Med classes- Skin Quiz 2 Flashcards
What are the 2 layers of the skin and what do they do? *
- Epidermis: is the protective layer—its outer most surface (the stratum
corneum) contains lipids & keratin - Dermis: lies between the epidermis and SQ fat layer—it is composed of
connective tissue and contains sweat glands, sebaceous glands, hair follicles and vessels
Key factors in a skin exam
-Perform in well-lit room
-Use hand-held light for illumination
-Wood’s lamp helpful for fluorescing certain types of lesions
-KOH (potassium hydroxide) and/or 5% acetic acid prep may be needed for certain pathogens
-With ANY suspicious lesion, skin cancer must be ruled out
What to know about steroids on the face*
-Use lowest strength possible,
starting with a potency that is less than the standard dosage
-NO fluorinated steroids on the face or perineum—can cause striae and
permanent thinning of the tissue
Why does the “vehicle” choice matter in terms of skincare? *
What would you use each for
-Therapeutic effect can depend on whether the vehicle is water or oil based
-Ointment= use for dry, thick, scaly (Psoriasis, eczema, con= greasy, staining, not suitable for hair)
-Cream= generalized use (con= more frequent application, less occlusive)
-Lotion= more water based, less greasy (Better for large, hairy, inflamed areas, cooling effect, fast absorption)
-Cons= less hydrating, may contain ETOH which causes stinging
-Gel= acne, scalp, rosacea (good for oily skin)
Cons= drying, irritation
-Foam: Hair or scalp (good absorption, but expensive)
-Solution: Good for oily skin, scalp Cons=can be drying
-Powder: Absorbent dry (good for fungal infections, reduces moisture and macerations, limited penetration)
What are the two main types of UV radiation? *
What is the effect of each on the skin?
- UVB [bad]: are the rays that burn us, cause wrinkling and skin cancers
- UVA can cause some wrinkling and with many decades of “lead time” may manifest itself as BCC, melanoma, SCC, and DNA damage later in life
-NOTE: Small amounts of UV exposure daily can help maintain our bone and teeth stability
Derm Terms to know*
- MED—minimal erythemal dose—minimum amount of UV radiation that produces evident erythema
after one exposure - SPF—describes the amount of UVB protection (i.e., protection against sunburn) that a sunscreen provides. SPF values are not related to time but rather to the amount of UV exposure [MED on protected skin ÷ MED on unprotected skin]; gives direction for how long one will be protected before burning
- Broad Spectrum—effective against both UVA & UVB radiation; these protect against sunburn, skin cancer
and photoaging - Water Resistant—sunscreen is effective for 40-80 minutes while a person is swimming [or is sweating]
Sunblock (Mineral) *
Sunblock:
-Usually contains Zinc oxide/Titanium dioxide
-Block ALL sun rays, not just protect from sun’s burning rays
Per chat:
-Works by reflecting/ scattering rays
-Works as physical blocker
-Thicker, may have a white cast
-Better for use on sensitive/ reactive skin
Sunscreen*
Need to double check what she’s looking for for SPF
-Per chat:
-Contains chemical ingredients like avobenzone, oxybenzone, octisalate, and homosalate.
-Absorbs UV rays chemically
-Works by chemical filter
-Usually lightweight/ transparent and can be used for all skin types
-Use of sunscreens with SPFs of >16 for 5 years will decrease malignant melanoma risk by 50%
-Educate your patient about what an SPF of a 2, 20, 15, 30 would mean…for a person who burns in 1 minute in the sun without sunscreen
-Recommended Use: 3 tablespoons every 120 minutes
Special considerations for sunscreen*
-Apply sunscreen, then wait 30 minutes to apply insect repellant
-Use a broad-spectrum sunscreen with an SPF of at least 15 (per FDA) or 30 (per the American Academy of Dermatology and Health Canada)
-Limit time in the sun, especially between 10AM and 2PM when the sun’s rays are the strongest
-Apply sunscreen 15 minutes before sun exposure for best effectiveness
-Reapply sunscreen at least every two hours, as well as right after sweating or swimming
-Use a lip balm with SPF 30 or higher to protect the lips
-For infants less than 6 months—use small amounts of SPF 15 or less sparingly
-Sunscreen expires 36 months after date manufactured date
Glucocorticoids: How they work on the skin*
-Occlusive dressings can significantly increase absorption and may also increase side effects
-Applying topical steroids to wet skin may improve effectiveness
-Total dose for very high potency steroids should generally not exceed 50 grams per week because of the potential for adrenal suppression
-Used to reduce inflammation, itching, and redness in skin conditions like eczema, psoriasis, and dermatitis.
They work by modifying the immune response and reducing skin inflammation.
Glucocorticoides: ADE *
-Acneiform eruptions, dermatitis, local infections, hypopigmentation
-In children, applying potent steroids to large BSA can cause systemic toxicity—depression of HPA axis and growth retardation
-Skin changes such as atrophy (thinning), telangiectasias (red or purple clusters on the skin from dilated capillaries), and striae
-Though mild atrophy usually resolves after stopping the steroid, telangiectasia and striae are less likely to resolve with discontinuation.
Acne Vulgaris *
What is it? Subcategories?
Patho: Excess sebum, Comedones, Propionibacterium acnes overgrowth, Inflammation
-How its classified:
-Comedones, pustular/papular and nodular
-Disease further subdivided as→
-Mild—comedonal, pustular/papular
-Moderate—pustular/papular, small nodules [up to 1 cm]
-Severe—nodular, cystic/pustular [also called acne conglobate]
Retinoids*
MOA/ADE
-Derivatives of Vitamin A
-Influence cell proliferation, immune function, inflammation & sebum production
-These agents are comedolytic and anti-inflammatory
MOA: mediated through nucleic
retinoic acid receptors
ADE’s: irritation, dryness, skin peeling, photosensitivity, dry MM &
eyes
Tretinoin (Prototype drug for retinoids) vs other retinoids*
-Tretinoin: 1 st generation agent
-Other agents:
-Isotretinoin—1 st generation
agent—category X agent (must be prescribed by licensed providers—I Pledge Program)
-Oral agent
-Used in scarring acne and in
severe disease
-Adapalene / Tazorac—3rd
generation agent—less irritating
-1st line for comedonal and
inflammatory acne
First line acne treatments *
- Benzoyl peroxide:
-1 st line for mild to moderate acne with NO inflammation
-MOA: antiseptic against P acnes and opens pores
ADE’s:—dry skin, peeling, irritation, eyebrow discoloration - Salicylic Acid:
-MOA: exfoliates to clear comedones; mild antiinflammatory activity and is keratolytic at high concentrations
-Usually for mild disease
-ADE’s: peeling, dryness, local irritation - Azelaic Acid:
-Antibacterial against P acnes and it has antiinflammatory actioins
-Used in mild to moderate inflammatory acne
-ADE: skin irritation
Antibiotics for acne*
-P acnes is a gram + rod associated
-For moderate to severe acne with inflammatory lesions, topical or oral antibiotics can inhibit this bacteria’s
growth (Erythromycin and Clindamycin are available and used)
-Topical antibiotics best when combined with Benzoyl peroxide or
retinoids
-Topical Dapsone [a sulfonamide] is available (MOA is unknown)
ADE: methylhemaglobinemia (PERMANENT DONT GIVE)
-Moderate to severe acne requires ORAL antibiotics— Doxycycline [preferred] or Minocycline
How to know which acne treatment to use *
For mild acne:
-If mainly comedones—treatment of
choice is topical retinoid
-If mainly is papular/pustular—treatment of choice is topical retinoid + benzoyl peroxide [BPO] OR topical retinoid + BPO/antibiotic combination
For moderate acne:
-For papular/pustular disease—topical retinoid + oral antibiotic & BPO (or OCP)
-For nodular disease— topical retinoid + oral antibiotic & BPO [or
BPO/antibiotic]
-Alternative—Isotretinoin orally
For severe disease:
-For nodular—oral antibiotic and topical retinoid + BPO (can add
OCP)
-For cystic/pustular—oral
Isotretinoin [Accutane]
-Alternative is high dose
oral antibiotic and topical
retinoid + BPO (& OCP)
Isotrentinoin important warnings*
-Requires prescribers be trained and registered— have a federal ID number
-Category X pregnancy
-The iPLEDGE program is a mandatory, FDA-regulated initiative for isotretinoin prescribing to prevent fetal exposure. Key components include:
-Monthly doctor visits for pregnancy tests and counseling (Check LFT’s/ cholesterol)
-Strict rules for contraception (two forms of birth control or abstinence).
Limited prescription fills (usually for 30 days).
Rosacea *
Etiology
-Chronic acne-like inflammation of central area of face, yet no comedones are present
-Etiology:
-Cutaneous vascular disorder of capillaries
» Increased reaction to heat causes “flushing”
» Ocular symptoms may include blepharitis, conjunctivitis
-Incidence/Demographics:
-Common in fair skinned, middle aged to elderly people
What is Rhinophyma *
-Severe form of rosacea seen almost exclusively in men >40 years
-Irreversible hypertrophy of
the nose– is a result of chronic
inflammation
What meds do we give for rosacea *
-Sodium Sulfacetamide with Sulfur
(Usually prescribed as a daily wash)
-Topical Metronidazole (This agent is considered DOC and is safe in pregancy)
-Azelaic acid ( Effective for papules,
pustules, erythema but does not
deter telangiectasias, Safe in pregnancy)
-Oral Doxycycline (Can give erythro)
What is Actinic Keratosis and how do you treat it? *
-Discrete, dry, scaly lesions occurring on sun exposed skin of susceptible adults (color ranges from light tan to brown with or without reddish tinge)
-Precursor to squamous cell carcinoma [SCC]
-Etiology: Recurrent or prolonged sun-exposure in fair skin
-Common in elders from photoaging of skin (More common in males)
-Topical Therapies:
-Cryotherapy, curettage, photodynamic therapy, facial resurfacing, chemical peels
-5 Flourouracil:
-MOA—inhibits DNA & RNA synthesis
-Side effects—redness, crusting, intense stinging
-Imiquimod:
-ADE: redness, crusting, intense stinging
Atopic dermatitis and how you treat it*
-Global term that may be referring to atopic dermatitis [eczema] or allergic contact dermatitis
-Causes profound pruritus—often termed “the itch that rashes”
-Chronic disorder; genetic linked, made worse by stress, hormonal variation
-These people often have marked allergies to food, meds, pollens, etc
-Lesions often appear in first year of life
-Treated with a regimen of emollients, topical steroids, +/- topical immune modulators
Calcineurin Inhibitors:
- Tacrolimus ointment
-Pimecrolimus cream
-BOTH Used as steroid sparing agents in chronic eczema
-Both have BLACK BOX WARNINGS for skin malignancies and lymphoma
-Neither to be used in children under the age of 3 years
Verruca (warts) Defined *
-Small, usually painless growths on the skin caused by [HPV]; generally harmless—they can itch or hurt
if on plantar aspect of the feet
-Different types of warts:
-common warts: are usually on hands, but can appear anywhere
-Flat warts—often found on face and
forehead; common, in children, rare in adults
-Genital warts (also known as condyloma):seen on genitals, in pubic area, and in between the thighs, but can appear inside vagina & anal canal
-Subungual and periungual warts: appear around the fingernails and toenails
-Plantar warts: are found on soles of feet
