Pharm - BP, Poison Ivy, Vitiligo Flashcards
Bullous Pemphigoid
- first line therapy
Topical or systemic steroids
Bullous Pemphigoid
- what is often added to first line therapy? why?
- immunomodulatory therapy
- minimize ADR or augment response
Bullous Pemphigoid
- 3 goals of therapy for
- Decrease blister formation and pruritis
- Promote healing of blisters and erosions
- Improve QOL
Bullous Pemphigoid
- What should be done with blisters?
rupture them daily - reduces lateral extension of blister edge
Bullous Pemphigoid
- risk factors for infection
- # of skin lesions
- use of immunosuppressants
Bullous Pemphigoid
- 3 treatment phases
- Control: intense therapy to suppress disease activity until no new lesions appear. Duration is weeks.
- Consolidation: drugs and doses are maintained until complete clearance of lesions
- Maintenance: meds gradually tapered until reach lowest dose that prevents new lesions
Bullous Pemphigoid
- why are topical vs. systemic steroids preferred in extensive disease
- Better clinical outcomes in extensive BP than with systemic steroid therapy
- One-year survival rate, disease response, server complications lower versus tx with systemic steroids
- There is apparently a third reason…
Bullous Pemphigoid
- what type of topical glucocorticoid is preferred
Super high potency
- clobetasol 0.05%
Bullous Pemphigoid
- How to dose topical corticosteroids
- full therapeutic dose until active disease process halts: once active inflammation, new blister formation, pruritis cease for min 2 weeks and 80% of blisters are healed
- prolonged taper needed: typically lasts 4 months or longer
Bullous Pemphigoid
- ADR of topical corticosteroids
- Cutaneous atrophy
- Striae
- Folliculitis
- Adrenal suppression
Bullous Pemphigoid
- what is second line when topical corticosteroids are not feasible
oral systemic corticosteroids
Bullous Pemphigoid
- The many ADR of systemic corticosteroids
- HTN
- Elevated blood glucose
- Osteoporosis
- Increased fx risk
- Cataracts
- Muscle wasting
- Thinning skin
- Increased bruising
- Immunosuppression
- Increased risk fo infection
- Weight gain/ increased appetite
- HPA axis suppression
- Psychological effects- depressed or elevated mood
- Changes in memory and behavior
Bullous Pemphigoid
- why are immunosuppressive and anti-inflammatory drugs used with glucocorticoids?
Minimize dependence on systemic glucocorticoid therapy
Bullous Pemphigoid
- how to dose glucocorticoid-sparing agents with glucocorticoids?
- Glucocorticoid-sparing drugs clinical response is slower than systemic glucocorticoids
- Begin treatment with glucocorticoid-sparing agent just prior to starting glucocorticoid taper
- Then slowly taper glucocorticoid with goal to discontinue completely and continue therapy with immunosuppressant alone
Bullous Pemphigoid
- what are three immunosuppressive drugs
- azathioprine
- Mycophenolate mofetil
- Methotrexate
Bullous Pemphigoid
- Risk associated with immunosuppressants
- cancer
- infection
Bullous Pemphigoid
- What baseline labs are needed before starting immunosuppressants?
- CBC
- Renal fn
- Liver fn
Bullous Pemphigoid
- how to dose methotrexate
weekly
Bullous Pemphigoid
- What must be added to methotrexate therapy
folic acid
- reduce hematologic and GI ADR
Bullous Pemphigoid
- what is benefit to abx other than antimicrobial
anti-inflammatory
Bullous Pemphigoid
- two abx used
- tetracyclines
- dapsone
- Use when glucocorticoid-sparing agent is required for pts with mild BP (risk of immunosuppressants outweighs the benefit)
- Also good option for pts who are not good candidates for immunosuppressants
Bullous Pemphigoid
- what needs to be screened before using Dapsone
G6PD deficiency
Bullous Pemphigoid
- what can be used to monitor response to therapy?
- BP 180 antibodies
- Generally correlate with clinical activity of BP
Vitiligo
- what is first line therapy for LIMITED dz
- super high potency topical steroids
- modulate immune response
Vitiligo
- Tx of choice for >10% BSA
- Narrowband/ NB-UVB phototherapy
- used for both stabilization and re-pigmentation
Vitiligo
- What treatment is used for depigmentation
- monobenzone
Poison Ivy
- role of decontamination after exposure
- After known exposure, remove any contaminated clothing and gently wash skin with mild soap and water (not rough, likely make dermatitis worse)
- After 10 minutes, 50% of urushiol can be removed
- After 30 minutes, 10% of urushiol can be removed
- Washing within 2 hours can sig reduce likelihood and severity of dermatitis
Poison Ivy
- Decontamination products (3)
- Tecnu
- Goop
- Dial ultra dishwashing soap
- all sig reduce dermatitis when used within two hours of exposure
Poison Ivy
- role of barrier cream in preventing exposure to poison ivy
- Topical preparations that are applied prior to exposure to contact allergen, attempt to prevent reaction
- Organoclay compounds more effective than other preparations
Poison Ivy
- topical treatments to relieve pruritus
- Oatmeal baths
- Cool, wet compresses
- Topicals containing menthol and phenol (calamine)
- Topical astringents: aluminum acetate (Burow’s solution) or aluminum sulfate and calcium acetate (Domeboro) used under occlusion dressing
- Soap mixture of ethoxylate and sodium lauroyl sarcosinate sufractants (Zanfel)
- Avoid topical antihistamines, anesthetics with benzocaine, abx with neomycin and bacitracin dt allergic potential
Poison Ivy
- role of oral corticosteroids to relieve dermatitis sx
- Severe dermatitis (esp on face or genitals) may require
- If too short a course, risk rebound dermatitis (ex. 6-day medrol dose pack)
Poison Ivy
- Oral corticosteroid example, dose, taper
- Prednisone
- 1 mg/kg/day
- Taper 2-3 weeks
