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AAI > Pharmacology - Dermatology > Flashcards

Pharmacology - Dermatology Flashcards

1
Q

Eczema: prevalence, symptoms, consequences

A
  • common esp in children >3yo
  • redness
  • scaling and dryness
  • thickening of skin (lichenification)
  • itchiness (pruritis)
  • scratching leads to breaking of skin (excoriations)
  • can get vesicles (blistering if allergic)
  • can get infected (bacterial)

-can be occular (in eye)

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2
Q

Eczema aim of treatment and treatment

A

reduce itching to reduce scratching
emollients
topical steroids

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3
Q

Atopic eczema/dermatitis: meaning, causes, management

A

Irritant contact dermatitis
ex: washing hands frequently, cheap jewelry

avoid irritant
treat with emollient

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4
Q

Allergic contact dermatitis: consequence and treatment

A

-can cause blistering

treat with emollient and topical steroid (hydrocortisone)

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5
Q

Psoriasis: what is it, how does it look like, common places, consequences

A

auto-immune disease

red, flaky, crusty patches with silvery scale

areas with more movement (elbows, knees, scalp etc.)

common behind ears, around hairline and in umbilicus

can be nail (depressions in nails, thickening of nails, separation from nail bed)
and joint involvement

fissures in skin

can get infected

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6
Q

Psoriasis treatment

A

First line:

  • emollients
  • vit D analogues (paricalcitrol) +/- potent topical steroids
  • coal tar
  • topical steroid monotherapy only in specific conditions (sensitive skin areas, thick skin sites such as palms)
  • Dithranol in hospital
  • topical retinoid (usually intolerated in psoriasis patients)
  • shampoos for scalp psoriasis
  • NEVER oral steroid

Second line:

  • phototherapy
  • acitretin
  • immunoppressants (ciclosporin etc.)
  • biological agents
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7
Q

ADR dermatitis example

A

amoxicillin

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8
Q

differential diagnosis

A

eczema: ill defined
psoriasis: well defined red plaques

eczema: itchiness
cellulite: discomfort

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9
Q

treatment of yeast caused eczema

A

antifungal (metronidazole)

topical steroid

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10
Q

cradle cap

A

neonate eczema
ignore

if severe: emollients

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11
Q

Infected eczema

A

antibiotics

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12
Q

Best emollient

A

patient’s preference

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13
Q

Topical steroid potency examples

A

mild–> 1% hydrocortisone

moderate–>clobetasone butyrate

potent–> betamethasone valerate

very potent –> clobetasone propionate

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14
Q

Topical steroid use

A

in bursts (ex: week or 2 when condition happens): breaks important to avoid insensitivity

once daily

affected areas only

do not apply sparingly

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15
Q

Fingertip unit

A

1 fingertip –> are of 2 palms –> approx. 0.5 g

whole body –> 100 g < 1 week

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16
Q

if topical steroids do not work…

A

topical calcineurin inhibitors (avoid sun to prevent cancer but no real evidence)

phototherapy

immunosuppression

alitretinoin (retinoid)

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17
Q

Pitfalls in psoriasis

A

steroid tachyphylaxis

-dec gradually

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18
Q

Drugs that exacerbate psoriasis

A
  • beta-blockers (no need stop but if starting, choose alternative)
  • lithium
  • interferon
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19
Q

Acne causes

A
  • increased sebum secretion
  • blocked pores
  • colonisation with P. acnes
  • inflammation
-NOT:
poor hygiene
not drinking enough water
eating too much chocolate
masturbation
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20
Q

Features of acne

A

non-inflammatory lesions:
-open and closed comedones

inflammatory lesions:

  • pustules
  • papules
  • nodules

scars

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21
Q

comedones treatment

A

topical retinoid

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22
Q

topical acne treatment

A

benzoyl peroxide

  • most effective OTC
  • bleach clothes
  • irritant, proper use
  • only on affected area
  • no bacterial resistance

azelaic acid
-gentler than benzoyl

retinoids

  • ex: adapalene
  • irritant
  • use in severe cases

antibiotics:
-ex: duac (clindamycin + benzoyl peroxide) in combination with retinoid

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23
Q

systemic acne treatment

A
  • antibiotics (ex: erythromycin in pregnancy)
  • oral contraceptive pill if acne gets worse around period (progesterone-only pills/mini-pills can raise androgen levels and exacerbate-rebound, long time to settle after withdrawal)
  • isotretinoin (monitor LFTs, avoid in pregnancy, can cause dry skin, use lip balm, mental complications?)
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24
Q

acne scars

A

permanent depressions

raised lesions can be treated with steroid injections but not very effective

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25
Rosacea treatment
azelaic acid in Finacea topical metronidazole isotretinoin (often recur)
26
Urticaria Features
wheel shaped oedema no scaling typically itchy (pruritus) ex: chicken pox lesions last <24 hours resolve without marks
27
Urticaria types
acute -easily identifiable trigger chronic
28
Urticaria treatment
crotamiton (?) calamine (soothing) for itching antihistamines (5x the licensed dose): non-sedating at morning and sedating at night if fail... H2 blocker (ranitidine) or LT blocker if fail.... short term immunosuppression omalizumab (not licensed for urticaria yet)
29
Urticaria causes
morphine (displace histamine from mast cells) nettle stings/insect bites (oral antihistamine / topical 1% HC) physical stimuli (ex: uv light, scratching, pressure such as belts and tight shoes)
30
Drug Exanthems
- typically 1-2 weeks after drug started (even if drug stopped) - low grade fever - stop drug and allow settle over 2 weeks - start on trunk - mildly pruritic
31
Drugs that cause eruptions
- anticonvulsants - sulfonamides - penicillins - cephalosporins - NSAIDs - allopurinol
32
Photosensitising drug
- doxycycline - NSAIDs - diuretics - phenothiazines - retinoids - sulphonylureas - quinine - amiodarone
33
Fixed drug eruption
most common on genitalia
34
Steven-Johnson syndrome
- rash, fever and respiratory systems - 2 or more mucosal sites - prolonged course
35
Skin failure
often painful: analgesia
36
Skin bacterial infection causes
- mostly S. aureus or Group A Strep | - co-infection may occur
37
Skin bacterial infection treatment
antibiotics | topical antiseptics
38
Skin bacterial infection examples
- impetigo - bacterial folliculitis - cellulitus
39
Cellulitis treatment
penicillin / benzylpenicillin prophylaxis
40
bacterial folliculitis treatment
``` topical antiseptics orqal antibiotics (flucloxacillin,doxycycline etc.) ```
41
Viral infections of skin (virus examples)
- herpes simplex (cold sores) - varicella zoster (chickenpox) - human papilloma virus (HPV) - molluscipox virus
42
Herpes simplex treatment
acyclovir when tingling before visible symptoms
43
Chickenpox features
- milder in children - fever - blisters - remain dormant in ganglion after infection and can re-emerge as shingles
44
Chickenpox treatment
no need unless severe (immunospressed patients): acyclovir
45
Shingles
- herpes zoster - caused by voricella zoster - triggered by stress, weakness etc.
46
Viral worts
- papilloma virus (HPV) - surgical intervention - OTC: salycilic acid - can resolve on their own - duct tape for 6 days, breathe 1 day and repeat, helps soften
47
Molluscum contagiosum
- papules with central depression - contagious - more common in eczema patients
48
Molluscum contagiosum treatment
self limiting surgical intervention cryotherapy hydrogen peroxide cream
49
Dermatophyte genera
Microsporum Trichophyton Epidermiphyton
50
Dermatophyte transmission
anthropophiliac (human) zoophilic (animal) geophilic (soil)
51
Tinea pedis treatment
local: topical antifungal Daktarin (miconazole) ``` extensive: oral antifungal (ex: terbinafine) ```
52
Tinea corporis
Body ringworm
53
Tinea capitis
scalp hair loss MUST oral antibiotic if inflamed: topical steroid
54
Tinea unguium/Onychomycosis
nail fungal infection clinically very similar to psoriasis MUST oral antifugal nail lacquer
55
Candidiasis versicolor
- hypopigmented patches of skin - sweating - asymptomatic aside from appearance
56
Candidiasis versicolor treatment
ketoconazole shampoo as body lotion
57
Infestations
scabies mites: - homes/army barracks/prisons - treat everyone - burrows - penile papules
58
Scabies treatment
Scabicide: - babies (whole body inc. scalp) - adults (neck down) - Permethrin (leave on for 8-12 hrs) - Malathon (leave for 24 hrs) - Treat on days 1 & 8 - Treat everyone simultaneously to prevent re-infection
59
Hair lice transmssion
- transmitted through hair-to hair contact | - can transmit bacteria
60
Hair lice treatment
removal: - wet combing - days 5, 9 and 13 shave head occlude with mosituriser Pediculicides (target live lice NOT eggs): - Dimeticone - Malathion - 2 applications 7 days apart
61
Warning signs of cancer
Pigmented lesion: - enlargement - colour change esp. darkening - change in shape - asymmetry - itching Non-pigmentes lesion: - enlargement - asymmetry - recurrent scabbing - bleeding
62
ABCDE rule
``` Asymmetry Border Colour Diameter (>6 mm) Elevation ``` 2 or more --> lesion suspicious
63
Dysplastic moles
- potential to become malignant | - bigger and more irregular border
64
Seborrheic keratosis
- not suspicious - well defined and brown - look stuck on
65
Campbell de Morgan spots
- red moles | - harmless
66
Bowen's disease
- very early form of skin cancer | - easily treatable
67
Squamous cell carcinoma
- look like volcano with crater | - refer
68
basal cell carcinoma
- pearly/shiny surface - central depression with scab/crest - refer
69
Dermatitis vs. eczema
Dermatitis: skin inflammation in general Eczema: chronic case of dermatitis

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