Lecture 6 - Dermatology 3 Flashcards
3 types of lice
Pediculus = Head and body….2-3mm in size
Phthirus = Crabs = 1mm size
symptoms of lice
inflammation and itching
presence of peppery flecks
macular swellings
behind ear good area to look
Lice treatment
topical pediculicides are typically preferred
1st line lice Treatment
Pyrethrin 0.33% and Permethrin 1%
0.33% > 2yrs, 1% > 2 months
about same cost
put into hair, let sit for about 10 min, remove with special comb
reapply in 7-10 days
2nd line lice treatments
topical prescription meds if fail/dont respond to 1st line
typically use Malathion
Malathion 0.5% lotion info
apply to dry hair, let air dry and wash off
usually 1 treatment enough, can repeat in 9 days
CI < 24 months old and dont use P.pubis
** Flammable until dry and malodorous **
Benzyl alcohol 5% lotion info
can use in infants 6 months or older who OTC dont work
applied to dry hair, rinsed after 10min and repeated after 7 days***
Is permethrin 5% more effective than 1%?
nah if failed 1% then probs fail 5%
Spinosad 0.9% suspension info
more effective than permethrin
apply to dry hair, rinse after 10min, repeat 7 days if live lice seen
Dont need to Nit comb, but recommended
Ivermectin 0.5% lotion info
can use > 6 months or older
apply, and rinse after 10min, single app
Why is Lindane 1% not recommended
Adverse drug events
Abametapir (Xeglyze) Lotion info
approved for those older than 6 months
apply, rinse after 10min
Can use shampoo anytime after treatment**
more risk of contact dermatitis
Oral lice treatments
Bactrim or Ivermectin
Bactrim: CI < 2months, preg/nursing, sulfa allergy
Ivermectin: 1 time dose
Non-pharm lice treatments
Petroleum jelly = massage int hair and left overnight, shampoo next morning…repeat 1 week
Cetaphil lotion = apply to hair, dry with hairdryer, leave overnight and shampoo morning, QW X 3wks
Lice exclusion for self-care w/ OTC
Hypersensitivity to chrysanthemums, ragweed, pediculicide ingredients
Presence of 2ndary skin infection
Presence of active tumor
2 previous unsuccessful treatment attempts
< 2yrs of age
Lice infestation of eyebrows/eyelid
Pregnancy/breast feeding
Lice counseling points
Treat other members
clean all bedding/clothing and high-heat drying
non-washable can be dry-cleaned of sealed bag for few weeks
vacuum
disinfect combs/brushes
teach children to avoid head-to-head contact
Factors that can affect acne
Hormone abnormalities or malfunctions
Physical occlusion or damage
Meds
other - Genetics, Climate, Diet, Excessive Sweating
Exclusions to Acne treatment
pts w/severe acne Type 3-4
Drug-induced acne
Possibility that its not acne
Acne persists or develops >30yrs old
No improvement after treatment attempt or 6 weeks
Non-pharm acne treatments
stress reduction
avoid extreme temps
use nondrying cleansing agents, dont want dry skin
can try comedones extractors
goals of acne therapy
reduce excess oil
control bacteria associated with acne
reduce effects of hyperkeratinization
unclog pores
what to use on Oily to normal skin?
Gels and solutions
what to use on normal skin?
Gels, solutions, lotions and creams
What to use on Normal to dry skin?
Lotion and Creams
Benzoyl peroxide info
no resistance reported
effects seen in ~5 days
comes in bunch of formulations
Fair or moist skin highest risk of irritation
can bleach or discolor fabrics
Salicylic acid info
repeated use can lead to salicylism
CI in pt who used isotrentinoin within last 6 months
Retinoid CI and Warnings
CI in retinoid hypersensitivity
avoided in women who are pregnant or breastfeeding
avoid pts with photosensitivity disorder or eczema
safety not established < 12yrs old
use limited by side effects
If patients has Fish allergy can you use Retin-A micro?
Nah
Tretinoin lotion info
patients > 9yrs older
Caution: fish allergy
use sunscreen and protective clothing
Adapalene info
good option for sensitive skin
OTC
Tazarotene info
more effective than other retinoids but more irritating
Pro drug and synthetic retinoid
Topical retinoid general info
takes few weeks to see effect, much longer then benzoyl peroxide
Dapsone info
used in females w/ inflammatory acne
localized discoloration of skin or facial hair * ADR*
Clindamcin info
preferred macrolide
BPO increases efficacy
* Diarrhea and pseudomembranous colitis can occur from topical use*
Why don’t use Erythromycin topical alone?
higher risk for resistance
Amzeeq info
approved for 9yrs or older
used for moderate to severe acne
used once daily, 1hr before bed
$$$$
Azelaic Acid
useful for noninflammatory and inflammatory acne
can improve acne-induced post-inflammatory hyperpigmentation
not clinically efficacious in treatment of acne
Acne tetracyclines
Doxy and minocycline
used in moderate to severe who haven’t responded
Limitations: GI upset, photosensitivity, superinfections, hepatotoxicity, intracranial hypertension = rare
** don’t combine with systemic retinoid **
when are macrolides used in acne?
usually pts who have intolerance or resistant strains to tetracycline
higher rates of bacterial resistance
When are oral contraceptives used for acne?
usually when also want to use for contraception
Net effect is an anti androgen effect
additional option to give to women taking isotrentinoin
Spironolactone for acne
pts who haven’t responded
not approved by FDA as anti-androgen agent
can safely use with OCs
Isotretinoin info
iPLEDGE program
highly effective
use for 15-20wks, then atleast 2 month break
Reserved for severe acne or other forms that have failed treatment
iPLEGE requirement
females of childbearing age be on 2 forms of BC, 1 month before/after/during treatment
females must have negative pregnancy tests conferred by lab monthly during, 1 month after treatment
pts must access iPLEDGE monthly to document what 2 forms of birth control have been used
Primary forms of birth contorl
Tying tubes
Vasectomy of partner
IUD
hormones
Secondary forms of birth control
Latex condom
Diaphragm
Cervical cap
Vag sponge
Other iPLEDGE requirements
Males also have to register
only registered pharmacy can dispense
have to have yellow approval sticker on RX
can only do 30 DS, no refills
1st choice mild acne
Topical retinoid or BPO or combo
1st choice moderate acne
Topical combo BPO + Topical antimicrobial….can also consider adding oral
1st choice severe acne
Oral antibiotic + topical combo therapy….oral isotretinoin is last line
acne monitoring
6-8 weeks look for results
treatment can last for 20 weeks before full results are seen
