Exam 4 Material Flashcards
1
Q
FTU scalp
A
3
2
Q
FTU face and neck
A
2.5
3
Q
FTU One hand (front and back) including fingers
A
1
4
Q
FTU One arm including entire hand
A
4
5
Q
FTU elbows
A
1
6
Q
FTU both soles
A
1.5
7
Q
FTU one foot including toes
A
2
8
Q
FTU one leg including foot
A
8
9
Q
FTU buttocks
A
4
10
Q
FTU knees
A
1
11
Q
FTU trunk both sides
A
14 (7 FTU each side)
12
Q
scaly dermatoses
A
dandruff
seborrheic dermatitis
13
Q
location of dandruff
A
scalp
14
Q
exacerbating factors of dandruff
A
generally stable; increases in dry climate, cold temperature, or stress
15
Q
appearance of dandruff
A
thin, white, or grey flakes on scalp
16
Q
inflammation of dandruff
A
absent
17
Q
epidermal hyperplasia of dandruff
A
absent
18
Q
epidermal kinetics of dandruff
A
2x’s faster than normal
19
Q
location of seborrheic dermatitis
A
scalp, face, and trunk
20
Q
exacerbating factors of seborrheic dermatitis
A
immunosuppression, neurologic conditions, environmental factors, stress
21
Q
appearance of seborrheic dermatitis
A
macules, patches and thin plaques of discrete yellow, oily scales on red skin
22
Q
inflammation of seborrheic dermatitis
A
present
23
Q
epidermal hyperplasia of seborrheic dermatitis
A
present
24
Q
epidermal kinetics of seborrheic dermatitis
A
3x’s faster than normal
25
location of psoriasis
scalp, elbows, knees, trunk, lower extremities
26
exacerbating factors of psoriasis
environmental factors, infection, medications, stress, alcohol, tobacco
27
appearance of psoriasis
discrete symmetrical, red plaques with sharp borders; silvery white scales, bleeding points
28
inflammation of psoriasis
present
29
epidermal hyperplasia of psoriasis
present
30
epidermal kinetics of psoriasis
8x's faster than normal
31
dandruff
chronic and non-inflammatory hyperproliferative epidermal scalp condition
-accelerated epidermal cell turnover and abnormal keratinization
-presence of Malassezia fungi
-causes mild inflammation, flaking, and pruritus
32
treatment goals of dandruff
reduce epidermal turnover rate of scalp skin and reduce the # of Malassezia fungi
minimize the cosmetic embarrassment of visible scarring
minimize itching
33
general treatment approach of mild dandruff
non-medicated shampoo: daily or every other day
34
mild presentation of dandruff
intermittent dandruff, mild inflammation
35
general treatment approach of moderate-severe dandruff
OTC medicated shampoos (pyrithione zinc, selenium sulfide, coal tar)
-leave on scalp for 3-5 min
-rinse well with water
-daily for 1 week, then 2-3 times weekly for 2-3 weeks, then once a week
36
moderate-severe presentation of dandruff
daily dandruff
moderate-severe inflammation
37
seborrheic dermatitis
chronic inflammatory disorder in areas of sebaceous gland activity (face, scalp, and chest)
involves Malassezia species and accelerated epidermal proliferation
no specific cure
neither harmful nor contagious
affects infants, adolescents, and adults
38
presentation of seborrheic dermatitis in infants
greasy or dry scaling of the scalp
aka cradle cap
39
presentation of seborrheic dermatitis in adolescents/adults
yellow, greasy scales in patches or plaques with exudates and crusting on red inflamed skin
-head, ear, face
-chest, mid-upper trunk and gluteal crease
-intertriginous areas
persons with darker pigmentation may present with hypopigmentation
40
increased risk and triggers seborrheic dermatitis
Malassezia
physical stress, fatigue, travel
zinc deficiency
change of season-worsens in cold weather
HIV infection; AIDS
Parkinson's disease
41
treatment goals of seborrheic dermatitis
reduce inflammation and epidermal turnover rate
minimize or eliminate visible erythema and scaling
42
general treatment approach of seborrheic dermatitis
loosen and remove scales and crusts
inhibit yeast colonization (Malassezia)
reduce erythema and itching
avoid perfumes, aftershave, ointments, soaps
control secondary infections
43
seborrheic dermatitis can be softened with
mineral oil or olive oil
cream containing salicylic acid or sulfur
44
seborrheic dermatitis skin should be washed _________ than 2x daily
more; may use dishwashing liquid
45
decreasing fungal growth for seborrheic dermatitis
wash the scalp with OTC antifungal shampoo
face and body: topical treatment with antifungal creams
UV light therapy
46
wash the scalp with OTC antifungal shampoo for seborrheic dermatitis
ketoconazole (1st line) or selenium sulfide, pyrithione zinc, cicpirox, coal tar (2nd lines)
-leave on scalp for 3-5 min
-daily for 1-2 weeks
-2-3 times a week for 4 weeks
-if see improvement after 4 weeks, may reduce the frequency to once weekly
-if disorder worsens or symptoms persist longer than 7 days, a health care provider should be consulted
47
OTC antifungal shampoo first line
ketoconazole
48
OTC antifungal shampoo 2nd line
selenium sulfide, pyrithione zinc, cicopirox, coal tar
49
how long should you wait to consult a health care provider regarding seborrheic dermatitis
if disorder worsens or symptoms persist > 7 days
50
reduce erythema and itching of seborrheic dermatitis
corticosteroid lotion for scalp
corticosteroid cream for other parts of the body
use moisturizing emollients after washing
ketoconazole shampoo and corticosteroid lotion most often are combined in therapy resistant cases
51
ketoconazole shampoo and corticosteroid lotion are combined together for
therapy resistant cases of seborrheic dermatitis
52
seborrheic dermatitis treatment in infant's scalp
massage scalp with baby oil or vegetable oil
then shampoo with non-medicated shampoo
use soft bristled brush
for severe cases salicylic acid 3-5% in olive oil or water-soluble base
53
seborrheic dermatitis treatment in infant's face
wash with mild soap or cleanser, apply facial emollient
DO NOT suggest corticosteroids
54
psoriasis
common chronic inflammatory disease
involves adaptive and innate immunity
T cell mediated inflammatory
55
predisposing and precipitating factors of psoriasis
multiple genetic factors
injury to the skin
a viral or strep skin infection
alcohol consumption
smoking cigarettes
obesity/metabolic syndrome
stress
medications
56
predisposing and precipitating medications for psoriasis
lithium
NSAIDs
antimalarials
B blockers
fluoxetine
withdrawal of corticosteroids
57
possible comorbidities of psoriasis
psoriatic arthritis
CV diseases
-MI
-stroke
-peripheral vascular disease
metabolic syndrome
malignancy
-T cell lymphoma
inflammatory bowel diseases
-Crohn's
-ulcerative colitis
psychological illness
-anxiety
-depression
renal disease
58
treatment factors for psoriasis
age/sex
socio-economic status
comorbidities
past/current treatment
location of lesions
severity of disease
59
mild psoriasis
BSA < 5%
60
moderate psoriasis
BSA >8%
61
severe psoriasis
BSA > 10%
62
lifestyle recommendations for psoriasis
reduce stress
regular exercise
weight management
moderation of alcohol
cessation of smoking
63
non-pharm treatments of psoriasis
moisturizers/emollients
oatmeal baths
sunscreen
64
pharm therapies for mild to moderate psoriasis
topical agents->topical agents + phototherapy->topical agents + systemic agent
+ nonpharm
65
topical agents of psoriasis (mild-moderate)
corticosteroids
vitamin D3 analogue
retinoids
anthralin
coal tar
salcylic acid
calcineurin inhibitor-pimecrolimus
66
corticosteroids for psoriasis
apply 2-4 times daily: cream or lotion-day, ointment-night
low potency for face, skin fold. limit duration and SA
67
vitamin D3 analogue (calcipotriene) for psoriasis
apply once or twice daily (ointment); twice daily (cream or foam)
68
retinoids for psoriasis
tazarotene, adapalene
apply once daily at bedtime
69
anthralin for psoriasis
applied only to the thick plaque lesions for 2 hrs or less and then wiped off (use Zn oxide around edges to protect normal skin)
SCAT therapy
70
coal tar for psoriasis
apply in evening, wash off in morning
71
salicylic acid for psoriasis
shampoo for scalp lesions
72
calcineurin inhibitors for psoriasis
pimecrolimus
apply to intertriginous areas (skin folds)
73
treatment for moderate to severe psoriasis
1. systemic agent =/- topical agent or phototherapy; consider biologic agent esp if comorbidities exist
2. more potent systemic agent or biologic agent (or less commonly 2 or more systemic agents in rotation) +/- topical agent
3. biologic agent (if not already used) +/- other agents
+ nonpharm
74
systemic agent options for psoriasis
apremilast (otezla)
tofacitinib (xeljanz)
acitretin
methotrexate
cyclosporine
abatacept (orencia)
75
apremilast/otezla
PDE-4 inhibitor
dose titration to max 30 mg BID over 1st week
renal impairment-once daily dosing
should see response by week 4
ADRs-N/V/D, depression, weight loss
76
tofacitinib/xeljanz
JAK inhibitor
psoriatic arthritis after fail on MTX
immunosuppressive
DO NOT use with DMARDs or with potent immunosuppressants; NO live vaccines
high risk of serious invasive infections
monitor lymphocytes, neutrophils, hemoglobin, liver enzymes, and lipids
BBW: serious cardiac events
77
what can you not take/use with tofacitinib/xeljanz
biologic DMARDs or with potent immunosuppressants
NO live vaccines
78
tofacitinib/xeljanz BBW
serious cardiac events such as heart attack or stroke, cancer, blood clots, and death
79
acitretin for psoriasis
retinoid (oral)
NOT immunosuppressive
max response 3-6 months
DO NOT drink alcohol
reproductive aged women-should not be pregnant or plan to become pregnant within 3 years following drug discontinuation
80
methotrexate for psoriasis
T cell and cytokine suppressors-oral DMARD
onset of action: 3-6 weeks
administer with folic acid
screen: CBC, LFTs
CI: pregnancy, cirrhosis, blood dyscrasias
increased risk of hepatotoxicity
81
what should you administer with MTX
folic acid
82
what are the contraindications of MTX
pregnancy, cirrhosis, blood dyscrasias
83
cyclosporine for psoriasis
T cell and cytokine suppressors-oral DMARD
not recommended for prolonged use (< 4 months bc of nephrotoxicity
dose on actual body weight
many drug interactions
CI: systemic malignancy, untreated HTN or infections
increased risk for elderly-HTN
84
what is the longest time frame that you can be on cyclosporine
4 months
85
contraindications of cyclosporine
systemic malignancy, untreated HTN or infections
86
abatacept/orencia
blocks T cell activation
SQ injection
screen: TB
interactions: live vaccines, COPD
87
biologics counseling points
NO live vaccines
screen for TB prior and during therapy (PPD annually)
discontinue therapy during active infection
88
adverse effects of biologics
increased risk of infections
contraindicated in patients with active infections/sepsis
hypersensitivity rxns
lymphoma and other malignancies
worsening or new onset heart failure: TNFa inhibitors
89
Biologic agents for psoriasis
adalimumab (humira)
etanercept (enbrel)
infliximab (remicade)
golimumab (simponi)
certolizumab (cimzia)
ustekinumab (stelara)
tildrakizumab (ilumya)
risankizumab (skyriza)
guselkumab (tremfya)
secokinumab (cosentyx)
ixekizumab (taltz)
brodalumab (siliq)
90
TNFa inhibitors
adalimumab (humira)
etanercept (enbrel)
infliximab (remicade)
golimumab (simponi)
certolizumab (cimzia)
91
TNFa inhibitors comments
TB testing should be performed on all patients, annually
Hep B screening recommended
monitor: CBC and LFTs
DO NOT use with:
-live vaccines
-patients with or with 1st degree relatives with a demyelinating disease or multiple sclerosis (MS)
-congestive heart failure
92
who can you not use TNFa inhibitors with
-live vaccines
-patients with or with 1st degree relatives with a demyelinating disease or multiple sclerosis (MS)
-congestive heart failure
93
ustekinumab/stelara
IL-12 and 23
avoid in ACTIVE TB; do not give concurrently with live vaccines
PPD monitoring
94
tildrakizumab/ilumya
IL-23
avoid in active TB; no live vaccines
95
risankizumab
IL-23
avoid in active TB; no live vaccines
96
guselkumab/tremfya
IL-23
avoid in active TB; no live vaccines
97
secukinumab/cosentyx
Crohn's
98
ixekizumab/taltz
IL-17A
99
brodalumab/siliq
IL-17A
BBW: increased suicide risk
must complete REMS
100
safety considerations for use of ALL biologics
serious infections, including TB
malignancies and lymphomas
anaphylaxis
101
safety considerations for use of anti-TNFs biologics
heart failure worsening
demyelinating disease
Hep B reactivation
cytopenias
lupus-like syndrome
102
safety considerations for use of anti-ILs biologics
inflammatory bowel disease
depression worsening
103
photochemotherapy for psoriasis
need skin biopsy of lesion to confirm diagnosis of psoriasis
90% efficacy with oral psoralens + UVA light
reserved for patients with severe, refractory psoriasis
104
side effects of photochemotherapy for psoriasis
serious burns, blistering, peeling, itching, nausea, potential increase in certain cancer rates (basal/melanoma), photoaging
105
MOA of photochemotherapy for psoriasis
psoralen cross-links with DNA in presence of UVA light; effects immune response in skin and lymphocytes
106
integrative and alternative medicine for psoriasis
traditional chinese medicine
herbal therapies
diet/dietary supplements
mind/body therapies
107
plant contact dermatitis is caused by what
urushiol
108
urushiol
active irritant, oily liquid
sensitization phase
elicitation phase
109
sensitization phase of urushiol/plant contact dermatitis
enters skin within 10 min of contact
urushiol binds to epidermal proteins to form an antigen
110
elicitation phase of urushiol/plant contact dermatitis
upon continued/subsequent exposures, hypersensitivity rxn occurs
rash may appear 2-48 hr after exposure
rash continues for 1-3 weeks
fast onset, long recovery
111
prevention of plant contact dermatitis
protective clothing and gloves
112
if exposed to urushiol, what should you do
rinse with large volumes of water
wash area with soap and water, remember under the nail
113
plant contact dermatitis signs/symptoms
early lesions of small blisters
appears in a line where the skin has brushed against the plant
severe respiratory symptoms
may occur following inhalation of burning poison ivy, oak, or sumac plants
itching
erythema
vesicles/papules
114
topical hydrocortisone
insect bites and stings
plant dermatitis (wet or dry)
atopic dermatitis
v mild psoriasis
treats pruritis and inflammation
do not use < 2 years
115
topical anesthetics products
pramoxine
benzocaine
dibucaine
lidocaine
116
topical anesthetics derm condition
insect bites and stings
plant dermatitis (dry)
sunburn
117
topical anesthetics comments
relieves pain and pruritis by numbing skin
do NOT use under occlusive dressing or on broken skin
caines-methemoglobinemia
118
topical antihistamines derm condition
insect bites and stings
119
topical antihistamine comments
relieve pain and pruritis
AVOID use in:
-chicken pox
-PLANT DERMATITIS
-sunburn
-broken, oozing skin
120
antipruritic or counterirritants products
phenol
camphor
menthol
benzyl alcohol
calamine
121
antipruritic or counterirritants derm condition
insect bites and stings
dry plant dermatitis
122
antipruritic or counterirritants comments
relieves pain and pruritis
many combo products
DO NOT use on broken skin or wound
123
astringent products
aluminum acetate
witch hazel
124
astringent derm condition
wet or weeping plant or atopic dermatitis
125
astringent comments
reduce inflammation by vasoconstriction
cool and dry the skin by evaporation
slows down oozing, weeping, or bleeding lesions
126
topical antibiotics products
bacitracin
neomycin
polymyxin B sulfate
mupirocin
127
topical antibiotics derm condition
minor burns
minor cuts
128
topical antibiotics comments
prevent or treat minor infection
contact MD if no improvement after 7 days
129
1st line of treatment for plant contact dermatitis for itching
oral antihistamine
130
what products do you NOT use for reducing itchiness in plant contact dermatitis
topical antihistamines or antibiotics
131
plant contact dermatitis follow up
refer to a physician if:
-do NOT see any improvement after 7 days
-symptoms become worse
-rash covers large area of face or swelling of eyelids
-rash involves genitalia
-secondary infection
132
insect bits
nonvenomous
mosquitos, fleas, bedbugs, ticks, most spiders
local effects
mild pruritis, erythema, papules
133
insect stings
venomous and contain allergenic proteins
bees, wasps, yellowjackets, hornets, fire ants
pain, pruritis, and irritation
134
prevention of insect bites
use insect repellants
avoid contact with insect
-cover skin
135
insect bites nonpharm measures
apply ice pack
avoid scratching area, keep nails trimmed
do NOT wear rough clothing over bite area
remove ticks with tweezers->disinfect skin with rubbing alcohol
136
insect bites treatment
any one or combo of following
-skin protectants (can be used in children <2)
-hydrocortisone
-topical anesthetics
-topical counterirritants
-oral antihistamines
-topical antihistamines
137
mosquito borne diseases
prevention
-protective clothing
-repellant
malaria, west nile, dengue fever, zika, etc
138
flea borne diseases
murine typhus
bubonic plaque
139
murine typhus
cats, rodents, possums
incubation period: 6-14 days
symptoms: headache, fever, nausea, and body aches
rash on trunk that spreads to arms and legs
give doxycycline
140
bubonic plague
rodents, pets, cats/dogs
give streptomycin, ciprofloxacin, levofloxacin, moxifloxacin, doxycycline, aminoglycosides
141
tick borne diseases
lyme disease
rickettsial spotted fevers
tularemia
erlichiosis
142
when do symptoms occur for tick-borne diseases
2-14 days after bit
143
symptoms of tick borne diseases
fever, headache, myalgias, rheumatoid rxn, rash
144
lyme disease prophylaxis treatment
within 72 of detaching tick
-doxycycline
145
lyme disease acute skin lesion treatment
early localized disease
doxycycline
amoxicillin
cefuroxime
2nd line: azithromycin
146
southern tick associated rash illness (STARI)
lone star tick
NO antibiotic rec
147
rickettsial spotted fevers
tick borne disease
doxycycline
148
insect bite follow up
refer if:
-symptoms persists after 7 days of treatment
-symptoms worsen
-develops secondary infection (fever, joint pain, lymph node enlargement, neurologic symptoms)
149
bee sting treatment
remove bee stinger
wash area with soap and water
apply ice pack
can use skin protectants, hydrocortisone, topical anesthetics, topical counterirritants, oral antihistamines, topical antihistamines
-if pain not relieved by topical, consider oral analgesic
150
bee/wasp/scorpion stings-referral and follow up
emergency care immediately if
-severe rxn history
-at any time after sting-experiences hives, dizziness, N/V, difficulty breathing
triage to provider, if symptoms worsen or don't improve after 7 days
151
insect stings nonpharm measures
apply ice pack
avoid scratching area, keep nails trimmed
do NOT wear rough clothing over bite area
remove stinger and venom sac with tweezers->disinfect skin with rubbing alcohol
152
local anesthetics, counterirritants for insect bites/stings
apply to area 3-4 times daily
do NOT use in < 2 year
do NOT use > 7 days
153
pramoxine or benzyl alcohol
less likely to cause sensitization or adverse effects of the local anesthetics
154
skin protectants for insect bites/stings
zinc oxide or calamine
reduce irritation or inflammation
may use in bacterial infection
apply up to 4 times daily
< 2 can use
155
do NOT use __________________ on scabies, bacterial infections, or fungal infections
hydrocortisone
156
types of pediculosis
head lice
body lice
pubic lice
157
lice nonpharm treatment
nit come
airalle
avoid direct physical contact
do not share combs, brushes, towels, caps, and hats
wash clothing, bedding, hairbrushes, combs in hot water
clean home
158
lice exclusions
no live lice seens
hypersensitivity to chrysanthemums, ragweed, or pediculicide ingredients
presence of secondary skin infection
< 2 years for pyrethrin treatment
< 2 months old for permethrins treatment
lice infestation of eyelids or eyebrows
preg or breast-feeding
presence of active tumors
159
wetting/occlusive agents for lice
cetaphil cleanser and hair dryer
dimethicone lotion
lycelle
natrum muriaticum
160
counseling points of head lice
apply enough to wet hair and scalp
allow treatment to stay for 10 minutes
rinse with water
use nit comb to remove dead lice and eggs
repeat process in 7-10 days if more are seen
161
follow up on lice
if live lice are found after 2 treatment round 1 week apart, need to refer to PCP to get a Rx product
162
scabies
contagious parasitic skin infection caused by arachnid mite
needs prolonged physical contact to transfer
impregnated female is responsible
weakened immune systems and elderly are at risk for secondary infection
163
scabies symptoms
inflammation and itching
164
scabies OTCs
permethrin 5%
crotamiton 10%
sulfur 5-10%
lindane 1%
ivermectin PO
165
how low can pruritus last after scabies treatment
4 weeks due to hypersensitivity rxns
166
what can you use for hypersensitivity rxns of scabies
oral antihistamines
topical steroids
167
venomous spiders found in texas
brown recluse
black widow
168
venomous spider bites first aid
clean wound with soap and water
apply cold pack
elevate limb to reduce swelling
may give tylenol
if possible, kill or capture spider in sealed container
bring spider and patient to ER
169
venomous snakes
pit vipers (rattle snakes, copperheads)
elapidae (coral snake)
170
prevention of venomous snakes
eliminate rock piles, brush piles, wood piles and areas of tall grass
wear thick work gloves and boots
control insect and rodent pop
171
snake bite first aid
keep patient calm
identify the snake
remove any constrictions from limb
wash bite with soap and water
immobilize bitten area and keep it even with or slightly lower than the heart
check for signs of envenomation (swelling and tenderness, pain, lab studies)
call poison control
172
snake bite medical care
tetanus injection
consider antibiotic therapy
173
coral snake bite medical care
NO antivenom
supportive care ONLY
174
pit viper bite medical care
should be scored to assess need for antivenom
many bites do NOT inject venom (dry bite)
symptoms usually evolve over several hours
175
mild or moderate envenomation
provide supportive therapy
176
severe envenomation
give antivenin, if available
provide supportive therapy
call surgery
177
rabies bit
most common
raccoons, bats, foxes, skunks, cats and dogs
178
non bite rabies
rare
scratches, abrasions, open wounds, or mucous membranes contaminated with saliva or other potentially infectious material from a rabid animal
179
untreated rabies is
fatal
180
rabies postexposure prophylaxis (PEP) not previously vaccinated
wound cleansing
human rabies immune globulin (HRIG)
rabies vaccine
181
rabies postexposure prophylaxis (PEP) previously vaccinated
wound cleansing
do NOT administer Human rabies immune globulin (HRIG)
rabies vaccine
182
poison control number
1-800-222-1222
183
patient risk to UVR induced problems
fair skin
blond, red, or light brown hair
freckles
a history of bad sunburns
a previous growth on skin or lips caused by UVR exposure
previous or current UV induced disorder
fam member with melanoma
increased UVR exposure
taking photosensitizing or immunosuppressive meds
a history of autoimmune disease
184
medications associated with increased sun sensitivity
antibiotics (doxy)
antihistamines
NSAIDs*
Combo oral contraceptives* and estrogens
retinoids*
*=may contribute
185
meds that MAY contribute to photosensitivity
anticonvulsants
antidepressants/antipsychotics
antihypertensives/diuretics
NSAIDs
oral contraceptives
retinoids
186
sun safety
high risk times are 10am-4pm
check UV index
apply sunscreen
sunglasses
hat (wide brimmed)
clothing
shade/umbrella
avoid tanning beds and devices
187
UVR causes
premature skin aging
skin cancers, which can increase risk of other cancers
188
exclusions for sunscreen
allergy to all sunscreen ingredients
< 6 months
189
sunscreen selection
compare spectrum coverage of ingredients
select from active and inert ingredients
select on specific patient info and characteristics
select product for the intended use/planned activity (ie swimming)
advise at least SPF > 15; prefer SPF 30+
190
physical sunscreen ingredients (sunblock)
zinc oxide
titanium dioxide
opaque, reflect and scatter the UVR rays to then protect spectrum coverage
191
chemical sunscreens (sunscreens)
absorb and block the transmission of UVR to epidermeris
aminobenzoic acid
benzophenones
cinnoxate
avobenzone
192
sunscreen ingredients to use if patient has sensitive skin or previous allergic rxns
AVOID PABA
consider GRASE sunscreen (generally recognized as safe and effective): zinc oxide and titanium dioxide
193
try to avoid this ingredient in sunscreen
oxybenzone (long term toxicity)
194
sunscreen application
adult: apply ~ 1oz of sunscreen over all exposed skin area 15 min prior to UV exposure
reapply after exposure to moisture or towel drying
reapply every 2 hrs
195
biggest factors leading to sunburn
not applying enough
not applying often enough
not apply evenly
196
does sunscreen affect vitamin D in the body
NO, it will not compromise vit status in healthy people
197
sunburn
peripheral vasodilation in the epidermis from UV light
inflammatory rxn->includes lymphocyte infiltrates
symptoms start ~4 hrs after exposure
erythema peaks ~24 hrs after exposure
may last for up to 5 days
198
skin and eye changes from sun exposure
cataract
pterygium
age spots
melasma
wrinkles
carcinoma
melanoma
199
ABCDE skin cancer identifiers
asymmetry
border is irregular
color is uneven
diameter increases
evolving-has changed
200
treatment plan of sunburn
initial treatment is nonpharm: in past 20 min, immerse in cool water/cool wet cloths
any combo of OTC products depending on symptoms and patient preference
201
sunburn exclusions
large areas of blistering
fever
extreme pain
headache or confusion
lightheadedness or vision changes
severe swelling
signs of infection (open blisters)
202
sunburn treatment
systemic analgesics
skin protectants
203
systemic analgesics for sunburns
prefer one with anti-inflammatory prop (NSAIDs, APAP)
decrease pain, erythema, and edema
longer DoA than topical anesthetics
use for first 1-2 days
204
skin protectants for sunburns
help with rehydration and skin irritation
ex: cocoa butter and petrolatum
apply as often as needed
wait until after 24 hrs to start using
205
alternative treatment for sunburn
aloe vera
-topical on intact skin
-decrease pain
-avoid internal use->multiple DIs and adverse effects
206
do NOT recommend for sunburn treatment
first aid antiseptics
topical anesthetics bc only on small areas of intact skin and may cause hypersensitivity rxn
207
sunburn follow up
refer if: burn has progressed or worsened after 24-48 hrs
if not healed in 7 days
208
sun exposure counseling points
use broad spectrum sunscreen w/ SPF > 15
-water resistant prop as appropriate
apply 1 oz over exposed areas, AVOID eyes and mucous membranes
apply sunscreen 15 min prior to sun exposure
use most substantive sunscreen available
limit time btwn 10am-4pm
reapply sunscreen at least every 40-80 min (as labelled)
check expiration dates; keep product out of sunlight
if taking photosensitizing drug: use sunscreen and protective clothing
stop using any product that causes redness, itching, rash
209
photoaging
associated with cumulative sun exposure and other environmental influences
classification starts at 20 (mild) to >60 (severe)
210
chronologic aging
thin skin
fine wrinkles
xerosis
laxity
seborrheic keratoses
senile angiomas
211
photoaging
atrophic skin
coarse wrinkles
leathery skin
lentigines
bronzed appearance
yellow cobblestone appearance
telangiectasis
bruising
sun induced dermatitis
212
skin anti-aging approaches
cosmetic care
topical meds
invasive procedures
systemic agents
prevention
213
photoaging prevention
reduce UVR exposure: sunscreens, protective clothing, sunglasses, hats
reduce exposure to environmental risk factors: air pollution, smoking
214
prevention approach to anti-aging
stop smoking
reduce exposure to pollution, UVR radiation, stress
nutrition
physical activity
healthy lifestyle
215
retinoids for anti-aging
increase keratinocyte cell division, replacing epidermal cells
enhances new collagen and elastic fibers in dermis
reduces melanin production
improves wrinkles, pigmentary mottling and texture
benefits from long term use
topical SEs
photosensitivity
216
alpha hydroxy acids for anti-aging
keratolytic
lactic, glycolic, citric, malic acids
increases dermal thickness:
-improves collagen and elastic fibers
-reduce hyperpigmentation
217
hydroquinone
depigmentation
reduces hyperpigmentation associated with sun exposure: melasma, lentigines
in combo products
limit use to 3 months
wear sunscreen
218
photoaging pharm treatments
topical retinoids
keratolytics
vitamin supplements
depigmenting agents
219
topical antioxidants
niacinamide (vitamin B3), ascorbic acid (vitamin C), D-alpha tocopherol (vitamin E), co-enzyme Q-10
alpha-lipoic acid
220
photoaging counseling points
is preventable, cumulative
protect skin from further damage
use broad spectrum sunscreen w/ SPF > 15 and reapply often
clean face 2x daily with mild soap product/cleanser
healthy lifestyle/stop smoking
221
hydroxy acid counseling points
apply to dry skin within 15 min of cleansing
SEs: stinging, burning, itching, skin lightening, dryness
222
retinoids counseling points (for photoaging)
apply once at night daily to dry skin after cleansing
add moisturizer/foundation product w/ SPF 30+ during day
SEs: scaling, redness, burning, dermatitis
223
types of acute wounds and burns
abrasions
punctures: bites, sharp objects
lacerations
burns: thermal, electrical, chemical, UVR
224
stage 1 wound
no loss of skin layers, reddened, non-blanching, unbroken skin
225
stage 2 wound
blister or partial thickness skin loss, involves all the epidermis and part of the dermis
226
stage 3 wound
full thickness skin loss, damage to the entire epidermis, dermis, and dermal appendages, may involve damage to the SQ tissues
227
stage 4 wound
further involves the SQ tissue, underlying muscle, tendon, and bone
228
minor burns and wounds exclusions for self treatment
face, hands, feet, major joints, genitals, or perineum
injuries larger than 3 inch in diameter
worsen or has not healed in 24-48 hrs and/or 7 days
chemical, electrical, or inhalation burns
deep partial thickness, full thickness, or subdermal skin injuries
signs of infection
229
gauze dressings
nonocclusive fiber dressing with loose, open weave
bandage, sterilux bulky gauze
230
nonadherent dressings
nonadherent, light coated porous dressings
adaptic, vaseline gauze
less adherent than plain gauze
231
adhesive bandages
adhesive bandage with nonadherent pad in the center
band-aid flexible fabric adhesive bandage
less adherent than plain gauze
232
hydrocolloids
wafer dressings composed of hydrophilic particles in an adhesive form covered by a water-resistant film or foam
band-aid advanced healing strips
provides moist healing environment
occlusive
233
transparent adhesive films
semi-occlusive, translucent dressings with partial or continuous adhesive composed of polyurethane or co-polyester thin film
tegaderm
used for uninfected wounds ONLY
not absorptive
234
minimize scarring by
avoid UVR exposure to wound
silicone sheets or gels
laser therapy
appropriate and consistent wound care
235
first aid antibiotics
preventative
active ingredients: bacitracin, neomycin, polymyxin B sulfate
apply after cleansing and before bandaging
toxicity risk increases with large areas of application
236
pro topical antimicrobial therapy
delivery of conc antimicrobial agent to site
less potential for systemic side effects or toxicity
ensures regular visual inspection of wound
237
con topical antimicrobial therapy
limited evidence of clinical efficacy
local allergic rxns
disruption of surrounding skin microbiota
minimal penetration depth
bacterial resistance from unnecessary use
potential for product contamination
238
antibiotic ointment effects
reduced health
aquaphor ointment was superior
use for infection prophylaxis in acute, minor, uncomplicated, soft tissue wounds
TAO can cause sensitivity rxns
239
topical anesthetics for wounds
temp relief of pain
limited evidence of efficacy or safety
benzocaine, lidocaine, pramoxine
240
first aid antiseptics
may cause cytotoxicity reducing wound healing
chlorhexidine, H2O2, povidone-iodine
241
minor burn
self care
adult: <15% BSA
child: <10% BSA
<2% deep partial thickness or full thickness burn
242
moderate burn
need referral
adult: 15-25% superficial
child: 10-20% superficial
2-10% BSA deep
243
major burn
need referral
adult: >25% BSA superficial
child: > 20% BSA superficial
>10% BSA deep
electrical burns
in eyes, ears, face, or genitalia
244
exclusions for self treatment of burns
moderate to severe burn to BSA of 2% or more
burns involving eyes, ears, face, or genitalia
chem burns
electrical or inhalation bursn
persons of advanced age
patients with diabetes or multiple medical disorder
immunocompromised patients
245
nonpharm for minor burn
cool water: reduces burning sensation, decreases morbidity
honey
aloe vera
246
OTC pharm therapy for minor burns
OTC systemic analgesics
skin protectants
topical antiseptics
topical antibiotics
topical anesthetics
247
topical antiseptics for minor burn
only on intact skin, edges of wound, reduces healing if used within wound
248
topical antibiotics for minor burn
may reduce the incidence of infection and promote healing when use 1-3x a day
systemic toxicity: neomycin
hypersensitivity rxn: polymyxin B
if improvement is not seen within 7 days, the should see PCP
249
topical anesthetics for minor burns
apply for pain max 4x a day
care should be taken to apply small quantities and low conc
systemic toxicity: lidocaine
hypersensitivity rxns: benzocaine, lidocaine
relief for 15-45 min
250
local impaired wound healing factors
tissue perfusion
bacterial contamination
foreign bodies
necrotic tissue
eschar
251
systemic impaired wound healing factors
poor vascularization
bacterial infection inadequate nutrition
coexisting medical condition
meds
252
Rx med that impede wound healing
chemotherapeutic agents
corticosteroids
253
comorbidities that impair wound healing
obesity
diabetes
severe anemia
peripheral vascular disease
congestive heart failure
254
social factors that impair wound healing
smoking
-vasoconstriction->decrease proliferation of erythrocytes, macrophages, and fibroblasts; decreases tissue O2 delivery
255
chronic wounds
start with conservative treatment as acute wounds
pressure relief or compression dressing
nutrition status
control infection
debridement
256
debridement of chronic wounds
sharp (removes devitalized tissues with scalpel or devices)
mechanical/enzymatic (removes biofilm and devitalized tissues with abrasion, whirlpool wet to dry dressing, maggot therapy)
surgical: deep tissue or bone biopsy; reconstructive
257
warts
caused by HPV
can occur anywhere on the body
transmission from other humans, auto-inoculation or inanimate objects
limited to epidermis
diff types for feet and hands
may resolve without treatment
recurrent or recalcitrant warts should be referred
258
warts characteristics
any area of skin susceptible to causative virus
rough cauliflower-like appearance; plantar hs disrupt normal skin ridges
usually not painful
size varies, may grow to 1 inch in diameter
caused by HPV
treat with salicylic acid or cryotherapy
259
corns characteristics
over bony prominences in the feet
raised, sharply demarcated, hyperkeratotic lesions with a central core
painful
size varies
caused by friction
treat with salicylic acid
260
calluses characteristics
weight bearing areas of feet
raised, yellowish thickening of the skin; broad based with diffuse borders; normal pattern of skin ridges
usually not painful
size varies
caused by friction, walking barefoot, structural problems
treat with salicylic acid
261
the only types of warts that are self-treatable
common and plantar
262
warts on hands
common
263
warts on face
flat
filiform
264
warts on feet
plantar
mosaic
265
warts on nails
periungual
266
nonpharm treatment of warts
AVOID cutting, shaving, or picking at warts
wash hands before and after treating or touching a wart
use a designated towel to dry any wart-affected areas
AVOID sharing towels, razors, socks, shoes
keep wart covered
use foot covering in bathrooms/public spaces
may suggest padding to relieve discomfort
267
wart removers pharm therapies
salicylic acid 40%: pads, strips, patches
salicylic acid 17%: gel, liquid, stick
cryotherapy: dimethyl ether and propane
cryotherapy: nitrous oxide
268
salicylic acid 40% counseling points
trim plaster to fit the wart, corn, or calluses apply plaster, and cover with an occlusive tape
remove plaster/pad/stick after 48 hrs
repeat every 48 hrs as needed
may use for up to 12 weeks
269
salicylic acid 17% counseling points
apply 1 drop at a time to cover the wart, corn, callus; protect adjacent healthy skin from coming into contact with the gel
let solution dry
cover wart with self-adhesive discs or an occlusive tape
repeat 1-2x a day until resolves; may be used up to 12 weeks
270
cryotherapy counseling points for warts
wash hands before and after use
before treatment, soak affected area in warm water for 5 min
wash and dry the affected area thoroughly
may use file for surface of wart
do NOT hold canister close to face, body or clothing
FLAMMABLE
have to activate the device
discard single-use applicators after 1 use
repeat after 2 weeks if needed; may be used for up to 3 treatments
271
complementary therapies for warts
vitamin A
dietary zinc
garlic->DIs
duct tape
272
corn
small, raised, sharply demarcated, hyperkeratotic lesion with a central core; lesion is cause by pressure from underlying bony prominences or joints
on top of foot
273
callus
bottom of foot
broad base, with relatively even thickening of skin
274
corns and calluses nonpharm
daily soaking of affected skin area for 5 min in warm water
remove any dead tissue gently
use circular foal or gel cushioning pads
use well-fitting, non binding footwear
orthotics
275
corns and calluses pharm counseling point
do NOT use on irritated skin, any area that is infected or reddened, moles, birthmarks, wart with hair growing from them, genital warts, warts on face, mucous membranes
do NOT use if diabetic, or poor blood circulation
276
corns and calluses pharm therapies
salicylic acid 17%
salicylic acid 40%
