Skin Flashcards
Atopic Dermatitis (Eczema)
form of allergic dermatitis
pruritic chronic inflammatory condition
pathogenesis of atopic dermatitis
involves genetic factors, skin barrier defects, and immune dysregulation
treatments for contact dermatitis
topical corticosteroids
systemic corticosteroids
topical immunosuppressives
antihistamines
dosage of topical corticosteroids for contact dermatitis
short term therapy with more potent steroids is preferable to long term therapy with less potent
how do you enhance the penetrance of topical corticosteroids
hydrate the skin
prolonged use of topical corticosteroids on the face
atrophy and acne-like eruptions
prolonged use of topical corticosteroids in the elderly
ecchymosis on arms and legs
prolonged use of topical corticosteroids: epidermal atrophy manifestations
striae
shiny, thin skin
telangiectases
when would you use systemic corticosteroids for contact dermatitis
if it is widespread or resistant to treatment
contraindications to systemic corticosteroids
systemic mycoses
patients receiving a vaccination
when would you use topical immunosuppressives for contact dermatitis
mod-severe atopic dermatitis that cannot tolerate topical steroids, not responsive to other treatments, or there is concern for topical steroid-induced atrophy
available topical immunosuppressives
Tacrolimus
Pimecrolimus
contraindications to topical immunosuppressives
Do not use under occlusive dressings
1st line therapy for contact dermatitis
topical corticosteroid low-intermediate potency applied BID
low potency are used on the face
oral antihistamines relieve itching
2nd line therapy for contact dermatitis
more potent topical steroids or topical immunosuppressives
3rd line therapy for contact dermatitis
systemic corticosteroids
topical steroids in pediatrics
should only be used for 7 days in children <6 and at the lowest potency
tinea capitis presentations
inflamed scaly alopecia patches (especially in infants)
tender pustular nodules
“gray patch” white scaly plaques with hair broken off clos to skin
tinea corporis
ringworm
affects face, limbs, trunk
tinea cruris
jock itch
infection of groin and inguinal folds
often accompanying infection of feet
tinea pedis
athletes foot
tinea manus
dermatophyte infection of the hand
tinea unguium
fungal infection of the nail
also called onychomycosis
treatment modalities for fungal infections
topical and systemic azoles
topical and systemic allylamine antifungals
griseofulvin
topical azole antifungals
effective against tinea corporis, tinea cruris, and tinea pedis as well as cutaneous candidiasis
apply 1-2xs daily for 2-4wks
continue use for 1 week after lesions clear
contraindications to topical azole antifungals
not recommended during pregnancy/lactation
caution with hepatocellular failure
avoid ketoconazole with sulfite sensitivity
Topical agents for tineas
effective for most but not tinea capitis or tinea unguium
1st line therapy for fungal infections
topical therapy for tinea corporis, pedis, cruris, manus when lesions affect a specific area
tinea capitis is griseofulvin admin with milk or food
tinea unguium (onychomycosis) is systemic therapy with itraconazole
2nd line therapy for tinea corporis, pedis, cruris, manus
if failure to respond to therapy, multiple lesions, or area is repeatedly shaved
terbinafine or fluconazole
2nd line therapy for tinea capitis
itraconazole, terbinafine, or fluconazole
tinea versicolor
superficial yeast infection that typically chronic and characterized by well demarcated scaling patches of varied color
therapy for tinea versicolor
1st line: topical selenium sulfide with a topical antifungal (terbinafine, ketoconazole, or sulconazole)
2nd line: systemic itraconazole
1st line tx for candidiasis
cutaneous cool wet soaks with Burow solution
keep areas dry by powdering or keeping OTA
can apply AF cream 1-2x daily x 10days
2nd line therapy for candidiasis
systemic itraconazole for adults only
follow up for fungal infections
Reassess in 2 weeks
for chronic systemic therapy monitor monthly to check liver function
treatment of herpes varicella (chicken pox)
systemic therapy only recommended for complicated cases
when should you treat for herpes zoster
if the rash has been present fewer than 72 hours or if new lesions are still developing
topical antiviral agents for herpes infections
Acyclovir (q3h, 6x/day x7 days)
Penciclovir (q2h while awake x4d)
systemic antiviral therapy is not recommended for who
healthy children <12
contraindications for systemic antiviral therapy
renal disease
CHF
lactation
disadvantage of oral acyclovir
reduced bioavailability of only 10-20%
1st line therapy herpes type 1 (face/skin above waist)
topical acyclovir or penciclovir
warts are caused by what
HPV
1st line therapy for filiform or flat warts
removed by dermatologist
1st line therapy for common warts
17% salicyclic acid at hs x8wks
1st line therapy for plantar warts
40% salicyclic acid at hs x8weeks or until wart is gone
on for 24-48 h then rub with pumice stone
initiating drug therapy for cutaneous HPV infection
aggressive therapy typically not needed unless there is report of pain as they will often spontaneously resolve in a few months-years
contraindications for topical treatment of cutaneous HPV infection
DM, impaired circulation, on moles, birthmarks, or unusual warts with hair growth
impetigo
highly contagious bacterial skin infection frequently on face, scalp, extremities
macules that develop into vesicles/pustules that ooze purulent liquid that, once dried, has a characteristic honey-colored crust
bullous impetigo
superficial, flaccid bullae on the skin
brownish gray lesions sometimes are crusted or have an erythematous halo
Ecthyma
impetigo that worsens and spreads deeply into the dermis
usually affects debilitated and the elderly
lesions are usually painful and may persist for weeks to months
what do red streaks signify in cellulitis
lymphatic spread or lymphangitis
erysipelas
cellulitis in the superficial layers of skin
most common in children (especially infants) and the elderly
pustular bacterial infections
folliculitis furuncle carbuncle paronychia felon
folliculitis
superficial infection of the hair follicle
erythematous papules that turn into small pustules in approx 48h
furuncle
painful pus-filled nodule that circles a follicle (develops from folliculitis)
carbuncle
confluence of several furuncles that forms deep within the dermis
frequently accompanied by systemic s/s such as fever, malaise, and HA
paronychia
infection of the tissue surrounding the nail bed
felon
infection that involves the pulp space in the tip of a digit
necrotizing fascitis
typically appears like cellulitis but there is severe pain, edema, and erythema
subQ tissue has a wood hard feel
typically accompanied by high fever
drainage usually present that looks like dishwater pus
severely ill requiring intensive care and tx by specialists
1st line therapy impetigo and ecthyma
minor impetigo can be tx with topical mupirocin for 7-10 days
bullous impetigo usually an oral broad-spectrum PCN (Augmentin or dicloxacillin) or 1st gen cephalosporin (Keflex)
Clindamycin is a good alternative for PCN allergy
Ecthyma needs oral agents such as dicloxacillin or keflx
2nd line therapy for impetigo and ecthyma
severe cases of ecthyma may need IV nafcillin
1st line treatment of cellulitis
systemic tx is always needed
see p.191
secondary infections with carbunculosis
osteomyelitis and endocarditis are risks therefore systemic abt are always given after lesions are drained
