used for?

extensive psoriasis, CTCL, lupus

Side effects of methotrexate

hepatotoxicity, myelosuppression, pneumonitis

Labs to order before Rx methotrexate

CBC, LFT, Liver biopsy

What can biological therapies be used for?

psoriasis, psoriatic arthritis and rheumatoid arthritis

What proteins do Biological therapies target?

TNF and IL12 and IL23

What can oral antibiotics be used for?

acne, folliculitis, cellulitis, rosacea, wound infection

What can anti-vitals be used for?

HSV infection, cold sores, zoster

What can antifungals be used for

Ring worm, athletes foot, infected foot

What are some miscellaneous therapies that can be used for different derm disorders?

UV light (psoriasis, eczema, inflammatory), Minoxidil, finasteride, Liquid nitrogen (some keratoses)

what can UV light therapy be used for?

psoriasis, pruritis, eczema, CTCL

What is minoxidil used for?

Alopecia

What is the action of minoxidil?

vasodilation and direct stimulation of hair shaft growth

What is finasteride used for?

androgenic alopecia

What is the action of finasteride?

Blocks 5-alpha reductase enzyme in follicles to inhibit the conversion of testosterone to dihydrotestosterone

What can liquid nitrogen be used for?

Warts, actinic keratoses, skin cancer

What are the three cycles of hair cycle?

Anagen, catagen, telogen

What typically causes scarring alopecia?

diseases

What causes androgenetic alopecia

Genetically determined miniaturization of follicles triggered by androgens

What are treatments of androgenetic alopecia?

minoxidil, finasteride, hair transplants

What causes telogen effluvium

Major stressors disrupting growth cycle of hairs causing premature shift to telogen

What causes alopecia areata

Autoimmune disease where T-cells attack hair bulb

What is treatment of alopecia areata?

minoxidil, anthralin

What does alopecia areata look like?

Circular patches on scalp or beard. Totalis= all scalp hair lost. Universalis= all body hair lost. Looks like that basketball player who KG called a cancer patient.

What causes secondary alopecia?

Chemotherapy, meds, thyroid disease, iron deficiency, nutritional disorders, renal or hepatic failure

What usually causes tinea capitis?

Trichopyton tonsurans

What is the treatment for tinea capitis?

Oral Grisofulvin, possibly terbinifine or itraconazole

What form of lupus causes hair loss?

Discoid lupus of the scalp can destroy hair units

Treatment of discoid lupus?

hydroxychloroquine

What is pediculosis?

Head lice and pubic lice

What is the treatment for pediculosis?

Permethrin, vaseline for eyelids, cetaphil cleansear, Remove nits, wash bedding and clothes

What is paranychia?

inflammation of the nail folds

What causes causes acute paranychia?

trauma, bacteria, contact dermatitis, acute eczema flair

What causes chronic paranychia?

contact dermatitis, eczema, psoriasis, candida

What organisms cause onychomycosis (tinea unguium)

T. rubrum, T. mentagrophytes

How do you treat onychomycosis (tinea unguium)

terbinafine, intraconazole, ciclopirox