Pharm - Hair and Nails Flashcards
clinical presentation of alopecia areata
- chronic, relapsing immune-mediated inflammatory disorder
- affects hair follicles resulting in nonscarring hair loss
- from small patching to complete loss
- MC in < 20 but can happen at any age
- M=F
fist line tx for alopecia areata
corticosteroids
what is the preferred route of administration for corticosteroids in the tx of alopecia areata?
intralesional
preferred pretreatment before intralesional corticosteroid injections
topical anesthetics
max dose of triamcinolone (injectable steroid) per tx session for alopecia areata
40 mg per tx session
ADRs of injectable and topical steroids
- local skin atrophy
- telangiectasia
- hypopigmentation
expected clinical response to injectable steroids
- new growth visible w/i 6-8 weeks
- if no response after 6 mos, dc tx and use alternative
role of potent topical steroids in the tx of alopecia
-for children and adults who cannot tolerate intralesional injections
place in therapy for topical immunity
for pts w/ extensive or recurrent scalp involvement
general mechanism of topical immunity
- potent contact allergy applied weekly to scalp precipitates allergic contact dermatitis
- the mild inflammatory rxn is associated w/ hair regrowth
what are the topical immunity products used for alopecia
- diphenylcyclopropenone (DPCP)
- squaric acid dibutyl ester (SADBE)
- dinitrochlorobenzene (DNCB)
admin process of topical immunity for alopecia
- application of solution to a small area to sensitize pt
- 1-2 weeks later, tx is initiated w/ application of very dilute concentration of the allergen to affected areas
- wash off after 24-48 hrs
- protect from sun exposure
ADRs of topical immunity
- severe dermatitis
- lymphadenopathy
- urticaria
- vitiligo
- dyschromia
2nd line therapy for alopecia
- minoxidil
- anthralin
ADRs of topical minoxidil
- unwanted growth of facial hair
- occasional dermatitis, pruritis, scalp irritation/redness
- chest pain, rapid HR, faintness, dizziness (d/t vasodilator properties)
- weight gain, swelling of hands/feet
ADRs of anthralin
- mild irritation
- will stain hair, skin, and clothing brown
what is the primary dermatophyte that causes onychomycosis?
trichophytaon rubrum
distal subungual onychomycosis (DSO)
- MC
- nail plate and bed affected
- matrix affected in severe dz
white superficial onychomycosis (WSO)
- caused by t. mentagrophytes
- infection localized to surface of nail plate
proximal subungual onychomycosis (PSO)
- MC cause: t. rubrum
- fungi invade nail through proximal nail fold and spread to nail plate/matrix
1st line tx on onychomycosis
terbinafine
alternative tx from terbinafine for onychomycosis
itraconazole
tx duration of oral antifungal therapy for toe and fingernail
- toenail: 12 weeks
- fingernail: 6 weeks
what is itraconazole pulse therapy?
intraconazole 200mg BID x1 week/month - repeat for 2 pulses for finger, 3 for toe
ADRs for terbinafine and itraconazole
- GI is common: n/d, dyspepsia, abd pain
- severe hepatotoxicity (rare) leading to liver failure
- itraconazole: risk of CHF
topical antifungals
- efinaconazole
- tavaborole
- ciclopirox
duration of topical antifungal therapy
up to 48 weeks
what is the preferred antifungal for children?
ciclopirox
candidates for topical therapy
- if CI or drug interactions to systemic therapy
- if < 3 nails are involved and prefer to avoid systemic tx
- not as high of risk for serious ADRs compared to systemic
behaviors associated w/ paronychia
- overzealous manicuring
- nail biting
- thumb sucking
- DM
- occupation where hands are frequently submerged in water
appropriate abx for tx of acute paronychia
-if not exposed to oral flora
-dicloxacillin/cephalexin in areas w/ low MRSA
appropriate abx for tx of acute paronychia
-if exposed to oral flora
abx that covers S. aureus, E corrodens, H. influenzae and beta-lactamase
appropriate abx for tx of acute paronychia
-if high MRSA area
TMP-SMX double strength BID
tx choice for chronic paronychia
- topical corticosteroids + protective measures
- systemic antifungal if unresponsive
RFs for ingrown toenails
- poorly fitting shoes
- excessive trimming of lateral nail plate
- pincer nail deformity
- trauma
conservative therapy for mild to moderate ingrown toenails
- cotton wedging/dental floss under lateral nail plate and separate nail plate from lateral fold to releive pressure
- soak in warm soapy water for 10-20 min. TID x 1-2 weeks; pushing lateral nail fold away from plate
topical abx tx for moderate to severe ingrown toenail
bacitracin/mupirocin ointment
skin lightening agents used to tx melisma
- hydroquinone
- azelaic acid
- mequinol in combo w/ topical retinoid
- kojic acid
