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Dermatology > Sec 36 Topical Therapy and Sec 38 Physical Treatments > Flashcards

Sec 36 Topical Therapy and Sec 38 Physical Treatments Flashcards

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1
Q

The rate-limiting barrier to percutaneous drug delivery.

A

Stratum corneum

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2
Q

This cornified layer is composed of ceramides, free fatty acids, and cholesterol in a 1:1:1 molar ratio

A

Stratum corneum

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3
Q

Composition: Stratum corneum

A

50% ceramides (acylceramides being the most abundant)
35% cholesterol
15% free fatty acids

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4
Q

Two main routes for permeation through the stratum corneum

A
  1. Transepidermal pathway

2. Transappendageal pathway

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5
Q

Involves the flow of molecules through the eccrine glands and hair follicles via the associated sebaceous glands

A

Transappendageal, or shunt route

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6
Q

Molecules pass between the corneocytes via the intercellular micropathway, or through the cytoplasm of dead keratinocytes and intercellular lipids

A

Transepidermal route

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7
Q

Considered the most important route for cutaneous drug delivery

A

Intercellular pathway

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8
Q

Difference in penetration (from most to least penetration)

A
  1. Mucous membrane
  2. Scrotum
  3. Eyelids
  4. face
  5. chest and back
  6. Upper arms and legs
  7. lower arms and legs
  8. Dorsa of hands and feet
  9. Palmar and plantar skin
  10. Nails
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9
Q

Occlusion increases drug delivery by

A

10-100x

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10
Q

Associated with adherence to a treatment regimen

A

Female gender
Employment
Being married
Low prescription costs

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11
Q

Decrease in drug response when used over a prolonged period of time

A

Tachyphylaxis

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12
Q

Worsening of preexisting dermatoses

A

Rebound effect

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13
Q

Emulsifying agents

A 
Cholesterol
Disodium mono-oleamidosulfosuccinate 
Emulsifying wax
Polyoxyl 40 stearate
Polysorbates
Sodium laureth sulfate
Sodium lauryl sulfate
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14
Q

Auxiliary emulsifying agents/emulsion stabilizers

A 
Carbomer
Catearyl alcohol
Cetyl alcohol
Glyceryl monostearate
Lanolin and lanolin derivatives 
Polyethylene glycol
Stearyl alcohol
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15
Q

Stabilizers

A 
Benzyl alcohol
Butylated hydroxyanisole 
Butylated hydroxytoluene chlorocresol
Citric acid
Edetate disodium
Glycerin
Parabens
Propyl gallate
Propylene glycol
Sodium bisul te
Sorbic acid/potassium sorbate
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16
Q

Solvents

A 
Alcohol
Diisopropyl adipate glycerin 
1,2,6-Hexanetriol 
Isopropyl myristate 
Propylene carbonate 
Propylene glycol 
Water
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17
Q

Thickening agents

A 
Beeswax
Carbomer 
Petrolatum 
Polyethylene 
Xanthan gum
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18
Q

Emollients

A 
Caprylic/capric triglycerides cetyl alcohol
Glycerin
Isopropyl myristate
Isopropyl palmitate
Lanolin and lanolin derivatives 
Mineral oil
Petrolatum
Squalene
Stearic acid
Stearyl alcohol
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19
Q

Humectants

A

Glycerin
Propylene glycol
Sorbitol solution

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20
Q

Absorb moisture and decrease friction; adhere poorly to the skin; use is mainly limited to cosmetic and hygienic purposes; used in the intertriginous areas and on the feet

A

Powders

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21
Q

Also referred to as a cataplasm; a wet solid mass of particles, sometimes heated; used as wound cleansers and absorptive agents in exudative lesions such as decubiti and leg ulcers

A

Poultice

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22
Q

Semisolid preparations that spread easily; petrolatum-based vehicles, capable of providing occlusion, hydration, and lubrication

A

Ointments

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23
Q

Also called oleaginous bases; often referred to as emollients because they prevent the evaporation of moisture from the skin; composed of a mixture of hydrocarbons of varying molecular weights; greasy and can stain clothing

A

Hydrocarbon bases

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24
Q

Contain hydrophilic substances that allow for the absorption of water-soluble drugs; these are lubricating and hydrophilic, and they can form emulsions; greasy to apply; do not contain water; examples: anhydrous lanolin and hydrophilic petrolatum

A

Absorption bases

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25
Q

Contains <25% water, with oil being the dispersion medium with the two phases separate unless shaken; less greasy, spread easily on the skin, and provide a protective film of oil that remains on the skin as an emollient, while the slow evaporation of the water phase provides a cooling effect

A

Water-in-oil emulsion

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26
Q

Contains >31% water with the aqueous phase may comprise up to 80% of the formulation; one most commonly chosen to deliver a dermatologic drug; spread very easily, are water washable and less greasy, and are easily removed from the skin and clothing

A

Oil-in-water emulsion

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27
Q

Consist either primarily or completely of various PEGs; water soluble, will not decompose, and will not support the growth of mold, and therefore require no preservative additives; much less occlusive than water-in-oil emulsions, nonstaining, greaseless, and easily washed off of the skin

A

Water-soluble bases

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28
Q

Made from water-soluble bases by formulating water, propylene glycol, and/or PEGs with a cellulose derivative or carbopol; consists of organic macromolecules uniformly distributed in a lattice throughout the liquid; suitable for facial or hairy areas

A

Gels

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29
Q

Incorporation of high concentrations of powders (up to 50%) into an ointment such as a hydrocarbon base or a water-in-oil emulsion; function to localize the effect of a drug that may be staining or irritating; also function as impermeable barriers that serve as protectants or sunblocks; less greasy than ointments, more drying, and less occlusive

A

Pastes

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30
Q

Involves the dissolution of two or more substances into homogenous clarity. The liquid vehicle may be aqueous, hydroalcoholic, or nonaqueous

A

Solutions

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31
Q

A hydroalcoholic solution with a concentration of alcohol of approximately 50%

A

Tincture

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32
Q

A nonaqueous solution of pyroxylin in a mixture with ether and ethanol, and is applied to the skin with a soft brush

A

Collodion

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33
Q

Nonaqueous solutions of drugs in oil or alcoholic solutions of soap; can be used as counterirritants, astringents, antipruritics, emollients, and analgesics

A

Liniments

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34
Q

Two-phase system consisting of a finely divided, insoluble drug dispersed into a liquid in a concentration of up to 20%; easier to apply and allow for uniform coating of the affected area; more drying than ointments, and preparations with alcohol tend to sting eczematized or abraded skin

A

Suspension or lotion

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35
Q

Lotions to which a powder is added to increase the surface area of evaporation; effectively dries and cools wet and weeping skin; tend to sediment

A

Shake lotions

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36
Q

Triphasic liquids composed of oil, organic solvents and water, which are kept under pressure in aluminum cans; formulated with a hydrocarbon propellant

A

Foams

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37
Q

Involve formulating the drug in a solution within a pure propellant which is a blend of nonpolar hydrocarbons; allow for the ease of application and high patient satisfaction but expensive and potentially ecologically damaging

A

Aerosols

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38
Q

Compound that is able to promote drug transport through the skin barrier

A

Penetration enhancer

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39
Q

Application of crystals (generally aluminum oxide) on the skin and the collection of such crystals and skin debris under vacuum suction

A

Microdermabrasion

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40
Q

Nontherapeutic ingredients and include the preservatives, antioxidants, and chelating agents

A

Stabilizers

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41
Q

Increase the viscosity of products or suspend ingredients in a formulation

A

Thickeners

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42
Q

Patients may detect burning or stinging sensations without any signs of cutaneous irritation after applying a topical medication

A

Sensory irritant contact dermatitis

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43
Q

Reported with the long-term use of nitrogen mustard

A

Keratoacanthomas
Basal and squamous cell carcinomas
Lentigo maligna
Primary melanoma

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44
Q

Factors that modulate absorption also influence toxicity

A 
Concentration of the drug
Vehicle
Use of occlusion
Body site and area treated
Frequency of use
Duration of therapy
Nature of the diseased skin
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45
Q

Parameters that Affect Drug Amounts in Skin Compartments

A
  1. Formulations may undergo drastic changes in composition and structure
  2. Drug or formulation may affect the skin barrier, resulting in time-dependent changes of the barrier function
  3. Skin barrier may be affected by the type and progression of a disease
  4. Regional variations in the barrier properties of the skin
  5. Skin may respond to topical drug, enhancing or retarding percutaneous absorption
  6. Metabolic capacity of skin may lead to exposure of skin or systemically to both parent drug and pharmacologically active metabolite(s)
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46
Q

Highly responsive dermatoses to topical application of corticosteroids

A

Psoriasis (intertriginous)
Atopic dermatitis (children)
Seborrheic dermatitis
Intertrigo

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47
Q

Moderately responsive dermatoses to topical application of corticosteroids

A 
Psoriasis
Atopic dermatitis (adults) 
Nummular eczema 
Primary irritant dermatitis 
Papular urticaria 
Parapsoriasis
Lichen simplex chronicus
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48
Q

Least responsive dermatoses to topical application of corticosteroids

A 
Palmoplantar psoriasis 
Psoriasis of nails 
Dyshidrotic eczema 
Lupus erythematosus 
Pemphigus
Lichen planus
Granuloma annulare
Necrobiosis lipoidica diabeticorum 
Sarcoidosis
Allergic contact dermatitis, acute phase 
Insect bites
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49
Q

The amount of an active ingredient that is still in contact with the nonvolatile constituents of its formulation after the latter had been massaged into the skin surface

A

Reservior

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50
Q

Microscopic spheres comprising a bilayer that encloses an inner aqueous core

A

Liposomes

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51
Q

Potential sites of discontinuity in the integrity of the skin barrier

A

Appendages

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52
Q

The uptake of compounds by the cutaneous microvasculature; directly related to the surface area of the exchanging capillaries as well as their blood flow

A

Resorption

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53
Q

MOA: Blockage of DNA synthesis by inhibition of thymidylate synthetase

A

5-fluorouracil

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54
Q

MOA: Alkylating activity, immune stimulation

A

Mechlorethamine (nitrogen mustard)

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55
Q

MOA: Alkylation agent: inhibits DNA, RNA, and protein synthesis

A

Carmustine

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56
Q

MOA: Antimitotic agent: acts by disrupting microtubules, blocking cell division in metaphase

A

Vinblastine

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57
Q

MOA: Disrupts DNA synthesis and causes scission of DnA strands

A

Bleomycin

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58
Q

MOA: Antimetabolite: interferes with DNA synthesis (inhibition of dihydrofolate reductase)

A

Methotrexate

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59
Q

MOA: Binds tubulin, disrupting the cellular cytoskeleton

A

Podophyllin

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60
Q

MOA: Cytotoxic - promotes phospholipid turnover

and modulates membrane signal transduction by inhibition of protein kinase c

A

Miltefosine

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61
Q

Indications: 5-fluorouracil

A

Actinic keratoses

Superficial basal cell carcinomas

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62
Q

Indications: Mechlorethamine (nitrogen mustard)

A

Mycosis fungoides Stages IA, IB

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63
Q

Indications: Carmustine

A

Mycosis fungoides Stages IA, IB

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64
Q

Indications: Vinblastine

A

Kaposi sarcoma

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65
Q

Indications: Bleomycin

A

Viral warts
Hemangiomas
Keloids
Hypertrophic scars

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66
Q

Indications: Methotrexate

A

Keratoacanthoma

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67
Q

Indications: Podophyllin

A

Anogenital warts

Facial angiofibromas

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68
Q

Indications: Miltefosine

A

Cutaneous metastases of breast cancer
Cutaneous lymphomas
Cutaneous mastocytosis

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69
Q

Indications: Tacrolimus and Pimecrolimus

A

Second-line therapy for atopic dermatitis
Children older than 2 years
Adults
Short-term, noncontinuous chronic therapy

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70
Q

Indications: Imiquimod

A 
External anogenital warts
Actinic keratosis
Superficial BCC smaller than 2 cm on trunk, neck, extremities
Immunocompetent adults
When surgical options less appropriate
Biopsy confirmed
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71
Q

Contraindications: Tacrolimus and Pimecrolimus

A

Immunocompromised
Netherton syndrome
Active bacterial or viral infection
Phototherapy

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72
Q

Contraindications: Imiquimod

A

Immunocompromised

Refractory, thicker, actinic keratoses

73
Q

Dosing of Imiquimod for Anogenital warts

A

3x/week

Max: 16 weeks

74
Q

Dosing of Imiquimod for Actinic keratosis

A

2x/week for 16 weeks

75
Q

Dosing of Imiquimod for Superficial BCC

A

5/week for 6 weeks

76
Q

Complications: Tacrolimus and Pimecrolimus

A

Elevated blood levels and risk of systemic immuno- suppression
Unclear long-term risk of lymphoproliferative disease
Unclear long-term malignancy risk
Eczema herpeticum

77
Q

Complications: Imiquimod

A

Irritant contact dermatitis
Ulceration
Incomplete treatment of malignancy

78
Q

Bisbiguanide which (1) binds to negatively charged bacterial cell wall and cytoplasmic components leading to altered osmotic equilibrium and (2) precipitation of cytoplasmic components; for gram-positive, gram- negative bacteria, enveloped viruses, and fungi; can cause keratitis, ototoxicity; used for antiseptic surgical hand B scrub and surgical site preparation

A

Chlorhexidine

79
Q

Dye with unknown MOA; for some vegetative gram- positive bacteria and yeast; can cause potential skin necrosis at high concentrations or when occluded, stains skin and clothing, tattooing when applied over granulation tissue and mutagenic; used for impetiginized eczema, mycotic skin infections, oral candidiasis and superficial skin infections

A

Gentian violet

80
Q

Dye with unknown MOA; for some vegetative gram- positive bacteria and yeast; can cause potential skin necrosis and stains skin and clothing; used for impetiginized eczema, mycotic skin infections, oral candidiasis and superficial skin infections

A

Brilliant green

81
Q

Peroxide which oxidizes microbial molecules and is a broad spectrum antimicrobial; can cause bleaching of hair; used for cleansing of wounds, suppurating ulcers, and local infections

A

Hydrogen peroxide

82
Q

Iodophor which oxidizes and releases of free iodine; for gram-positive, gram-negative, enveloped viruses, fungi, sporicidal, Mycobacterium tuberculosis; can cause potential systemic toxicity in neonates or when applied to large body surface area, neutralized by blood, serum proteins, and sputum; used as antiseptic surgical hand c scrub, prevention or treatment of topical site
infection associated with surgery, burns, minor cuts/ scrapes

A

Povidone-iodine

83
Q

Iodophor which oxidizes and releases free iodine, chelates bacterial surface and trace metals needed for bacterial growth; for gram-positive, gram-negative, enveloped viruses, fungi, sporicidal, M. tuberculosis; may have possible irreversible optic atrophy and peripheral neuropathy (oral), contraindicated in children <2 years of age, contraindicated for diaper rash, stains skin yellow and neutralized by blood, serum proteins, and sputum; approved for fungal — infections; also used for pyoderma, folliculitis, and impetigo

A

Clioquinol

84
Q

Imidazole which acts by creation of reduced intermediate compounds and free radicals on anaerobes, protozoa, and microaerophilic bacteria used in Rosacea; contraindicated during 1st trimester of pregnancy

A

Metronidazole

85
Q

A fermentation product of Pseudomonas fluorescens which acts by inhibiting bacterial isoleucyl-t- RnA synthetase on gram-positive, some gram-negative, but spares normal flora; used in non-bullous impetigo, B eradication of nasal carriage of S. aureus; potentially toxic amounts of polyethylene glycol contained in vehicle may be absorbed in patients with extensive burns or open wounds

A

Mupirocin

86
Q

Pleuromatilin which acts by inhibits 50S subunit of prokaryotic ribosome on Gram + bacteria; used in nonbullous impetigo

A

Retapamulin

87
Q

Dicarboxylic acid which acts by inhibition of microbial respiratory chain of Propionibacterium acnes and S. epdermidis; used in Acne; may cause hypo pigmentation

A

Azaleic acid

88
Q

Peroxide which oxidizes microbial molecules; used in Acne; bleaches dark clothing

A

Benzoyl peroxide

89
Q

Astringent which acts by coagulation of proteins used for weeping, impetiginized skin disorders; should not be used under impervious material to prevent evaporation

A

Aluminum salts

90
Q

Astringent which acts by oxidation microbial molecules used for weeping, impetiginized skin disorders; can cause skin discoloration and caustic at high concentrations or with contact of undissolved crystals

A

Potassium permanganate

91
Q

Astringent which acts by precipitation of bacterial proteins by free silver ions used for eeping, impetiginized skin disorders, cauterization
of wounds, removal of granulation tissue and aseptic prophylaxis of burns; can cause black skin discoloration, caustic at high concentrations and potential methemoglobinemia

A

Silver nitrate

92
Q

Agents that cause contraction of the tissues, arrest of secretion, or control of bleeding or a drug product that is applied to the skin or mucous membranes for a local and limited protein coagulant effect

A

Astringent

93
Q

Synthetic pyrethroid which inhibits nerve cell sodium ion influx used in lice and scabies and used on clothing as an insect repellant; may cause itching and stinging
on application and contraindicated for infants <2 months of age

A

Permethrin (1% or 5%)

94
Q

Natural botanical which inhibit nerve
cell sodium ion influx or inhibits cytochrome P450; used for lice; can cause itching and stinging on application and ragweed or chrysanthemum allergy

A

Synergized pyrethrins

95
Q

Organophosphate which is a cholinesterase inhibitor used in lice; flammable; not approved for children <6 years of age

A

Malathion (0.5%)

96
Q

Crotonyl-N-ethyl- O-toluidine with unknown MOA; used in Scabies

A

Crotamiton (10%)

97
Q

Organochlorine which is a cholinesterase inhibitor used in lice and scabies; may cause seizures, muscle spasms, aplastic anemia; not for use in children <3 years, pregnant or breastfeeding women, patients with underlying neurologic disorders, or over broken skin

A

Lindane (1%)

98
Q

Fermentation product which acts by generalized central nervous system excitation leading to paralysis in lice

A

Spinosad (0.9%)

99
Q

Topical antipruritic has local anesthesia and histamine antagonism

A

Diphenhydramine

100
Q

Tricyclic antidepressant with antipruritic effects through histamine antagonism, interference with neuronal synaptic communication; decreased awareness through production of drowsiness

A

Doxepin

101
Q

Cyclic terpene alcohol which acts as a counter-irritant; cooling sensation may be the result of a direct interaction of menthol with cold receptors and/or nerve fiber

A

Menthol

102
Q

In low concentrations (0.5% to 2.0%) acts as an antipruritic agent through its anesthetic effect; percutaneously absorbed and should be avoided in pregnant women and infants. In higher concentrations, it is caustic and is used for deep chemical peels

A

Phenol

103
Q

Effective in cases of mild to moderate pruritus; inhibits conduction of nerve impulses by altering the cell membrane permeability to ions; onset of action: 2-5 minutes

A

Pramoxine Hydrochloride

104
Q

A vitamin D analog which inhibits epidermal proliferation, induces epidermal differentiation, and exerts anti-inflammatory effects

A

Calcipotriol

105
Q

Keratolytic (available at concentrations up to 12%); increases ceramide production by keratinocytes improving water barrier function

A

Lactic acid

106
Q

Humectant that is proteolytic at high concentrations; added to some topical glucocorticoid preparations to increase penetration; used for dry skin and nail plate destruction

A

Urea

107
Q

In concentrations of 3% to 6%, it causes shedding of scales by softening the stratum corneum, dissolving the intracellular matrix, and loosening connections between corneocytes. In concentrations > 6%, it is destructive to tissue.

A

Salicylic acid

108
Q

Humectant, occlusive, and keratolytic agent, often combined with other medications to enhance their penetration used in patients with lamellar ichthyosis and n various other hyperkeratotic diseases

A

Propylene glycol

109
Q

Reduce the thickness of hyperkeratotic stratum corneum by an incompletely understood mechanism wherein the acids may directly solubilize the protein components of desmosomes or activate endogenous hydrolytic enzymes by changing the pH of the stratum corneum, resulting in keratolysis

A

A-Hydroxy acids

110
Q

UVB filter most commonly used PABA derivative and is photounstable

A

Padimate O

111
Q

Cinnamate most widely used UVB filter and is photounstable; rarely a photoallergen

A

Octinoxate

112
Q

Weak UVB absorbers which improves photostability of other filters

A

Octisalate

113
Q

Weak UVB absorbers. good substantivity: used in water-resistant sunscreens and hair-care products

A

Trolamine salicylate

114
Q

Photostable UVB filter and improves photostability of photolabile filters

A

Octocrylene

115
Q

Water soluble UVB filter and enhances sun protection factor of the final product

A

Ensulizole

116
Q

Most commonly used UVA filter; most common cause of photoallergic contact dermatitis to UV filters

A

Oxybenzone

117
Q

A weak UVA filter with no sensitization reaction reported.

A

Meradimate

118
Q

Photounstable UVA1 filter which enhances the photodegradation of octinoxate

A

Avobenzone

119
Q

Factors affecting sun protection of garments

A 
Style of garment
Number of layers
Fabric thickness
Type of fibers (polyester > wool, silk, nylon > cotton, rayon)
Stretching
Laundering
Wetness
Chemical treatments
120
Q

Ratio of the minimal erythema dose (MED) of a subject’s sunscreen-protected skin over the MED of the unprotected skin

A

Sun protection factor (SPF)

121
Q

Most widely used method to evaluate protection against UVA

A

Persistent pigment darkening (PPD)

122
Q

Quantifies the ability of the sunscreen to prevent immunosuppression

A

Immune Protection Factor (IPF)

123
Q

Narrowband UVB by MED

A 
1-cm2 areas on the lower back or inner aspect of the forearm:
200, 400, 600, 800, 1,000, 1,200 mJ/cm2
read at 24 h
initial: 50-70% of MED
2–5 times per week
Increase by 10%–20%
124
Q

Narrowband UVB by Fitzpatrick Skin Phototype

A 
I - 130 - 2,000
II - 220 - 2,000
III - 260 - 3,000
IV - 330 - 3,000
V - 350 - 5,000
VI - 400 - 5,000
125
Q

Broadband UVB by MED

A

1-cm2 areas on the lower back or inner aspect of the forearm:
20, 40, 60, 80, 100, 120 mJ/cm2
read at 24 h
initial: 50-70% of MED
2–5 times per week
Increase by 25% x 10 treatments then 10% thereafter

126
Q

Broadband UVB by Fitzpatrick Skin Phototype

A 
I - 20
II - 25
III - 30
IV - 40
V - 50
VI - 60
127
Q

Oral PUVA by MPD

A

1-cm2 areas on the lower back or inner aspect of the forearm:
0.5, 1.0, 2.0, 3.0, 4.0, 5.0 mJ/cm2 UVA
read 72 h after UVA
initial: 50-70% of MPD
2-4 times per week
Increase UVA dose per table entries each week

128
Q

Oral Psoralen dose

A

8-MOP micronized 0.6 mg/kg; 120 minutes before UVA 8-MOP dissolved 0.4-0.6 mg/kg; 90 minutes before UVA

129
Q

Oral PUVA by Fitzpatrick Skin Phototype

A 
I - 0.5 - 0.5
II - 1.0 - 0.5
III - 1.5 - 1.0
IV - 2.0 - 1.0
V - 2.5 - 1.5
VI - 3.0 - 1.5
130
Q

Bath Psoralan dose

A

8-MOP dissolved in bath water for a final concentration of 1.0 mg/l
Bath water is at body temperature (98.6°F)
Duration of bath is 15–20 minutes

131
Q

Modification of Phototherapy Dose: No erythema

A

Increase by 25%

132
Q

Modification of Phototherapy Dose: Erythema with no pain

A

No increase

133
Q

Modification of Phototherapy Dose: Erythema with pain

A

Hold treatment until symptoms subside

134
Q

Modification of Phototherapy Dose: Erythema with pain and blistering

A

Hold treatment until symptoms subside and then reduce dose by 50% from last dose

135
Q

Modification of Phototherapy Dose: Missed <1 week

A

No increase in dose

136
Q

Modification of Phototherapy Dose: Missed 1–2 weeks

A

Decrease dose by 50% (BB-UVB) or 25% (NB-UVB or PUVA)

137
Q

Modification of Phototherapy Dose: Missed 2–3 weeks

A

Decrease dose by 75% (BB-UVB) or 50% (NB-UVB PUVA)

138
Q

Modification of Phototherapy Dose: Missed >3 weeks

A

Restart at initial exposure dose

139
Q

Diseases amenable to UVA1

A 
Atopic dermatitis
Cutaneous T-cell lymphoma
Localized and systemic scleroderma
Chronic GVHD
Lymphomatoid Papulosis
Telangiectasis macularis eruptiva Perstans
Urticaria pigmentosa
Granuloma annulare
Chronic hand eczema
140
Q

Phototherapy-Responsive Diseases for therapy

A 
Psoriasis
Palmoplantar pustulosis 
Mycosis fungoides (stages IA, IB)
Vitiligo
Atopic dermatitis 
Generalized lichen planus 
Urticaria pigmentosa 
Cutaneous graft-versus-host disease
Generalized granuloma annulare
Pityriasis lichenoides
Lymphomatoid papulosis
Pityriasis rubra pilaris
Localized scleroderma
141
Q

Phototherapy-Responsive Diseases for prevention

A 
Polymorphous light eruption
Hydroa vacciniformea 
Solar urticaria 
Erythropoietic protoporphyria
Chronic actinic dermatitis
142
Q

Indications for Photopheresis (with sufficient evidence)

A

Erythrodermic cutaneous T-cell lymphoma
Chronic graft-versus-host disease
Acute graft-versus-host disease
Organ transplant rejection

143
Q

Indications for Photodynamic Therapy - Oncologic

A

Actinic keratosis
Bowen disease
Superficial BCC

Off label:
Actinic Cheilitis
Nevoid BCC syndrome
Keratoacanthoma 
Superficial SCC
Kaposi sarcoma
Cutaneous metastases
Cutaneous T-cell lymphoma
144
Q 
308 nm
Excited dimer molecules (Xe-Cl)
Different gases
Gas
Pulsed μs–ms
A

Excimer laser

145
Q 
532 nm
Nd
Crystal: Yttrium- aluminum Garnet (Y3Al5O12)
Solid state
Pulsed μs–ms
A

“KTP” laser (Nd:YAG laser) frequency doubled with KTP crystal

146
Q 
585–600 nm
Dyes (e.g., Rhodamines)
Organic solvents
Liquid
Pulsed ms
A

Dye laser

147
Q 
694 nm
Cr
Al2O3
Solid state
Pulsed μs–ms
A

Ruby laser

148
Q 
755 nm
Cr
Chrysoberyl (BeAl2O4)
Solid state
Pulsed μs–ms
A

Alexandrite laser

149
Q 
Different wavelengths (e.g. 810, 940)
InGaAs, AlGaAs
Semiconductor material
Solid state
Pulsed μs–ms
A

Diode laser

150
Q 
1,064 nm
Nd
Crystal: Yttrium-aluminum Garnet (Y3Al5O12)
Solid state
Cw, Pulsed μs–ms
A

Nd:YAG laser

151
Q 
2,940 nm
Er
Crystal: Yttrium-aluminum Garnet (Y3Al5O12)
Solid state
Pulsed ms
A

Er:YAG laser

152
Q 
10,600 nm
CO2
Different gases
Gas
Cw, Pulsed ms
A

CO2 laser

153
Q

Power × Time

W x s

A

Energy (J)

154
Q

Power / Area

W / cm2

A

Intensity

155
Q

Power x Time / Area

A

Radiant exposure (“Fluence”)

156
Q

Target - DNA, proteins
Effect - Photochemical reactions
Application - Comparable to narrow band UVB 311nm

A

Excimer (XeCl) (308)

157
Q

Target - Vascular lesions; Tissue
Effect - Semiselective coagulation; Coagulation
Application - Telangiectases, spider nevi, venous lakes;
Syringoma, xanthelasma, epidermal nevi

A

Argon (488/514)

158
Q

Target - Vascular lesion
Effect - Selective coagulation (“KTP” laser)
Application - Telangiectases, spider nevi, venous lakes

A

Frequency-doubled Nd:YAG (532)

159
Q

Target - Pigmented lesions
Effect - Selective and fast heating Nd:YAG (explosion)
Application - Benign melanin-containing lesions, tattoos (red)

A

Frequency-doubled Nd:YAG (532)

160
Q

Target - Vascular lesions; Tissue
Effect - Selective Coagulation
Application - PWS, telangiectases, rosacea, spider nevi; Scars, keloids, warts, photoaging

A

Flashlamp pulsed dye (585–600)

161
Q

Target - Pigmented lesions
Effect - Selective and fast heating (explosion)
Application - Benign melanin-containing lesions, tattoos (black, blue, green)

A

Ruby (694)

162
Q

Target - Vascular lesions; Tissue; Pigmented lesions
Effect - Selective coagulation; Selective and fast heating (explosion)
Application - large vessels (leg veins, hypertrophic PWS) Hair removal; Benign melanin-containing lesions, tattoos (black, blue, green)

A

Alexandrite (755)

163
Q

Target - Vascular lesions; Tissue
Effect - Selective coagulation
Application - large vessels (leg veins, hypertrophic PWS); Hair removal

A

Diode (810)

164
Q

Target - Vascular lesions, Tissue, Pigmented lesions
Effect - Unspecific coagulation, Selective coagulation, Selective and fast heating (explosion)
Application - Vascular malformations, tumors; Large vessels (leg veins, hypertrophic PWS), Hair removal; Benign melanin-containing lesions, tattoos (black, blue, green)

A

Nd:YAG (1,064)

165
Q

Target - Tissue
Effect - Selective coagulation (nonablative)
Application - Skin remodeling, photoaging

A

Diode (1,450)

166
Q

Target - Tissue
Effect - Selective and fast heating (ablation)
Application - Skin resurfacing, epidermal ablation

A

Er:YAG (2,960)

167
Q

Target - Tissue
Effect - Unspecific coagulation (vaporization); Selective and fast heating (ablation)
Application - Vaporization of tissue; Skin resurfacing, epidermal ablation

A

CO2 (10,600)

168
Q

Refers to the delivery of specified radiation dose in temporally separate treatments

A

Fractionation

169
Q

A phenomenon describing a cutaneous reaction in the area of previous radiation exposure, in response to specific systemic agents

A

Radiation recall

170
Q

Faint erythema

Dry desquamation

A

Radiation Dermatitis Grade 1

171
Q

Moderate-to-brisk erythema
Patchy moist dequamation (mostly confined to skin folds and creases)
Moderate edema

A

Radiation Dermatitis Grade 2

172
Q

Moist desquamation (other than skin folds and creases) Bleeding induced by minor trauma or abrasion

A

Radiation Dermatitis Grade 3

173
Q

Skin necrosis
Ulceration of full thickness of dermis
Spontaneous bleeding

A

Radiation Dermatitis Grade 4

174
Q

Death

A

Radiation Dermatitis Grade 5

175
Q

Delivers 20% less energy to melanin and proportionally more to oxyhemoglobin thus, reducing the epidermal damage, especially for dark skin. The epidermis is further protected by cooling during the procedure. The spot size can be varied from 5–12.5 mm and makes possible the rapid treatment of larger areas.

A

Alexandrite Laser (755 nm)

176
Q

At this wavelength, the energy is well absorbed in the follicle but less absorbed by competing chromophores like oxyhemoglobin or water. In addition, a penetration depth of 3 mm can be reached. The laser light is scarcely absorbed by the epidermis, making the device well suited to dark skin. The long impulse duration (up to 50 ms) and high fluences make epidermal cooling mandatory.

A

Diode Laser (800/810 nm)

177
Q

This laser penetrates very deep (5-7 mm), so that even deep-lying follicles receive enough energy for epilation. There is also very little epidermis absorption, making the device well suited for dark skin. Surface cooling is essential to reduce pain and side effects. This has the fewest side effects but is most painful.

A

Pulsed Nd: YAG Laser (1,064 nm)

178
Q

These sources have a broad emission spectrum extending into the near infrared region, which allows for excellent depth of penetration and have the largest spot sizes (around 5 cm2) of all the photoepilation units, which make rapid treatment possible. In the epilation mode, a cut-off filter at 600 nm is usually employed in order to filter out shorter wavelengths destined to be absorbed in the epidermis. The impulse durations are 0.5–25 ms, while 20 ms is usually chosen. A cooling gel is used to improve the coupling of light into the skin, cool the epidermis, and reduce pain. This is a method well suited for all skin types and with few complications.

A

High-energy Flashlamps (590–1,200 nm).

Dermatology (26 decks)

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