Module 4: Derm

Question 1

What are the non-pharmological interventions for psoraisis?

Answer 1

• Soak lesions to ease adherent scale removal
• Topical moisturizers (eg: Vaseline) as adjunct therapy (apply 20 min after corticosteroid application to boost steroid effect)

Question 2

What are some complications of MRSA?

Answer 2

• Mild to moderate skin & soft tissue infections
• Can progress to more severe systemic disease including necrotizing pneumonia, necrotizing fasciitis, sepsis, osteomyelitis

Question 3

What are the pharmalogical interventions of pediculosis?

Answer 3

1 st line: Permethrin 1%
Use: Apply 30-60mls to washed, towel dried hair and
leave on for 10 mins then rinse off. Repeat treatment in
7 days. Brush with lice comb
Adverse Effects: asthma exacerbation, burning,
stinging, contact dermatitis

Question 4

What is the management of scabies?

Answer 4

• Decontaminate clothing, bed sheets, and stuffed animals with machine wash at 60 degrees and hot dryer
• Consider mild topical steroids and antihistamines for adjunctive management as pruritis can last 2 months due to hypersensitivity reaction

Question 5

What are the Non-Pharmacologic interventions for Uncomplicated Cutaneous Infections?

Answer 5

● Folliculitis and furuncles: usually self-limiting.
Hot compresses and anti-septic cleanser may be
beneficial. Systemic therapy not generally
required

● Folliculitis: address contributing factors such as
eliminating tight-fitting clothing and reducing
friction, moisture and heat

● Furuncles and carbuncles: incision and drainage

Question 6

What is the treatment of uncomplicated cutaneous infections?

Answer 6

● For folliculitis start with removing contributing
factors (friction, tight clothing, etc.) re-evaluate
after 7 days, if no improvement, progress to topical
antiseptics or drying agents.

● Re-evaluate after 7 days of topical antiseptics or
drying agents, if still no improvement, progress to
topical antibacterial mupirocin or fusidic acid.

● If no improvement after 7 days of topical
antibacterial, progress to oral antibiotic (e.g.
cephalexin x 7-10 days)

● If no improvement after 48hrs of oral abx, modify
therapy based on C+S

Question 7

What are the non-pharmacological interventions for acne vulgaris?

Answer 7

1. management of acne is primarily pharmacologic
2. advise client not to squeeze, pick or “pop” lesions as this leads to scarring and delays healing
3. although they may be under the impression that sunlight exposure helps to “clear” skin, evidence is insufficient and increases risk of skin cancer
4. debunk myths about chocolate and greasy food but advise to avoid known triggers to client
5. remove acnegenic creams, mineral oils or cleansers from skin regimen and suggest washing face OD with a mild soap

Question 8

What are the non-pharmacologic interventions of warts?

Answer 8

• Provide health education
  
  • Most warts resolve spontaneously in weeks to months
  • No intervention may be best option particularly in pediatric warts which are self-limiting (children under 9 should not be treated)

Question 9

What are Uncomplicated Cutaneous Infections?

Answer 9

● Folliculitis: Infection of skin and hair follicle to variable
depths producing papules and pustules. Infections
causes include S. aureus (most common) and
Pseudomonas aeruginosa

● Furuncles: a.k.a. boils, are an S. aureus-mediated
infection of the hair follicle with extension of
suppurative material into the dermis and
subcutaneous tissue.

● Carbuncle: interconnecting multiple furuncles.

● Erythrasma: Not addressed in any of our course
texts/resources and not easy to find reliable

information on. Description from the free area of Up-
to-date: a superficial infection of the skin caused by

Corynebacterium minutissimum, a gram-positive, non-
spore-forming bacillus. The disorder typically presents

as macerated, scaly plaques between the toes or
erythematous to brown patches or thin plaques in
intertriginous areas

Question 10

What is the Plan of Care/Monitoring for MRSA?

Answer 10

● Symptoms should improve within 48 hours,
consider follow-up at this point to assess response
and review culture

● Prompt return if systemic symptoms occur, or
failure to see improvement within 48 hours

Question 11

What are the non-pharmalogical interventions of Lyme Disease?

Answer 11

• Health Education/Teaching:
• Avoidance of tick-infested areas is most important preventative measure. Walk in the centre of trail paths
• Teach pts when to promptly seek medical attention if a
  skin lesion or viral infection-like illness develops one month after removing tick
• Clothing: wear light-coloured (increase tick visibility); tuck shirt into pants and pants into socks (use tape if needed). Spray clothes with permethrin. After wear, remove and wash + dry in high temperature
• Spray all exposed areas other than face, hands and
  broken skin with insect repellant containing DEET
• Inspect self after post-outdoor exposure (w/ close
  attention to hairy areas). Inspect pets daily and remove
  ticks
• Do not donate blood if active disease present, donation is acceptable post-LD tx
• Remove attached whole tick with blunt, medium-tipped
  angle forceps only, as close to skin as possible

Question 12

What are the pharmalogical interventions of Lyme Disease?

Answer 12

- Adults:

• First Line: Amoxicillin 500mg TID or Doxycycline 100mg BID PO
• Second Line: Cefuroxime-AX 500mg BID PO
• Third Line: Ceftriaxone IV 2g q24h or Cefotaxime IV 2g
  q8h or Penicillin G IV 3-4 million units q4h
  Children:
• First Line: Amoxicillin 50 mg/kg/day divided q8h PO
• Second Line: Cefuroxime-AX 30 mg/kg/day divided q12h PO or Doxycycline 2-4 mg/kg/day divided q12h
• Third Line: Ceftriaxone IV 75-100 mg/kg/day divided q24h or Cefotaxime IV 100-180 mg/kg/day divided q6-8h or Penicillin G IV 200 000 – 400 000 U/kg/day divided q4h
• Usual duration of tx is 14-21 days. With early stages of LD, 10 days of doxycycline may be sufficient. May require
  another second 4-week course of oral antibiotics for pts w/ persistent/recurrent joint swelling
• Consider parenteral tx in pts w/ CNS or cardiac s/s

Question 13

What is the Plan of Care/Monitoring of Herpes Zoster?

Answer 13

-Treat inflammatory and neuropathic pain-
NSAIDs, amitriptyline, short-acting narcotics
- Antihistamine at HS can help with sleep
Follow-up is not necessary for most pts.
- Pts with postherpetic neuralgia-follow- up for
support and eval of response to pain control is
based on individual needs

Question 14

What are the Drug & Disease-related problems of Lyme Disease?

Answer 14

• Don’t treat pts whose only evidence of LD is a (+)
  immunologic test - risk of empiric ABx tx outweighs the benefits (Resistance?)
• Use of tetracyclines in children <9 years old and
  pregnant women is not generally recommended

Question 15

What are the pharmalogical interventions for bites?

Answer 15

• Ensure tetanus prophylaxis is up to date and administer Td or Tdap if needed
• ALERT: consider community-acquired MRSA as possible pathogen (from human skin or colonized pet). If high suspicion, doxycycline or TMP-SMX provide good coverage

Question 16

What is the plan of care for warts?

Answer 16

• Teach patient how to apply topical treatments in
  office and stress the need to continue therapy as
  indicated.
• Several types of therapy and multiple applications
  may be required to remove warts (e.g. may need cryotherapy in office and use OTC treatment at home in combination)
• OTC preparation will take 6-8 weeks to work

Question 17

What are the pharmacologic interventions for Scabies?

Answer 17

1 st line: Permethrin 5% Cream (age >2 mo)
Trade: Nix Dermal Cream
Action: actions on nerve cell membrane causing
delayed repolarization and paralysis of mites
Dose: 30 gram tube
Use: after bathing, apply thin layer to
body from neck to feet with special attention to space
in between fingers and toes. Leave on for 8-14 hrs then
wash off completely. If hands are washed during this
time, re-apply cream. Repeat in 1 week.

2 nd line: Crotamitin 10% Cream (infants)
Dose: 30 gram tube
Use: after bathing, apply from neck down, wash off
after 48 hrs since application. Repeat in 24 hrs.
Note: consider safer in pregnancy and infants, but has
high treatment failure rate.

Question 18

What are the non-pharmalogical interventions for bites?

Answer 18

• All wounds should be thoroughly/ copious cleaned w/NS, irrigated, and debrided
• DO NOT suture bites that are likely to become infected (ie. hand bites, bites older than 8 hrs, deep or puncture bites, bites with extensive injury)
• Vascular structures such as the face and scalp are less likely to become infected so consider suturing
• Education around how to avoid animal bites

Question 19

What is Pediculosis?

Answer 19

• A highly contagious ectoparasitic infection of the skin causing significant pruritus especially at night caused by Sarcoptes scabiei variety hominis. 5-15 female mites
• Mites burrow into upper layers of epidermis and mate; after fertilized, female remains in stratum corneum, makes a burrow, deposits eggs and fecal pellets; eggs hatch 2-3 days, larvae →nymphs; maturity in approx. 2 week
• hypersensitivity rx results from proteins in saliva of parasites. Pruritus may not develop until after 4-10 weeks after first exposure
• Other variants: crusted scabies-hundreds to millions female mites; nodular scabies where pruritic nodules develop but do not contain mites in the nodules

Question 20

What is Herpes Zoster?

Answer 20

• Painful vesicular rash
• Cause: varicella-zoster virus (VZV)
• Patho: virus causes 1. Varicella/chickenpox, 2.
  Latency/reactivation—herpes zoster (after primary infection, virus is latent in dorsal root ganglia & is contained by cellular immune system, can become reactive = herpes zoster (HZ) or “shingles” d/t
  immunocompromised with age/immunosuppressive agents.
• Recurrent disease
• Characteristics: unilateral pain that
  follows a dermatome; i.e. stabbing,
  burning, pruritic, itching, preceded by
  3-5days of eruption of vesicles/bullae,
  followed by crusting & erosion
• Prodromal symptoms: tingling, pain,
  burning, hyperesthesia 4-5days before
  any skin eruptions malaise. Fever
  rare.
• Zoster ophthalmicus: ophthalmic
  branch of trigeminal nerve
  involvement (shingles on tip of nose
  signifies ocular involvement)

Question 21

What are Tinea Infections?

Answer 21

● Infection of skin, hair, and nails caused by dermatophytes (fungi that live within the epidermal keratin or hair follicle and do not penetrate into
deeper structures
● Digestion of keratin by dermatophytes results in scaly skin, broken hairs, crumbling nails/onycholysis
● Small ring-shaped spots on the body that grow larger as the infection spreads. The skin at the outside of the ring is red and scaly. Inside the ring the skin looks normal.

Question 22

What is the Plan of Care/Monitoring for Psoraisis?

Answer 22

• F/U recommendations: measure BSA involvement to
  determine if therapy is working, change/add agent if no
  improvement

Question 23

What are the pharmcological interventions for moderate acne vulgaris?

Answer 23

Moderate Acne
1 st line
Add Topical Abx to BPO -/+ Retinoid
1. erythromycin 3%/BPO 5% (Benzamycin) gel apply BID to affect area. A/E: drying, burning, erythema, pseudomembranous colitis (rare)

Question 24

What are problems that may be anticipated with warts treatment?

Answer 24

• Topical treatments may cause local irritation, mild-
  moderate pain
• Expect pain, followed by necrosis and possible
  blistering after cryotherapy in genital warts

Question 25

What are the non-pharmological interventions for MRSA?

Answer 25

● Education re: transmission
o Encourage hand hygiene (MRSA most commonly spread
via direct skin-to-skin contact)
o Avoid sharing personal care items (e.g. towels, razors)
o Use personal protective equipment when in contact
with bodily fluids

Question 26

What is the treatment considerations for bites?

Answer 26

Elevate injured area to decrease swelling
- Monitor for 24-48 hrs for signs of infection
- Potential complications: septic arthritis,
osteomyelitis, extensive soft tissue injury
w/scarring, hemorrhage, sepsis, meningitis,
endocarditis, PTSD, Death
- ALERT: Asplenic patients and those w/hepatic
disease at risk of bacteremia and fatal sepsis
after dog bite w/ Capnocytophaga canimorsus
(gram – rod)
- Human- Pediatric (bitting btwn children)
consider prophylactic abx (3-5 days) if moderate
to severe tissue damage, deep puncture
wounds, or bites to face, hand, foot, or genitals
(more than a superficial abrasion). Where the
status of the biter or victim is unknown for HBV,
low risk does not warrant HBV testing
- Human-Adult: assess for risks of blood borne
pathogen transmission and treat appropriately

-Refer to plastics if bite is to ear, face, genitalia,
hands and feet or if large contaminated wound
-Refer to ID if bite is from primate or unusual
species
-Report to Public Health office if potentially exposed to rabies (e.g. wild or domestic animal
bites)

Question 27

What are the Drug and Disease-Related problems for Rosacea?

Answer 27

• Metronidazole is contraindicated in those with a
  history of hypersensitivity to this drug or it’s
  nonmedical ingredients (refer to RxTx)
• There is insignificant plasma concentrations after
  topical use that systemic adverse reactions should
  not be expected
• Avoid excessive sunlight when using this drug

Question 28

What is Psoraisis?

Answer 28

● Chronic, non-contagious, relapsing, proliferative, systemic inflammatory disorder
● T cell immune–mediated skin disease
● Characterized by: scaly, thick, silvery, elevated lesions, usually on the scalp, elbows, or knees caused by a high rate of mitosis in the basale layer

Question 29

What is the Plan of Care/Monitoring for Scabies?

Answer 29

• Pt Education regarding decontamination of
  home and preventing transmission
• Prescribe treatment and advise re: OTC
  therapy
• Consider alternatives if treatment failure
• Pt to RTC if signs of secondary infections or
  therapy failure results

Question 30

What are the non-pharmalogical interventions for Candidiasis?

Answer 30

• Zinc gluconate lozenges (Uphold)
• Oral vitamins (vit B, vit B complex, lysine) (Uphold)
• Sage and camomile mouthwash (Uphold)
• Carrot, celery and cantaloupe juices (Uphold)

Question 31

What are the Drug & Disease-Related problems of Herpes Zoster?

Answer 31

• Antivirals are well tolerated
• Antivirals do not prevent postherpetic
  neuralgia (PHN)
• Postherpetic neuralgia (PHN): condition of
  constant burning/aching pain, intermittent
  shocklike pain & allodynia that persists
  >90days after rash onset requires pain
  treatment (topical products like capsaicin and
  lidocaine AND oral meds like gabapentin or
  pregabalin)

Question 32

What are Non-Pharmacologic interventions for Tinea Infections?

Answer 32

● T. pedis- Expose feet to air as much as possible. Change socks during the day in hot weather; wear sandals, wear synthetic socks that wick away moisture. Air shoes between days and do no wear the same pair of consecutive days.
● Careful handwashing and personal hygiene; laundering of towels/clothing of affected individual; no sharing of towels/clothes/headgear
● Avoid predisposing conditions such as hot baths and
tight-fitting clothing (boxer shorts are better than briefs).
● Keep area as dry as possible (talcum/powders may be
beneficial).

Question 33

What are the Pharmacologic interventions for Rosacea?

Answer 33

• First line: topical Metronidazole- 0.75% gel, cream or lotion; available as generic (prescription below)
• Oral antibiotics also listed with first line- consider with extensive involvement, nodular rosacea or ocular symptoms
• Combo of topical and oral can be used

Question 34

What are/is Candidiasis?

Answer 34

• Chronic inflammation of the oral mucosa tissue with ulcers often called canker sores
  Appears as discrete ulcers without preceding vesicles
  Ulcers are located on the inner lip, tongue, and buccal
  mucosa
• Lesions last about 1 to 2 weeks
• Cause is unknown, but immunological mechanisms play a major role
  Common in persons with leukemia, neutropenia and HIV
• Increased prevalence in pts with autoimmune diseases such as Crohn’s, Behcet’s, Reiter syndrome, and
  ulcerative colitis

Question 35

What are the pharmalogical interventions for Candidiasis?

Answer 35

Topical corticosteroids provide pain relief and promote healing, but may worsen viral infections and result in oral candidiasis.
Can try 1% triamcinolone dental paste (Kenalog) or 0.05% fluocinoninde cream (Metosyn) or hydrocorticson (Corlan) 2.5mg pellets applied in thin layer QID x 2 weeks (Uphold)
- Amlexanox 5% adhesive paste (Aphthasol) apply ¼” to each ulcer QID after meals and HS (may promote healing and lessen pain) (Uphold)
- Mouth rinses or washes: 0.12% or 0.2% Chlorhexedine gluconate
mouthwash (Peridex) QID OR Maalox used as a swish and spit OR tetracycline syrup (Sumycin) 250mg/10mL rinse for 2 minutes then expectorate QID x 7-14 days (contraindicated in pregnant women or children under 8) OR dexamethasone elixir (Decadron) 0.5mg/5mL rinse with 5mL and then expectorate Q12h (Uphold)
- Severe recurrent aphthous ulcers may require oral
corticosteroids: prednisone 30-60mg/d with tetracycline syrup QID x 5 d, then titrate over 10 days (Uphold)

Question 36

What is the Plan of Care/Monitoring for Pediculosis?

Answer 36

• Pt Education regarding decontamination of home and preventing transmission
• Prescribe treatment and advise re: OTC therapy
• Consider alternatives if treatment failure
• Pt to RTC if signs of secondary infections or therapy failure results

Question 37

What are Scabies?

Answer 37

• A highly contagious ectoparasitic infection of the skin causing significant pruritus especially at night caused by Sarcoptes scabiei variety hominis. 5-15 female mites
• Mites burrow into upper layers of epidermis and mate; after fertilized, female remains in stratum corneum, makes a burrow, deposits eggs and fecal pellets; eggs hatch 2-3 days, larvae →nymphs; maturity in approx. 2 week
• hypersensitivity rx results from proteins in saliva of parasites. Pruritus may not develop until after 4-10 weeks after first exposure
• Other variants: crusted scabies-hundreds to millions female mites; nodular scabies where pruritic nodules develop but do not contain mites in the nodules

Question 38

What are Pharmacologic interventions for Tinea Infections?

Answer 38

● Tinea capitis requires systemic antifungal therapy- 1 st line- Chiuldren > 2 yo. Griseofulvin, 10-20 mg/kg/day orally in a single dose daily. Adults: griseofulvin 500 mg/day once daily. Concurrent use of a topical antifungal shampoo such as selenium sulfide 2.5% applied X2/week.
● Infections involving the skin- can be treated with topical and/or oral antifungal drugs
● T.cruris, corporis, pedia, versicolor – Selected topical
treatments- Azoles (clotrimazole, econazole, miconazole) to be applied X2 daily; Allylamines (terbinafine) X2 daily on skin; Banzylamines (lotrimin ultra)- X2 daily. All therapy for 1-4 weeks.
- if moist- apply wet compresses using Burow’s solution
X2 daily until skin has dried; apply Zeasorb powder
after infection has resolved.
● T.pedis- soak feet in Burow’s sol’n X2 daily for 10-15 min,
until lesions no longer moist. Zeasorb powder after infection resolved
● Onychomycosis: oral and topical agents- Terbinafine 250 mg PO once/day for 6 weeks. If toenail involved must be 12 weeks. Topical- ciclopirox 8% nail lacquer daily application for 48 weeks.

Question 39

What is the Plan of Care/Monitoring for Rosacea?

Answer 39

• Follow-up at 4-6 weeks when initiating therapy; then
  less frequent dosing and less frequent F/U once
  condition is controlled
• Refer to a dermatologist if patient does not respond
  to treatment
• Refer to a dermatologist if patient has severely
  inflamed rosacea or a nodulocystic component

Question 40

What is the plan of care of aphthous ulcers?

Answer 40

Consult specialist if not healed in 2-3 weeks

Question 41

What are the Drug & Disease-related problems of Pediculosis?

Answer 41

• Consider adherence issues if pt re-presents with scabies-may need to consider oral therapy to increase adherence probability

Question 42

What are warts?

Answer 42

• Virus induced (various strands of HPV depending on
  kind of wart) proliferation of keratinocytes resulting in
  growths on the skin and mucous membranes
• Verruca vulgaris (common warts)- elevated epithelial
  growth with papillated surface. Distributed mostly at
  trauma sites, hands, fingers, knees (>80 types of HPV
  are causative)
• Verruca plantaris/palmaris (plantar/palmar warts)-
  hyperkeratotic, sharply marginated growths,
  interrupts epidermal ridges. Need to scrape this lesion
  to differentiate it from callus/corn. Located at
  pressure sites on feet. (HPV 1,2,4,10)
• Verruca planae (flat warts)- multiple discrete, skin
  coloured, flat topped papules, grouped or in linear
  formation. Face dorsa of hand, shins, knees. (HPV 3,
  10)
• Condyloma acuminata (genital warts)- skin coloured
  pinhead papules/soft cauliflower masses in clusters.
  Can be asymptomatic, last months to years, highly
  contagious, transmitted sexually or non-sexually.
• Genitals and genital regions

Question 43

What are the non-pharmacologic interventions of Herpes Zoster?

Answer 43

• Immunocompetent adult:
  o First line- Famciclovir 500mg TID x 7days OR Valacyclovir 1g TID x 7days
  o Second line-Acyclovir 800mg 5x/day x 7days
• Immunocompromised host:
  o First line- Acyclovir IV 10mg/kg/dose q8h x7-14days

-Zoster ophthalmicus:
o Immediate referral to ophthalmology
o (Famciclovir OR Valacyclovir- see above for
PO dosing)

• *Topical antivirals are not recommended
• Varicella zoster vaccine is indicated for prevention in
  immunocompetent pts >60years but can be given in
  those who are 50-59years (efficacy decreases with age
  as well as yearly post-vaccination)

Question 44

What are the Drug &aDisease-Related problems for Psoraisis?

Answer 44

• Topical corticosteroids ok w/pregnancy and breastfeeding
• Children: higher % of topically applied corticosteroid
  (higher skin surface to body wt ratio) therefore, children
  have greater susceptibility to topical corticosteroid-
  induced HPA axis suppression and to exogenous
  corticosteroid effects

Question 45

What is the Plan of Care/Monitoring for Lyme Disease?

Answer 45

• Closely monitor all pts who have had a tick bite
  (including those who have received ABx) and/or
  have removed ticks for up to 30 days
• Particularly watch for development of
  erythema migrans
• Pts tx w/ oral ABx should be re-evaluated at the end
  of tx
• Pts with severe symptoms should be seen more
  frequently based on their condition
• Consult with specialist regarding testing of pts with
  suspected CNS involvement as antibody testing of
  CSF is frequently recommended

Question 46

What is Rosacea?

Answer 46

• Common chronic inflammatory facial eruption primarily of convex areas of central face – cheeks, chin, nose and central forehead
• Occurs in middle age and older adults
• Causes are unknown
• Primarily a vascular disorder
• facial flushing
• Dermal inflammation in the form of acneiform papules and pustules

Question 47

What is the plan of care/monitoring of Candidiasis?

Answer 47

• Consult specialist if not healed in 2-3 weeks

Question 48

What are the pharmological interventions for Psoraisis?

Answer 48

Pharmacologic
For Mild to moderate: BID for 2-4 weeks
1 st line: ointments r most effective
- topical hydration (emollients) ex: petrolatum/ointments to minimize
pruritus and risk of koebnerization
- topical corticosteroids- until lesions flatten/resolve, then PRN, **
pregnancy Category C
 **gradual tapering in frequency is necessary if using topical steroids
For severe disease: combination therapy depending on skin type (most
common-methotrexate)

Question 49

What are the non-pharmalogical interventions for aphthous ulcers?

Answer 49

• Zinc gluconate lozenges
• Oral vitamins (vit B, vit B complex, lysine)
• Sage and camomile mouthwash
• Carrot, celery and cantaloupe juices

Question 50

What are the pharmological interventions for aphthous ulcers?

Answer 50

• Topical corticosteroids provide pain relief and promote healing, but may worsen viral infections and result in oral candidiasis. Can try 1% triamcinolone dental paste (Kenalog) or 0.05% fluocinoninde cream (Metosyn) or hydrocorticson (Corlan) 2.5mg pellets applied in thin layer QID x 2 weeks (Uphold)
• Amlexanox 5% adhesive paste (Aphthasol) apply ¼” to each ulcer QID after meals and HS (may promotehealing and lessen pain) (Uphold)
• Mouth rinses or washes: 0.12% or 0.2% Chlorhexedine gluconate mouthwash (Peridex) QID OR Maalox used as a swish and spit OR tetracycline syrup (Sumycin) 250mg/10mL rinse for 2 minutes then expectorate QID x 7-14 days (contraindicated in pregnant women or children under 8) OR dexamethasone elixir
• (Decadron) 0.5mg/5mL rinse with 5mL and then expectorate Q12h (Uphold)
• Severe recurrent aphthous ulcers may require oral
• Corticosteroids: prednisone 30-60mg/d with tetracycline syrup QID x 5 d, then titrate over 10 days (Uphold)

Question 51

What are the non-pharmalogical interventions of Pediculosis?

Answer 51

• Decontaminate clothing, bed sheets, and stuffed
  animals with machine wash at 60 degrees and hot dryer
• Consider mild topical steroids and antihistamines
  for adjunctive management as pruritis can last 2
  months due to hypersensitivity reaction

Question 52

What are the pharmological interventions for MRSA?

Answer 52

● Minor skin lesions
o Topical therapy (e.g. mupirocin)
o Incision and drainage

● Moderate (minimal systemic features)
o Sulfamethoxazole-trimethoprim (TMP/SMX) ▪ 2 regular tabs OR 1 DS tab (equivalent to 2 regular
tabs) BID-QID
● DS tab: 160mg TMP, 800mg SMX
▪ Children: 8-12mg/kg/day TMP component q12h
**Note**

● Colonization: occurs when MRSA present on or in the body
with no signs and symptoms of infection

● Colonized people can transmit MRSA, however
decolonization NOT recommended in the community
o Re-colonization may occur when treatment stops
o Frequent decolonization will contribute to emergence
of resistant organisms

● Consider decolonization only under exceptional
circumstances

Question 53

What are the Non-Pharmacologic interventions for Rosacea?

Answer 53

• Counselling:
• Provide supportive counselling
• How has the patient responded to current condition?
• Explore psychological effects on patients (changes in mood?
• socialization?)
• Explore patient’s expectations for health outcomes
• Explore whether patient is agreeable and accepting of plan
• of care recommendations
• Provide self-management support- help patient gain skills
• and confidence to manage this chronic disorder
• Health education:
• Provide information about the disorder (i.e. causes, clinical
• course and treatment options)
• Possible exacerbating factors/triggers include heat, cold,
• wind, sun, stress, hot liquids, spicy food, alcohol, caffeine.
• Health teaching:
• Avoid exacerbating factors/triggers
• Use sunscreen daily
• Avoid topical corticosteroids
• Wash face twice daily with a gentle cleanser (avoid soaps,
• scrubs and toners)
• Use moisturizers
• Alternative:
• Telangiectasia treatment- physical ablation (electrical
• hyfrecators, vascular lasers or intense pulsed light
• therapies)
• Phymatous changes treatment- physical ablation or removal
• (paring, electrosurgery, cryotherapy, laser therapy)

Question 54

What are the pharmacologic interventions of herpes zoster?

Answer 54

• Immunocompetent adult:
  o First line- Famciclovir 500mg TID x 7days OR
  Valacyclovir 1g TID x 7days
  o Second line-Acyclovir 800mg 5x/day x 7days
• Immunocompromised host:
  o First line- Acyclovir IV 10mg/kg/dose q8h x7-
  14days
• Zoster ophthalmicus:
  o Immediate referral to ophthalmology
  o (Famciclovir OR Valacyclovir- see above for
  PO dosing)-
• *Topical antivirals are not recommended
• Varicella zoster vaccine is indicated for prevention in
  immunocompetent pts >60years but can be given in
  those who are 50-59years (efficacy decreases with age
  as well as yearly post-vaccination)

Question 55

What is MRSA?

Answer 55

● Infection caused by staphylococcus that is resistant to certain abx.

● Community associated (CA) and healthcare-
associated (HA) MRSA caused by different strains

● CA-MRSA usually manifests as skin infection

Question 56

What are the pharmacologic interventions of Warts?

Answer 56

• For warts on the face refer to a specialist
• Most removal requires a course of therapy not just one treatment. No single therapy is completely effective in removal
• First line therapy for non-genital warts: salicylic acid preparations (OTC e.g. compound W), cryotherapy (in office), topical cantharone, or combination
• A first line therapy for genital warts- podofilox 0.5% gel topical BID for 3 days, followed by 4-day break than another 3 days (can be repeated 4 times).
• Cryotherapy can be administered in office, will sometimes require repeat applications every 1-2 weeks

Question 57

What is Lyme Disease?

Answer 57

• Infection caused by the spirochete, Borrelia
  burgdorferi (in North America), B. garinii &
  B. afzelii (Europe + Asia)

-Transmitted to humans by infected Ixodes tick bite (vector).
- Mice and white-tailed deer also serve as hosts for ticks
Clinical Features:
- Stage 1 (Early localized, 7-14 d post
bite): malaise, fatigue, headache, myalgias, erythema migrans
- Stage 2 (Early disseminated, weeks
post-infection): [CNS]: aseptic meningitis, CN VII palsy, peripheral neuritis. [Cardiac]: transient heart block
or myocarditis

- Stage 3 (Late persistent, months-years
post infection): may have no hx of s/s of early stage. [MSK]: arthritis. [Neuro]: encephalopathy, meningitis,
neuropathy

Question 58

What are aphthous ulcers?

Answer 58

• Chronic inflammation of the oral mucosa tissue with ulcers often called canker sores
• Appears as discrete ulcers without preceding vesicles
• Ulcers are located on the inner lip, tongue, and buccal mucosa
• Lesions last about 1 to 2weeks
• Cause is unknown, but immunological mechanisms play a major role
• Common in persons with leukemia, neutropenia & HIV
• Increased prevalence in pts with autoimmune diseases such as Crohn’s, Behcet’s, Reiter syndrome, and ulcerative colitis

Question 59

What are important treatment considerations for acne?

Answer 59

• Acne is a condition that can last a life time and have rebound effects when treatment is stopped.
• Oral antibiotic therapy requires 3 months of use before assessing efficacy and requires a suppressive topical treatment when discontinuing

Question 60

What is acne vulgaris?

Answer 60

• Inflammation of the pilosebaceous glands
• Three key factors: follicular keratinization, androgens, propionibacterium acnes (gram positive anaerobe)

Question 61

What is the Plan of Care/Monitoring for Tinea Infections?

Answer 61

● For T. pedis, corporis, cruris- no follow up required
unless there is treatment failure. For T.capitis a visit
in 4 weeks to evaluate the effectiveness of therapy.
Perform a culture to det. Length of therapy. If
culture negative total of 6 weeks therapy.