FINAL - Dermatology Flashcards

Question

Atopic Dermatitis

Answer 1

Most common form of **eczema** Usually presents in infancy 1 in 5 children 1 in 12 adults **80% mild; 20% mod-severe** Significant QOL issues -Sleep -Depression, anxiety, productivity

Answer 2

**Atopic march** - Often first disease of atopic allergic triad to be observed -50-75% also develop allergic rhinitis and or asthma **Atopic Dermatitis Allergic rhinitis Asthma**

Answer 3

**Pruritis** -Symmetrical red papules or plaques -Scaling excoriations **Overall dryness of skin** -Redness and inflammation -History of allergic disease -Risk of 2nd infection

Answer 4

**Infant** -**Red, papular skin rash on cheeks and skin** -Lesions often crust over time -**lesions later appear on neck, trunk and groin** -Itching often results in irritability **Child** **Face, neck, flexural creases of arms and legs** -Skin often appears dry, flaky, rough, cracked, and may bleed from scratching -Sleep disturbance is common -Greater risk of secondary skin infections **Adult** -Hands and neck** **Flexor surfaces of the arms and legs** -Excoriation and lichenification from chronic scratching -Intense itching; sleep disturbance; Altered QOL; depression

Answer 5

Allergens Chemicals Bathing **Detergents** Soaps Smoke Dust **Infections**

Answer 6

**Non-pcol measures** -Lukewarm/tepid baths -**Emollients** -Eliminate irritants; modify environment; avoid triggers -Trim fingernails; Non-irritating clothing **Topical Therapy** -Topical corticosteroids (TCS) -Topical calcineurin inhibitor therapy -Topical JAK inhibitor -Strength/duration of use based on severity **Systemic therapy** -Phototherapy -Oral immunosuppressant therapy -Oral JAK inhibitors -Injectable biologic agents

Answer 7

**Acute flares** -**Moderate to severe**: medium potency TCS BID for up to 3 days beyond CL of lesions **Refractory** **Refractory to topical agents or widespread lesions**: Phototherapy or oral immunosuppressive therapy **Inadequate response to all therapies**: consider emerging biologic agents **Maintenance therapy** **Moderate to severe** Basic measures plus daily application of low-potency TCS or 2-3 times weekly application of TCS or other topical anti-inflammatory agent **Written action plan**

Answer 8

Location of lesions Type of lesion Severity of lesion/degree of inflammation Degree of skin penetration desired

Answer 9

Classified according to potency, which corresponds to **anti-inflammatory activity** and vasoconstrictive potency -Very-high-high-Mid-low (Grades I to VII) -Vehicle impacts delivery **and** potency of corticosteroids -Only 2% absorbed when applied to normal **intact** skin -**Occlusion enhances penetration** -Increases penetration up to 10X

Answer 10

-Thinning of skin -Dilated blood vessels -Increased bruising -Skin color changes -Risk of HPA suppression w/long-term use of high potency agents -Development of tolerance (tachphylaxis)

Answer 11

Very high potency: Class I **Betamethasone** dipropionate ointment Comments: -Used for very severe lesions and on thickened skin when max penetration is needed -**DO NOT USE ON FACE** -Avoid using super potent agents for **>2 weeks** Limit to no more than 50g per week High potency class 2 **Betamethasone dipropionate Lotion** (Diprolene) Comments: -Used for very severe lesions and on thickened skin when max penetration is needed -**DO NOT USE ON FACE** -Avoid using super potent agents for **>2 weeks** Limit to no more than 50g per week Mild potency classes 3-5 **Betamethasone dipropionate lotion (Diprolene) Comments: -Used on most skin surfaces for exacerbations -Moderate anti-inflammatory effect -Safer for longer usage than high potency Low potency Classes 6-7 -Hydrocortisone (Cortaid) -Desonide (Desonate) Comments: -Use on face, groin, genitals, axilla -Mild anti-inflammatory effect -Safest for long-term maintenance use

Answer 12

MOA: blocks pro-inflammatory cytokine genes **Primecrolimus and tacrolimus** **CAN BE USED ON ANY AREA** -Equivalent to mid-potency corts -No risk of atrophy -Few side effects - burning $$$

Answer 13

**Now considered 2nd line treatment** -Intermittent use only -Recent concern regarding long-term use -Risk of malignancies -Risk of resp infect in children <2 yrs

Answer 14

Phosphodiesterase- Inhibitor (non-steroidal) **Alternative to TCS and TCIs** -steroid phobia Mild or moderate AD BID for 28 days $619-$735

Answer 15

**Opzelura 1.5% cream** -Mild to moderate atopic dermatitis -Not well controlled with other therapies -MOA: JAK inhibitor Mediates signaling of cytokines -Apply a thin layer BID up to 20% BSA -Short term use -Max of 60g per week Avoid in immunocompromised pts

Answer 16

Rinvoq -Moderate to severe atopic dermatitis Not well controlled with other therapies -MOA: JAK inhibitor Mediates signaling of cytokines and growth factors -15 mg - 30 mg PO once daily Well tolerated Higher Rates of major CV events and thrombosis

Answer 17

Dupixent -First biologic indicated for mod-severe AD Not well controlled with other therapies **MOA: Human monoclonal antibody against IL-3 receptor alpha** Inhibits signaling of IL-4 and IL-3 (Th2 cytokines) -600mg initially, then 300mg SC q2 Weeks -Well tolerated $37,00 per year -Specialty pharmacy - expanded indication Tralokinumab -Adbry - recently approved

Answer 18

**Definition**: A chronic inflammatory disease of the sebaceous glands and hair follicles of the skin characterized by comedones, papules, and pustules **Affects 90% of the adolescent population** -Corresponds to increased **androgen** production 80% of patients with acne are between **12-30 years old** -Males more severe during puberty -Females more severe during adulthood

Answer 19

**Oil based cosmetics Emotional stress Irritation/Physical pressure Drugs** -**Androgenic steroids** -Corticosteroids -Lithium -Anti-epilepitcs (phenytoin) -Tuberculostatic drugs -OCs

Answer 20

Keratinous obstruction of sebaceous follicle outlet -Traps sebum -**Comedone** - hair follicle plugged with sebum, keratin and dead skin -Bacterial colonization in **trapped sebum**

Answer 21

Propionibacterium acnes - naturally colonize the skin and sebaceous glands -Proliferates in sebum environment -Bacteria **converts** TG to FFA which irritates local cell resulting in inflammation

Answer 22

**Non-inflammatory** 1. white heads 2. Black heads **Inflammatory** 1. Papules 2. Pustules 3. Ruptured Contents

Answer 23

Excoriations Erythematous macules Hyperpigmented macules **Scars**

Answer 24

Dermabrasion Chemical peels -70% glycolic acid Laser resurfacing **$$$**

Answer 25

**Long-term control** -Relieve discomfort -Improve skin appearance -Minimize physiological stress **Prevent scars**

Answer 26

-Antimicrobial -Anti-inflammatory -Decrease sebum production -Keratolytic Compounds that break down the outer layers of the skin; decrease the thickness; and promote sloughing -Salicylic acid; urea; alpha-hydroxy acids Comedolytic -A product or medication that inhibits the formation of comedones -Tretinoin; aldapalen; azelaic acid

Answer 27

Follow a regular skin cleansing regimen using a mild facial soap **BID** **Minimize** the use of products that cause irritation or stinging (aftershave, alcohol based cleansers) Use tepid, **not hot** water to clean affected areas **NO QUICK FIX** - weeks to months

Answer 28

-First line: ** Topical retinoids** -Alt: Benzoyl peroxide (BP) Azelaic acid (lower strengths

Answer 29

First line: -**Adapalene + BP or -Clindamycin +BP** Alt: -Alternative retinoids -Adapalene + Oral antibiotics (OA)

Answer 30

First line **Oral isotretinoin** Alt: OA + Adapalene OA + adapalene +BP OA + Azelaic acid OA + Oral antiandrogens Oral antiandrogens + topicals

Answer 31

First line **Oral isotretinoin** Alt: -OA + Azelaic acid Other topical agents or oral antiandrogens can be substituted for AA

Answer 32

First line **Adapalene** Alt: -Tazarotene -Tretinoin -Azelaic acid -Benzoyl peroxide

Answer 33

Formulation: -Gel -Cream -Solution MOA: -Retinoid -Regulate epithelial cell growth **Daily at hs** Burning/stinging

Answer 34

Formulation: -Cream -Gel MOA: -Retinoid Daily start lower strength very drying category X

Answer 35

Formulation: -Cream -Gel -Solution MOA: -Retinoid **Daily at hs** sting, burn Dryness Photosensitivity 4-6 weeks until improvement

Answer 36

Formulation -Cream MOA: Antibacterial Keratolytic Adjunct Well tolerated

Answer 37

Formulation: -Gel -Cream -Lotion MOA: -Antibacterial -Comedolytic/keratolytic -Anti-inflammatory **BID** -Dry skin/irritation Can bleach skin/hair Start lower strength Avoid contact with clothin

Answer 38

Formulation: -Gel -Solution -Lotion MOA: Topical Antibiotic **Daily or BID**

Answer 39

Formulation: -Gel -Solution Topical Antibiotic **BID** Expires in 30 days

Answer 40

Formulation: -Cream Topical antibiotic Limits resistance

Answer 41

**Adapalene has the least** Tretinoin has the most Erthema Scaling Burning Flare Resistance HEAVY in antibiotics ONLY

Answer 42

Clindamycin + Benzoyl Peroxide -Duac Adapalene + Benzoyl Peroxide -Epiduo Forte **Most combo products are expensive!! Most insurances will not cover combo, but may cover individual ingredients**

Answer 43

**Minocycline; Doxycycline; Erythromycin; Azithromycin; TMP/SMX **Decreased bacteria and inflammation** -weeks to see improvement **MOST EFFECTIVE WHEN INFLAMMATION PRESENT** -Risk of allergy, photosensitivity, GI upset, thrush -Risk of resistance developing (Limit to 6-8 weeks if possible)

Answer 44

Low dose oral contraceptives Spironolactone **Ideal for females whos acne flares during menstrual cycle** -Decreases androgen Topical hormone -**Clascoterone 1% Cream** -Androgen receptor inhibitor May be used in males and females Applied BID Local erythema most common SE

Answer 45

**Isotretinoin** -**Used for severe acne or when patients have failed other treatments or when it relapses soon after d/c other therapies** Vitamin A derivative **$393** - good rx Provides resolution in 80% of cases Reduces sebum production and shrinks sebaceous glands

Answer 46

**0.5-2mg/kg/day in 2 doses (with food) for 15-20 weeks** **Acne will get worse before it gets better** -If acne flares after > 2 months off tx, a 2nd course may be used -Effectiveness increases with **higher doses**

Answer 47

Skin: -Dry skin -Dry eyes and nose -Dry lips -Hair shedding -Peeling of palms and soles -Photosensitivity MSK -Back pain -Arthralgias -Myalgias -Fatigue -Risk of osteoporosis -Delayed bone healing Labs: -Elevated AST/ALT -Elevated chol and triglycerides Other **Category X** hA Mood changes Night blindness **Depression/suicide**

Answer 48

AVOID pregnancy Do not take vitamin A sup Use moisturizer, lip balm, and artificial tears use sunscreen Take with food

Answer 49

Can only dispense 30 day supply Females must have negative pregnancy test every month to be on therapy

Answer 50

For any pt with acne: -2-6 months will be necessary to determine if a regimen has been successful Lengthening acne free periods is key

Answer 51

A common chronic progressive inflammatory dermatosis based on **Vascular instability** Characterized by **facial flushing/blushing** facial erythema, papules, pustules and **telangiectasia** Ages 25 and 70 years People with fair complexions Women > men Chronic, persisting for years with periods of exacerbation and remission

Answer 52

**Telangiectactic** -Visibly dilated blood vessels -Very red skin **Papulopustular** -Resembles acne **Phytmatous** -Enlarges sebaceous glands -**Especially the nose** -More common in males **Ocular** -Watery eyes -Bloodshot eyes

Answer 53

Foods Temp Weather Beverages Medical conditions Emotional influences Physical exertion Skin products **Drugs** -**Vasodilators** -Topical corticosteroids -Nicotinic acid -ACE inhibitor -Calcium channel blockers -Statins

Answer 54

**Avoid triggers** -avoid excessive exposure to the sun -Use mild soaps and cleansers -Stress adherence to topical meds Topical meds should be allowed to penetrate the skin for **5-10 min** before applying make-up

Answer 55

**Mild** -Avoid triggers -Topical antibiotics (metronidazole) -Topical retinoids **Moderate** -Oral antibiotics -Topical retinoids **Severe** -Oral isotretinoin -Laser treatments

Answer 56

Topical Antibiotics: **Metronidazole 1%** cream; gel; lotion **Tx of choice** - apply bid -Clindamycin Sulfur Topical retinoids **Azelaix acid** - Finacea Gel 15% antibacteral

Answer 57

Alpha-2 adrenergic agonist -**Tx of persistent facial erythema** Ophthalmic drops for ocular rosacea

Answer 58

**Thickened red patches covered by silver-white scales** 2% of us population Onset usually prior to 40 y/o

Answer 59

**Limited** -<5% BSA **Generalized** -Moderate 5-10% BSA **Severe** >10% BSA 80% of pts have mild to moderate 20% have severe disease

Answer 60

**Stress** Cold environment Injury infection smoking Drugs (NSAIDs, ACE, Lithium) Diet

Answer 61

Decrease symptoms. % of BSA affected **Improve QOL** Reduce inflammation and slow down rapid skin cell division **Prolong periods between exacerbations**