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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
Q

Rosacea treatment

A

azelaic acid in Finacea

topical metronidazole

isotretinoin (often recur)

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26
Q

Urticaria Features

A

wheel shaped oedema

no scaling

typically itchy (pruritus) ex: chicken pox

lesions last <24 hours

resolve without marks

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27
Q

Urticaria types

A

acute
-easily identifiable trigger

chronic

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28
Q

Urticaria treatment

A

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
Q

Urticaria causes

A

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
Q

Drug Exanthems

A
  • 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
Q

Drugs that cause eruptions

A
  • anticonvulsants
  • sulfonamides
  • penicillins
  • cephalosporins
  • NSAIDs
  • allopurinol
32
Q

Photosensitising drug

A
  • doxycycline
  • NSAIDs
  • diuretics
  • phenothiazines
  • retinoids
  • sulphonylureas
  • quinine
  • amiodarone
33
Q

Fixed drug eruption

A

most common on genitalia

34
Q

Steven-Johnson syndrome

A
  • rash, fever and respiratory systems
  • 2 or more mucosal sites
  • prolonged course
35
Q

Skin failure

A

often painful: analgesia

36
Q

Skin bacterial infection causes

A
  • mostly S. aureus or Group A Strep

- co-infection may occur

37
Q

Skin bacterial infection treatment

A

antibiotics

topical antiseptics

38
Q

Skin bacterial infection examples

A
  • impetigo
  • bacterial folliculitis
  • cellulitus
39
Q

Cellulitis treatment

A

penicillin / benzylpenicillin

prophylaxis

40
Q

bacterial folliculitis treatment

A 
topical antiseptics
orqal antibiotics (flucloxacillin,doxycycline etc.)
41
Q

Viral infections of skin (virus examples)

A
  • herpes simplex (cold sores)
  • varicella zoster (chickenpox)
  • human papilloma virus (HPV)
  • molluscipox virus
42
Q

Herpes simplex treatment

A

acyclovir when tingling before visible symptoms

43
Q

Chickenpox features

A
  • milder in children
  • fever
  • blisters
  • remain dormant in ganglion after infection and can re-emerge as shingles
44
Q

Chickenpox treatment

A

no need unless severe (immunospressed patients): acyclovir

45
Q

Shingles

A
  • herpes zoster
  • caused by voricella zoster
  • triggered by stress, weakness etc.
46
Q

Viral worts

A
  • 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
Q

Molluscum contagiosum

A
  • papules with central depression
  • contagious
  • more common in eczema patients
48
Q

Molluscum contagiosum treatment

A

self limiting

surgical intervention
cryotherapy

hydrogen peroxide cream

49
Q

Dermatophyte genera

A

Microsporum
Trichophyton
Epidermiphyton

50
Q

Dermatophyte transmission

A

anthropophiliac (human)
zoophilic (animal)
geophilic (soil)

51
Q

Tinea pedis treatment

A

local:
topical antifungal
Daktarin (miconazole)

extensive:
oral antifungal (ex: terbinafine)
52
Q

Tinea corporis

A

Body ringworm

53
Q

Tinea capitis

A

scalp
hair loss
MUST oral antibiotic
if inflamed: topical steroid

54
Q

Tinea unguium/Onychomycosis

A

nail fungal infection

clinically very similar to psoriasis

MUST oral antifugal
nail lacquer

55
Q

Candidiasis versicolor

A
  • hypopigmented patches of skin
  • sweating
  • asymptomatic aside from appearance
56
Q

Candidiasis versicolor treatment

A

ketoconazole shampoo as body lotion

57
Q

Infestations

A

scabies mites:

  • homes/army barracks/prisons
  • treat everyone
  • burrows
  • penile papules
58
Q

Scabies treatment

A

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
Q

Hair lice transmssion

A
  • transmitted through hair-to hair contact

- can transmit bacteria

60
Q

Hair lice treatment

A

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
Q

Warning signs of cancer

A

Pigmented lesion:

  • enlargement
  • colour change esp. darkening
  • change in shape
  • asymmetry
  • itching

Non-pigmentes lesion:

  • enlargement
  • asymmetry
  • recurrent scabbing
  • bleeding
62
Q

ABCDE rule

A 
Asymmetry
Border
Colour
Diameter (>6 mm)
Elevation

2 or more –> lesion suspicious

63
Q

Dysplastic moles

A
  • potential to become malignant

- bigger and more irregular border

64
Q

Seborrheic keratosis

A
  • not suspicious
  • well defined and brown
  • look stuck on
65
Q

Campbell de Morgan spots

A
  • red moles

- harmless

66
Q

Bowen’s disease

A
  • very early form of skin cancer

- easily treatable

67
Q

Squamous cell carcinoma

A
  • look like volcano with crater

- refer

68
Q

basal cell carcinoma

A
  • pearly/shiny surface
  • central depression with scab/crest
  • refer
69
Q

Dermatitis vs. eczema

A

Dermatitis: skin inflammation in general

Eczema: chronic case of dermatitis

AAI (13 decks)

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