Papulosquamous

Question 1

What are the 3 pharmacologic targets for treatment of seborrheic dermatitis?

Answer 1

1. Keratolytic: decrease scale and crust and improve penetration of other topicals
2. Anti-inflammatory: reduce inflammation
3. Antifungl: decrease yeast burden

Question 2

Antifungal treatment for seborrheic dermatitis

Answer 2

Ketoconazole 2% cream
Miconazole cream
Ketoconazole 2% shampoo
Ciclopirox 1% shampoo
Selenium sulfide 2.5% shampoo

Question 3

Anti-inflammatory treatment for seborrheic dermatitis

Answer 3

Hydrocortisone for face

Clobetasol or Betamethasone for scalp

Question 4

General skin care for seborrheic dermatitis

Answer 4

Rotating between antifungal and keratolytic shampoo can be helpful

Selenium sulifide

Pyrithione

Salicylic acid

Coal tar

Lithium salts

Non-soap cleansers

Fragrance free light moisturizers

Water-based makeup (non-oily)

Topicals with nonirritating vehicles to prevent secondary ICD

SPF: with hyaluronic acid sodium salts, water based, noncomedogenic

Question 5

Treatment for severe or recalcitrant Seborrheic Dermatitis

Answer 5

Oral antifungals (fluconazole, itraconazole, terbinafine)

Oral prednisone is NOT recommended

Question 6

Treatment of Seborrheic Dermatitis in infants

Answer 6

Emollients and zinc oxide

Ketoconazole cream for trunk or intertriginous areas (no more than 1 week)

Question 7

High risk patients for intertrigo

Answer 7

Immobility

Obesity

Hyperhidrosis

Immunosuppression

Incontinence

Poor hygiene

Diabetes

Question 8

Pathophysiology of lichen planus

Answer 8

Immune response (T-cell mediated) to an antigen (viruses, medications, allergens, etc)

Question 9

What are the 7 “P’s” of Lichen Planus?

Answer 9

1. Planar (flat-topped)
2. Pruritic (intense)
3. Purple
4. Polygonal (irregular angulated border)
5. Papules
6. Penile (commonly affects glans penis)
7. Prolonged course (>18 months)

Question 10

First line for cutaneous Lichen Planus

Answer 10

Topical anti-pruritic

Mid-high potency topical steroid

Calcineurin inhibitors (off label)

PO antihistamine

Question 11

Second line for cutaneous lichen planus

Answer 11

IL TAC

Phototherapy/ Chemophototherapy

PO steroids if severe

Generalized: dapsone, MTX, Plaquenil

Steroid-sparing immunosuppressants

Question 12

First line for genital lichen planus

Answer 12

Mid-high potency topical steroids

Tacrolimus vaginal suppositories

Tacrolimus cream

Question 13

Second line for genital Lichen Planus

Answer 13

PO steroids

PO retinoids

Plaquenil

Azathioprine

Cellcept

Dapsone

Question 14

First line for oral Lichen Planus

Answer 14

Topical steroids

pimecrolimus 0.1%

Topical retinoids

Lidocaine

Consider antimycotic (antifungal)

Question 15

Second line for oral Lichen Planus

Answer 15

PO retinoids

Cyclosporine (PO or mouthwash)

Plaquenil

Azathioprine

Cellcept

PDT

Question 16

Etiology of Grovers?

Answer 16

UNKNOWN

Question 17

Potential triggers for Grovers

Answer 17

1. Significant sun exposure
2. Heat
3. Sweating
4. Ketogenic diet
5. Humid conditions
6. Menopausal symptoms
7. Hospitalization
8. Acute myeloid leukemia
9. End stage renal disease
10. Organ transplant patients
11. Less often medications such as chemo drugs

Question 18

First line treatment for Grover’s

Answer 18

Avoidance of exacerbating factors
-heat
-sweating
-sunlight
-friction

Emollients
-may be helpful to decrease friction but can also worsen if too occlusive

Mod-high potency topical steroids for limited time

Question 19

Second line treatment for Grover’s

Answer 19

Adjunctive PO antihistamine

Vitamin D analogues (off label)