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PHRM 825 > PHRM 825: Dermatology > Flashcards

PHRM 825: Dermatology Flashcards

1
Q

What 2 primary lesions are flat, nonpalpable changes in skin color

A
  • Macule

- Patch

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2
Q

What 3 primary lesions are elevated and formed by a fluid in a cavity (no color change)

A
  • Vesicle
  • Bulla
  • Pustule
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3
Q

What 5 primary lesions are elevated, palpable solid masses?

A
  • Papule
  • Plaque
  • Nodule
  • Tumor
  • Wheal
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4
Q

What primary lesion are most drug rashes made of?

A

Macules

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5
Q

What 3 secondary lesions have material on the skin surface?

A
  • Scale
  • Crust
  • Keloid
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6
Q

What 4 secondary lesions have loss of skin surface?

A
  • Erosion
  • Ulcer
  • Excoriation
  • Fissure
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7
Q

What are the 4 vascular lesions?

A
  • Cherry angioma
  • Telangiectasia
  • Petechiae
  • Ecchymosis
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8
Q

What does occlusive mean in regards to ointments?

A

Promotes retention of water in the skin

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9
Q

What does humectant mean in regards to ointments?

A

Causes water to be retained because of its hygroscopic properties

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10
Q

What does emollient mean in regards to ointments?

A
  • Softens the skin

- Soothes irritation in skin or mucous membranes

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11
Q

What does protective mean in regards to ointments?

A

Protects inured or exposed skin surfaces from harmful or annoying stimuli

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12
Q

What form of topical agent has the greatest bioavailability of active ingredient?

A

Ointment

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13
Q

What topical agent is essentially a watered-down cream?

A

Lotion

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14
Q

What 4 topical vehicles are preferred for hair bearing skin?

A
  • Gel
  • Lotions
  • Solution
  • Foam
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15
Q

Characteristics of oleaginous bases

A
  • Absorbs no water

- Not water washable (requires soap)

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16
Q

Characteristics of absorption bases

A
  • Can absorb several times it’s weight of water

- Not water washable

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17
Q

Characteristics of water-in-oil emulsion bases

A
  • Absorbs less water than absorption bases

- Not water washable

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18
Q

Characteristics of oil-in-water emulsion bases

A
  • Water washable

- Add water=lotion

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19
Q

What base is most commonly used therapeutically to treat skin disorders?

A

Creams

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20
Q

What are 3 drug-induced skin disorders?

A
  • Hypersensitivity/allergic reaction
  • Photosensitivity
  • Toxic Reaction
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21
Q

How do you treat drug-induced skin disorders?

A
  • Stop the drug
  • Systemic antihistamines
  • Systemic or topical corticosteroids
  • Soothing baths or soaks
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22
Q

What are the 2 types of photosensitivity reactions?

A
  • Phototoxic

- Photo allergic

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23
Q

What causes a phototoxic skin reaction?

A

Drug or its metabolite accumulates in the skin, absorbs light and undergoes a photochemical reaction resulting in local tissue damage

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24
Q

What causes a photo allergic reaction?

A

Drug or its metabolite induces a cell mediated immune response which on exposure to light (longer wave length) produces a papular or eczematous contact dermatitis like picture

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25
Q

How do you prevent photosensitivity reactions?

A

Sunscreen SPF >30 and clothing

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26
Q

How do you treat photosensitivity reactions?

A
  • Systemic analgesics
  • Systemic antihistamines for itching
  • Prevent infection
  • Moisturizers
  • Cooling creams and gels (Aloe)
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27
Q

What are characteristics of toxic skin reactions?

A
  • Epidermal detachment

- Erosive mucosal lesions

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28
Q

What causes a toxic skin reaction?

A

Drug protein complex reaction leads to T-cell activation which migrates to the dermis and releases cytokines

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29
Q

What drug is most commonly responsible for Steven Johnsons Syndrome?

A

Anti-convulsants

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30
Q

What is cellulitis and should you treat or refer?

A
  • Infection near break in skin
  • Red, warm, swollen (fever?)
  • Refer
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31
Q

How do you treat cellulitis?

A
  • Oral antibiotics

- IV antibiotics in severe cases

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32
Q

What is impetigo and should you treat or refer?

A
  • Topical staph skin infection
  • Most common in children
  • Direct spread
  • Refer
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33
Q

How do you treat impetigo?

A

Topical or oral antibiotics

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34
Q

Where is topical candida infection most common?

A
  • Moist areas in humid conditions

- Obese patients

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35
Q

How do you treat topical candida infection?

A
  • Topical antifungals

- Dry affected area

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36
Q

What is Tinea pedis?

A
  • Athlete’s foot
  • Dermatophyte infection
  • Often spread in pools/showers
  • Moist environments promote growth
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37
Q

How is tinea pedis (athlete’s foot) treated?

A

Topical antifungals

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38
Q

What is tinea corporis?

A
  • Body ring worm
  • Commonly transmitted in day-care
  • Hot/humid environments promote growth
  • Small, circular, red scaly areas
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39
Q

How is tinea corporis/body ring worm treated?

A

Topical antifungals

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40
Q

What is Pediculosis and do you treat or refer?

A
  • Head lice
  • Children 3-12 years old
  • Scalp redness and scaling
  • Pruritus
  • Refer
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41
Q

How is head lice/pediculosis treated?

A
  • Permethrin 1%
  • Malathion
  • Oral Ivermectin
  • Spinosad
  • Topical Ivermectin
  • $$$
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42
Q

What is scabies and do you treat or refer?

A
  • Sarcoptes scabiei infestation
  • Primarily in children and adolescents (LTCF)
  • Raised lines caused by mites burrowing under the skin
  • Extreme pruritus
  • Refer to PCP
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43
Q

How is scabies treated?

A
  • Permethrin 5%
  • Crotamiton
  • Oral Ivermectin
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44
Q

What is Herpes zoster and do you treat or refer?

A
  • Shingles
  • Adults >40 yo
  • Especially in pts who previously had chicken pox
  • Potentially contagious while blisters are present
  • Triggered by stress, old age, immunosuppression
  • Extreme pain along dermatome
  • Tender red papules that progress to scabs
  • Refer to PCP
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45
Q

How do you treat herpes zoster/shingles?

A
  • Oral valacyclovir or famciclovir
  • Manage acute pain and postherpetic neuralgia (oral opioids for acute pain, gabapentin for PHN, lipoderm patches once lesions have healed)
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46
Q

What is the most common type of skin cancer?

A

Basal cell carcinoma

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47
Q

What is the most deadly type of skin cancer?

A

Melanoma

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48
Q

How is skin cancer treated?

A
  • Removal of lesion
  • Chemotherapy
  • Radiation
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49
Q

What is xerosis?

A

Dry skin

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50
Q

Who is at risk for xerosis?

A

Elderly
-decreased activity of sweat and sebaceous glands
-very warm, dry environments
Frequent bathing

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51
Q

How is xerosis treated?

A
  • Emollients (first line for itching/restores barrier and skin function)
  • Agents for itching
  • Alter bathing habits
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52
Q

Dr. Martin’s Rules of 3’s for xerosis

A
  • Bathe 3 times per week
  • tepid water (3-5 degrees above body temp)
  • Bathe for 3 mins
  • Apply emollient within 3 mins
  • Apply emollients 3 times daily
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53
Q

What agents reduce itching?

A
  • Menthol and camphor
  • Pramoxine
  • Aluminum acetate
  • Hydrocortisone
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54
Q

What is dermatitis?

A

Inflammatory process of the upper two layers of skin

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55
Q

What are the 3 stages of dermatitis?

A
  • Acute
  • Sub-acute
  • Chronic
56
Q

What characterizes acute dermatitis?

A
  • Red patches or plaques
  • Pebbly surface or blisters (vesicles)
  • Itching is common and intense
57
Q

What characterizes sub-acute dermatitis?

A
  • Dry
  • Less red than acute dermatitis
  • Crusting, oozing
  • Mild thickening
  • Red scaling, fissured, patches or plaques
  • Slight to moderate pruritis, pain, stinging, or burning
  • Itching is common but less intense than acute dermatitis
58
Q

What characterizes chronic dermatitis?

A
  • Epidermal thickening
  • Exaggerated skin markings
  • Lichenification
  • Scaling
  • Less itching
59
Q

What is the main symptom of acute contact dermatitis?

A

Itching

60
Q

What are the 2 types of contact dermatitis?

A

Allergic and irritant

61
Q

What is the itch-scratch cycle?

A

Inflammation/excitation of C-nerve fibers leads to itching which leads to scratching and repeat

62
Q

What is an irritant?

A

Non-immunologic reaction to frequent contact with everyday substances

63
Q

Which is more common: allergic or irritant contact dermatitis?

A

Irritant

64
Q

What is the main symptom of poison ivy?

A

Intense pruritis

65
Q

How is poison ivy treated?

A

Topical therapy

If >10% BSA involved, oral therapy

66
Q

What are poison ivy treatment options?

A
  • Remove source
  • Soaks
  • Calamine lotion
  • Topical antihistamines
  • Oral antihistamines
  • Topical corticosteroids
  • Oral corticosteroids
67
Q

When are soaks used to treat acute dermatitis?

A

For oozing, weeping, crusting lesions

68
Q

When are wet-to-dry dressings useful?

A

For drying acutely, inflamed, wet areas

69
Q

What is the MOA of topical corticosteroids?

A
  • Anti-inflammatory
  • Anti-pruritic
  • Suppress immune response
70
Q

How are topical corticosterois classified?

A

According to potency corresponding to anti-inflammatory activity
(very high-low corresponds with grades I to VII)

71
Q

What technique enhances penetration of topical agents?

A

Occlusion

72
Q

What are side effects of topical corticosteroids?

A
  • Thinning of skin
  • Dilated blood vessels
  • Increased bruising
  • Skin color changes
  • Risk of HPA suppression with long-term use of high-potency agents
  • Development of tolerance (tachyphylaxis)
73
Q

What is the MOA of topical calcineurin inhibitors?

A

Blocks pro-inflammatory cytokine genes

74
Q

What are 2 topical calcineurin inhibitors

A

-Pimecrolimus and tacrolimus

75
Q

What class of medications can be used for systemic treatment of acute dermatitis?

A

Corticosteroids

76
Q

What non-sedating antihistamines are used as systemic therapy for acute dermatitis?

A
  • Loratadine
  • Desloratadine
  • Fexofenadine
77
Q

What sedating antihistamines are used as systemic therapy for acute dermatitis?

A
  • Diphenhydramine
  • Cetirizine
  • Hydroxyzine
  • Doxepin
78
Q

What is atopic dermatitis and its characteristics?

A
  • Most common form of eczema
  • Usually presents in infancy
  • 1 in 5 children
  • 1 in 12 adults
  • 80% mild and 20% mod-severe
  • Significant QOL issues (sleep, depression, anxiety, lack of productivity)
79
Q

What is included in the atopic triad?

A
  • Atopic dermatitis
  • Asthma
  • Allergic rhinitis
80
Q

What is the first diseases of atopic/allergic triad to be observed?

A

Atopic march

81
Q

What is atopic dermatitis and its characteristics?

A
  • Pruritis
  • Symmetrical red papules or plaques
  • Scaling excoriations
  • Overall dryness of skin
  • Redness and inflammation
  • History of allergic disease
  • Risk of 2nd infection
82
Q

What are triggers for atopic dermatitis?

A
  • Detergents
  • Infections
  • Allergens
  • Chemicals
  • Bathing
  • Soaps
  • Smoke
  • Dust
83
Q

What is dupilumab and what is its MOA?

A
  • First biologic indicated for moderate to severe AD (not well controlled with other therapies
  • Human monoclonal antibody against IL-4 receptor alpha (inhibits signaling of IL-4 and IL-13 (Th2 cytokines)
84
Q

What is stasis dermatitis and what are it’s characteristics?

A
  • Patients > 50yo
  • Poor circulation
  • Most common around ankles
  • Aching, swelling, edema, discomfort
  • Red, scaly, crusted plaques
  • Secondary infection and ulcers common
  • Hyperpigmentation (retention of iron in skin)
85
Q

How is stasis dermatitis treated?

A
  • Topical corticosteroids (for itching)
  • Emollients (for all pts)
  • Oral antibiotics for local infections (cephalexin)
  • Support/compression stockings to relieve edema
86
Q

What is chronic dermatitis and what are it’s characteristics?

A
  • Well documented lichenified, thickened plaques
  • Excoriations, fissures, scaling
  • Itching predominates (minor irritations or trauma worsens itching)
87
Q

How is chronic dermatitis treated?

A
  • Emollients
  • Avoid long-term corticosteroids
  • UV light
88
Q

What patients are at risk for topical fungal infections?

A
  • Obese!
  • Infants
  • Elderly
  • Immunosuppressed
  • Incontinence
  • Warm and humid climates
  • Usually a combination of risk factors
89
Q

Should you treat or refer topical fungal infections?

A
  • Most can be treated with OTC
  • Refer if systemic symptoms
  • Refer if patient is immunocompromised
90
Q

OTC products for topical fungal infections

A
  • Miconazole
  • Clotrimazole
  • Terbinafine
91
Q

Rx products for topical fungal infections

A
  • Nystatin
  • Ciclopirox
  • Ketoconazole
92
Q

Treatment options for diaper rash

A
  • Remove irritant (frequent diaper changes)
  • Air dry
  • Keep clean
  • Antifungal agents +/- corticosteroids
93
Q

What is seborrhic dermatitis?

A
  • Erythema with greasy yellow scaling
  • Hairline, scalp, nose, neck, ears, back
  • Itching
  • Includes cradle cap in infants
94
Q

How to treat cradle cap

A
  • Baby oil to soften
  • Baby shampoo
  • No drug tx usually required
95
Q

Treatment options for seborrhic dermatitis

A
  • Medicated shampoos (contact time is critical)

- Topical corticosteroid (low strength ideal for lesions on face and ears)

96
Q

Acne definition

A

Chronic inflammatory disease of the sebaceous glands and hair follicles of the skin characterized by comedones, papules, and pustules

97
Q

What percentage of the adolescent population experiences acne?

A

90%

Corresponds to increased androgen production

98
Q

80% of patients with acne are within what age range?

A
  • 12-30
  • Males more severe during puberty
  • Females more severe during adulthood
99
Q

Factors that exacerbate acne

A
  • Oil-based cosmetics
  • Emotional stress
  • Irritation/physical pressure
  • Drugs
100
Q

What drugs exacerbate acne?

A
  • Androgenic steroids!!!
  • Corticosteroids
  • Lithium
  • Anti-epileptics (phenytoin)
  • Tuberculostatic drugs
  • Oral contraceptives
101
Q

What is a comedone?

A

Hair follicle plugged with sebum, keratin, and dead skin

102
Q

What bacteria naturally colonizes the skin and sebaceous glands and causes acne?

A

Propionibacterium acnes

103
Q

What are the 2 classes of acne?

A

Non-inflammatory and inflammatory

104
Q

What are the non-inflammatory lesions of acne?

A

Whiteheads and blackheads

105
Q

What are the inflammatory lesions of acne?

A
  • Papules
  • Pustules
  • Ruptured contents
106
Q

What constitutes a whitehead?

A

Trapped contents in a closed comedo

107
Q

What constitutes a blackhead?

A
  • Trapped contents
  • Dilated opening
  • Open comedo
  • Melanin accumulates
108
Q

What is the difference between a papule and a pustule?

A

Papules are red and inflamed while pustules are yellow and inflamed

109
Q

What are complications of acne?

A
  • Excoriations
  • Erythematous macules
  • Hyperpigmented macules
  • Scars
110
Q

What are treatment options for complications of acne?

A
  • Dermabrasion
  • Chemical peels
  • Laser resurfacing
  • $$$
111
Q

What are the goals for treatment of acne?

A
  • Long-term control
  • Prevent scars
  • Relieve discomfort
  • Improve skin appearance
  • Minimized psychological stress
112
Q

What oral antibiotics are used for acne?

A
  • Minocycline
  • Doxycycline
  • Erythromycin
  • Azithromycin
  • TMP/SMX
113
Q

What type of therapy is ideal for females who’s acne flares during the menstrual cycle?

A

Hormone treatment/oral contraceptive

114
Q

What is isotretinoin and what is it used for?

A

Used for severe acne or when patients have failed other treatments or when it relapses soon after discontinuing other therapies

115
Q

How long must someone wait to determine if an acne treatment regimen has been successful?

A

2-4 months

116
Q

What is rosacea?

A
  • Chronic, progressive inflammatory dermatosis based upon vascular instability
  • Primarily affects central part of face
  • Characacterized by facial flushing/bluching, facial erythema, papules, pustules, and telangiectasia
  • 25-75 years of age
  • Women > men
117
Q

What characterizes telangiectatic rosacea?

A
  • Visibly dilated blood vessels

- Very red skin

118
Q

What characterizes papulopustular rosacea?

A
  • Resembles acne

- Often referred to as “adult acne”

119
Q

What characterizes phytmatous rosacea?

A
  • Enlarged sebaceous glands
  • Especially the nose
  • More common in males
120
Q

What characterizes ocular rosacea?

A
  • Watery eyes

- Bloodshot eyes

121
Q

What are triggers for rosacea?

A
  • Temperature!
  • Drugs!
  • Foods
  • Weather
  • Beverages
  • Medical conditions
  • Emotional influences
  • Physical exertion
  • Skin products
122
Q

What drugs are the main trigger for rosacea?

A

Vasodilators

123
Q

What is psoriasis and how does it present clinically?

A
  • Chronic autoimmune inflammatory skin disorder
  • T-lymphocyte mediated disease
  • Keratinocyte proliferation
  • Thickened, red patches covered by silvery-white scales
  • Results from rapid skin growth (7x faster than normal)
124
Q

How do you treat psoriasis?

A
  • Not curable!

- Attempt long remissions

125
Q

What is psoriatic arthritis?

A
  • Usually in joint area
  • Defined with red patches on skin topped with silvery scales
  • Usually psoriasis diagnosed first and then psoriatic arthritis
  • Joint problems can begin before skin lesions appear
126
Q

What is guttate psoriasis?

A
  • Usually in children or young-adults
  • Small, pink-red spots often appearing on trunk, upper arms, thighs, scalp due to URI, stress, skin injury, or commonly beta-blockers
127
Q

What is erythrodermic psoriasis?

A
  • Inflammatory form of psoriasis, often affects most of body surface
  • Usually rare, and usually develops from pustular psoriasis or unstable plaque psoriasis
  • Characterized by redness and severe itching throughout the entire body
128
Q

What is inverse psoriasis?

A
  • Develops in body’s skin folds: armpits, genitals, under breasts, buttocks
  • Painful and difficult to treat
129
Q

What BSA% characterizes “limited psoriasis”

A

<5%

130
Q

What BSA% characterizes “moderated psoriasis”

A

5-10%

131
Q

What BSA% characterizes “severe psoriasis”

A

> 10%

132
Q

What are comorbidities of psoriasis?

A
  • Psoriatic arthritis
  • Crohn’s disease
  • Psychiatric disorders
  • Metabolic syndrome (CV disease/stroke)
133
Q

When is topical therapy most effective to treat plaque psoriasis?

A

When it covers <20% of BSA

134
Q

What technique enhances penetration of topical therapies?

A

Occlusion (increases penetration by 10x)

135
Q

What is goeckerman therapy?

A

All day occlusive coal tar followed by light therapy

136
Q

What infection can biologic therapy activate?

A

TB

PHRM 825 (36 decks)

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