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PHRM 504 > Lecture 18: Dermatology III > Flashcards

Lecture 18: Dermatology III Flashcards

1
Q

Causes of Hair Loss

A
  • Chronic Illnesses
  • Dietary Changes or Deficiencies
  • Genetics
  • Hormonal Changes
  • Local Trauma
  • Medications
  • Physiologic stress
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2
Q

Chronic Illnesses

A

Autoimmune disorders, eating disorders, endocrine disorders,

hepatic failure, infections, renal failure

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3
Q

Dietary Changes or Deficiencies

A

Protein restriction/deficiency, rapid weight loss, strict

vegetarian diet, zinc/biotin/iron deficiency

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4
Q

Hormonal Changes

A

Hyperandrogenic conditions, menopause, post-partum,

pregnancy

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5
Q

Local Trauma

A

Hair care practices, tinea capitis, trichotillomania

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6
Q

Medications

A

ACE inhibitors, androgenic medication, anticoagulants,

anticonvulsants, antidepressants, beta blockers, chemotherapeutics, et

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7
Q

Physiologic Stress

A

Fever, infection, hemorrhage, surgery, trauma

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8
Q

Androgenetic Alopecia (AGA)

A 
Most common form of hair loss
• Only form of hair loss approved for self-care therapy
- Etiology
• Hereditary
• Hormonal
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9
Q

Androgenetic Alopecia (AGA) Pathophysiology

A

Changes in hair follicle cycle
• Shorter time in active growth
• Shorter transitional/resting period before hair sheds

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10
Q

Androgenetic Alopecia (AGA) Clinical Presentation for Males

A

Gradual onset with progression of patterned hair loss
Frontal hairline
○ Occipital regions
○ Top rear of head (vertex)

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11
Q 
Androgenetic Alopecia (AGA)
Clinical Presentation for Women
A

Gradual onset with progression of patterned hair loss
Central portion of scalp
○ Wide midline part on crown with progression
to diffuse thinning over crown

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12
Q

Androgenetic Alopecia (AGA) exclusions

A

● <18 years of age
● Pregnancy or breastfeeding
● Recent discontinuation of oral contraceptives
● Hair loss in patient with no family history of hair loss
● Hair loss related to history of endocrine dysfunction,
medical treatments, or dietary deficiencies
● Sudden or patchy hair loss
● Evidence of fever or inflammation (typically occurring 3-6
months before hair loss begins)

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13
Q

Androgenetic Alopecia (AGA) exclusions to self-care pt 2

A

Skin lesions that indicate autoimmune disease or infection
● Scaling, sunburn, or other damage to scalp
● Broken off hair shafts that resemble those cause by fungal
infection or trichotillomania
● Loss of eyebrows or eyelashes
● Changes in nails
● Women with sudden or severe hair loss
● Postpartum women with hair loss

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14
Q

Androgenetic Alopecia (AGA) Non-Pharm Therapy

A 
● Cosmetic
○ Camouflage
○ Surgical transplantation
●Hair care
○ Avoid hairstyles that pull; avoid heat or oily products
● Proposed, but ineffective
○ Electrical stimulation
○ Frequent shampooing
○ Scalp massage
●Unknown efficacy
○ Low-level light therapy
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15
Q

Androgenetic Alopecia (AGA) Pharm-Therapy

A

Minoxidil

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16
Q

Minoxidil Brand Name

A

Rogaine

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17
Q

Minoxidil MOA

A

Increases cutaneous blood flow directly to hair follicles

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18
Q

Minoxidil Indications for Use

A

Men: baldness at the crown of head
Women: hair thinning at the frontoparietal area

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19
Q

Minoxidil Warnings/ Precautions

A

Do not use in heart disease unless recommended by primary care
provider

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20
Q

Minoxidil Adverse effects

A

Local: itching, irritation, dryness, or scaling at the application site
Long-term use: transient hypertrichosis
Systemic: hypotension, tingling/numbness, vision changes - RARE

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21
Q

Minoxidil Drug Interactions

A 
Hair chemicals (colors, perms, relaxants); oral minoxidil; topical
corticosteroids, petrolatum, or retinoids
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22
Q

Minoxidil Dosage Forms

A

○ Hydroalcoholic solution: 2%, 5%

○ Solvent-free foam: 5%

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23
Q

Minoxidil Applications methods

A

○ Dropper
○ Foam
○ Rub-on
○ Spray

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24
Q

Minoxidil Application

A

Ensure scalp and hair are clean and dry
▪ Apply and massage 1 mL solution or ½ capful foam to
affected scalp area twice daily (men) or once daily (women)
▪ Wash and dry hands after application
▪ Allow product to dry completely and penetrate the scalp (2-4
hours)
▪ Do not use a hairdryer
▪ May stain clothing/linens

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25
Q

Minoxidil Patient Education/Follow Up

A

● Increased hair loss may occur within the first few weeks of
use
●Must continue use indefinitely to maintain new hair growth
● Consider discontinuation if hair density does not increase after 4 months of treatment

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26
Q

Wounds Acute

A

typically caused by trauma and tend to heal within one month

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27
Q

Wounds Chronic

A

any wound that does not heal properly through the normal

stages of tissue repair (longer than 2-3 weeks)

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28
Q

Abrasions

A

rubbing or friction that affects the epidermis

● May extend to uppermost portion of dermis

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29
Q

Burns

A

caused by chemical, electrical, thermal, or ultraviolet radiation
(UVR) exposure

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30
Q

Lacerations

A

result from a sharp-edged object cutting through the

various skin layers

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31
Q

Punctures

A

piercing of epidermis by a sharp-pointed object

32
Q

Risk Factors for Poor Wound Healing

A 
● Bacterial contamination and infection
● Inadequate nutrition
● Medications
○ Chemotherapeutics, systemic steroids
● Poor vascularization → poor oxygenation
○ Congestive heart failure, diabetes, hypotension, peripheral
vascular disease, severe anemia
●Unfavorable wound characteristics
○ Foreign bodies, necrotic tissue, scab
● Advanced age
●Obesity
33
Q

Exclusions to Self-Care - General

A

● Chronic wounds (> 2-3 weeks)
● Contains foreign matter after irrigation
● Caused by an animal or human bite
● Signs of infection
● Involvement of face, mucous membrane, or genitalia
● Deep wound (extending below dermis)
● Patients with immunocompromising conditions

34
Q

Exclusions to Self-Care - Burns/Sunburns

A

● Burns to BSA ≥2%
● Burns involving eyes, ears, face, hands, feet, or perineum
● Chemical, electrical, or inhalation burns
○ Use first-aid measures then seek medical attention
● Older age
● Immunocompromised patients or those with multiple medical
disorders

35
Q

Non-Pharmacologic Therapy for Wounds

A

First-aid measures to relieve pain, prevent contamination, and
promote healing
● Wound Irrigation
○ Remove dirt/debris by flushing with normal saline or water
○ Mechanical removal with clean gauze
● Soaking in water
● Covering
○ Nonadherent, hypoallergenic dressing may be applied
○ Create a moist wound environment
● Do NOT pull at or peel off loose or burned skin

36
Q

Pharmacologic Therapy for Wounds – Systemic Analgesics

A

● Recommended for short term use
● Preferably an agent with anti-inflammatory properties
● NSAIDs
● Ibuprofen 200-400 mg PO every 4-6 hours as needed
● Naproxen 220 mg PO every 8-12 hours as needed
● Acetaminophen
● 325-1000 mg PO every 4-6 hours as needed

37
Q

Wounds- Pharmacologic Therapy – Skin Protectants

A

Protects from mechanical irritation caused by friction and rubbing
• Prevent drying/provide lubrication
- Apply as often as needed

38
Q

Skin protectants common ingredients

A
  • Allantoin
  • Cocoa butter
  • Petrolatum
  • Shark liver oil
  • White petrolatum
39
Q

Wounds-Pharmacologic Therapy – First-aid antiseptics

A

Chemical substances applied to intact skin up to edges of damaged skin area
for disinfection purposes
-Apply to intact skin only

40
Q

First-aid antiseptics common ingredients

A
  • Camphorated phenol
  • Ethyl alcohol
  • Hydrogen peroxide
  • Iodine
  • Isopropyl alcohol
  • Povidone/iodine
41
Q

Pharmacologic Therapy – First-aid antibiotics

A 
Help prevent infection
• Ingredients
• Bacitracin
• Neomycin
• Hypersensitivity reactions in 3.5-6% of patients
• Polymyxin B sulfate
42
Q

Pharmacologic Therapy – First-aid antibiotics Directions

A

Use after cleansing wound bed

• Apply 1-3 times daily

43
Q

General Treatment Approach

A

● Clean the wound carefully
● Selective use of antiseptics and antibiotics
● Systemic analgesics for pain as needed
● Close/cover the wound with an appropriate dressing

44
Q

Minor Burns Approach

A
  • Actively cool burns with cool tap water continuously for first 10 minutes
  • Cleanse the area with water and a mild soap
  • Apply a non-adherent dressing or skin protectant
  • If skin is broken, use topical antibiotics to prevent infection
  • Systemic analgesics for pain as needed
  • Reassess after 24-48 hours
  • Inflammatory response to a burn evolves
  • Initial appearance may lead to underestimation of actual severity
45
Q

Follow-up/Monitoring

A

REFER if infection suspected or wound or burn does not show signs of healing in 7 days

46
Q

Dermatomycoses

A

Fungal Skin Infections
One of the most common skin infections – occur in 10-20% of the
population
• “Tinea” refers to dermatophyte infections

47
Q

Tinea corporis

A 
Body
Often involves smooth bare skin
● Begins as small, circular, erythematous, scaly areas that spread
peripherally
● May also be referred to as “ringworm”
○ Ring-shaped lesions with clear centers and red, scaly borders
● Self-Care?
○ YES
48
Q

Tinea pedis

A 
Feet
Also known as “athlete’s foot”
● Risk Factors
○ High impact sports with chronic trauma to feet (long distance
running)
○ Occlusive footwear
○ Public pools/bathing facilities
○ Warm/humid environment
● Self-Care?
○ YES
49
Q

Tinea cruris

A 
Groin
Also known as “jock itch”
● Occurs more often in men than women
● Occurs on medial upper parts of thighs and pubic area
○ Usually spares the penis and scrotum
● Well-demarcated lesions, slightly elevated and
erythematous
● Associated with significant pruritus
● Self-Care?
○ YES
50
Q

Tinea unguium

A 
Nails
Tinea infection of the nails
● Loss of shine, become opaque
● Can progress to thick, rough, yellow, friable
● Self-Care?
○ NO
51
Q

Tinea capitis

A 
Scalp
Fungal infection of the scalp
●Often presents with pruritic scaling areas of
hair loss
● Primarily occurs in children
● Self-Care?
○ NO
52
Q

Dermatomycoses Risk factors

A
  • Diabetes
  • Human immunodeficiency virus (HIV)
  • Immunosuppressive medication use
  • Occlusive clothing/footwear
  • Sweating/humidity
53
Q

Dermatomycoses Exclusions to Self-Care

A

●Unsuccessful initial treatment or worsening of condition
●Nails or scalp involved
● Face, mucous membranes, or genitalia involved
● Signs of secondary bacterial infection
● Large area, seriously inflamed, or debilitating
● Immunocompromization

54
Q

Dermatomycoses Clincal Presentation

A

Often occurs in areas of body where excess moisture accumulates
(feet, groin, scalp, under the arms)
●Usually localized to a single region of the body, but can spread
● Signs/symptoms
○ Soggy malodorous thickened skin, acute vesicular rash, or fine
scaling
○ Varying degrees of inflammation
○ Itching and pain

55
Q

Dermatomycoses Non-Pharmacologic Therapy

A

●Use a separate towel to dry the affected area
● Avoid sharing personal articles
● Launder contaminated towels and clothing in hot water and
dry them on a hot dryer setting
● Cleanse skin daily with soap and water
● Avoid contact with infected fomites or persons with a fungal
infection
●Do not wear clothing/shoes that cause the skin to stay wet

56
Q

Dermatomycoses: Pharmacologic Therapy: Topical Antifungals

A

● Apply once or twice daily (depends on formulation)

● Length of treatment depends on formulation and infection

57
Q

Pharmacologic Therapy: Topical Antifungals

Various treatment options available OTC:

A 
● Clotrimazole 1%
● Miconazole nitrate 2%
● Terbinafine hydrochloride 1%
● Butenafine hydrochloride 1%
● Tolnaftate 1%
● Also approved to PREVENT tinea infection
58
Q

Dermatomycoses: Pharmacologic Therapy: Formulation Considerations

A

Creams/solutions
● Most efficient/effective for delivery of active ingredient to epidermis

● Sprays/powders
● Less effective – not rubbed into the skin
● Used as adjuncts or prophylactic agents

59
Q

Dermatomycoses: Follow Up

A

There should be some relief of itching, scaling, and/or
inflammation within 1 week
● If improvement seen, continue treatment for 1-3
weeks depending on type of tinea infection and
medication being used
● REFER if no improvement or condition has worsened

60
Q

Warts Pathophysiology

A

● Common benign skin disorder caused by human papillomaviruses
(HPV)
● Transmitted via person-to-person contact, autoinoculation, or fomites
on contaminated surfaces
● May affect any skin and mucous membranes
● 1-24 month incubation period following inoculation

61
Q

Warts Risk factors

A
  • Biting fingernails
  • Depressed immune system
  • Going barefoot, especially on wet surfaces (public pools, showers)
  • Meat handling occupation
  • Previous or existing warts
62
Q

Warts Clinical Presentation

A 
• Can appear on any skin
• Hands and feet are most common
• Raised lesions, typically 1-3 mm
• May present as slight scaly, rough papules or nodules or even
cauliflower-like in appearance
• May have black spots
• May appear in groups or alone
• Begin as minute skin-colored lesions that enlarge over time
• May be painful if pressure is applied
63
Q

Warts Exclusions to self-care

A

● <4 years of age
● Pregnancy or breastfeeding
● Chronic, debilitating conditions that affect sensitivity or circulation of
the hands or feet
○ Diabetes, peripheral vascular disease (PVD), neuropathy
● Immunocompromization
● Large or multiple warts located on one area of body
● Painful plantar warts
● Warts located on the face, breasts, armpits, fingernails, toenails,
anus, genitalia, or mucous membranes

64
Q

Warts Non-Pharm therapy

A

Focus on prevention of spread of HPV
○ Autoinoculation
■ Avoid cutting, shaving, or picking warts
■ Keep feet clean and dry
■ Use designated towel to dry warts
■ Wash hands before/after treating or touching warts
○ Transmission to others
■ Avoid sharing towels, razors, socks, shoes, etc.
■ Do not walk barefoot
■ Keep wart covered
• Duct tape

OTC treatment options cannot treat/cure HPV, they only remove the wart

65
Q

Warts Pharm-therapy

A

Salicylic Acid

66
Q

Salicylic Acid Brand Names

A

Compound W®, Dr. Scholl’s Clear Away®, TransVer-Sal®

67
Q

Salicylic Acid MOA

A

May induce an immune response secondary to

mild irritation

68
Q

Salicylic Acid Indications

A

Common and plantar warts

69
Q

Salicylic Acid Adverse Effects

A

Skin irritation

70
Q

Salicylic Acid Dosage Forms

A
  • Liquid (colloidion vehicle) – 17%
  • Patches (karaya gum glycol plaster vehicle) – 15%
  • Pads/strips (plaster vehicle) – 12 - 40%
71
Q

Salicylic Acid - Keratolytic Agent

A

slowly destroys virus-infected cells

72
Q

Salicylic Acid Note

A

Should see some improvement in 1-2 weeks
• Can use up to 12 weeks of treatment
• REFER if not cleared after 12 weeks

73
Q

Salicylic Acid Application Collodion Vehicle Liquid

A

Wash/soak and dry affected area

○ Apply one drop at a time to cover wart
○ Allow solution to dry completely and cover with occlusive tape
○ Repeat 1-2 times daily

74
Q

Salicylic Acid Application Karaya gum glycol vehicle Patch

A

Wash/soak and dry affected area

○ Use file to gently remove keratinous surface and apply drop of warm
water to wart
○ Apply patch at bedtime and remove after at least 8 hours
○ Repeat daily

75
Q

Salicylic Acid Application Plasters/Pads/Strips

A

Wash/soak and dry affected area

○ Apply appropriate size to wart and remove after 48 hours

76
Q

Pharmacologic Therapy: Cryotherapy

A

●Destroy warts by freezing the wart tissue
● Blister will form under the wart
● Warts may fall off within 10 days
● If not cleared after 12 weeks or 4 treatments, REFER

77
Q

Cryotherapy Application

A
  • Wash hands before/after use
  • Soak wart in warm water for 5 minutes
  • Use a file or pumice stone to remove wart’s keratinous surface
  • Apply applicator to center of wart
  • Keep in contact with skin for no more than 40 seconds
  • Discard applicator after use
  • Repeat use after 14 days if needed

PHRM 504 (22 decks)

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