Skin conditions Flashcards
T/F - Topical docosanol helps to cure herpes simplex.
False - it does not help CURE it, but it may help relieve pain and discomfort, or may help the sores heal faster
Which form of LICE is related to poor hygiene?
body lice
how is head lice transmitted/spread?
hair contact
bedding
furniture
common items: brushes, combs, hats, scarves
how is body lice transmitted/spread?
sexual contact (and it is occurs related to poor hygiene)
how is pubic lice transmitted/spread?
sexual contact with an infected partner
how to identify pubic lice?
puncture point (bite sites), lice are small, yellow-brown to gray dots.
can cause itching, burning, eye irritation
which type of lice is common in children?
head lice
Who requires prophylaxis treatment for head lice?
bedmates (ex. 2 children sharing the same bed, or spouse)
signs and symptoms of body lice
nocturnal pruritus, erythematous papules
When to refer a patient with lice?
- unresponsive or recurrent head lice.
- patient has contraindication or resistant to use of pediculicide
- children < 2 months
- evidence of bacterial infection (red, puss)
- excessive itching even after treatment (normal to be itchy for several weeks post-tx, but may need steroid cream or antihistamine)
Do close contacts of a person with head lice require prophylactic treatment?
no, unless they also have nits or head lice, or if they are bed mates
how can pubic lice affect eye lashes?
scratching then touching the eyes can spread the lice
how does head lice spread?
head to head contact. the lice can not fly.
patient Y comes to the pharmacy with head lice. they are afraid that their pet dog may also get it. patient Y is wondering if she should cut or shave her hair.
pets do not have head lice.
cutting or shaving hair is not the solution.
how long can head lice survive off the head?
4 days
nits = survive for 10 days off the head
Drug options for the treatment of lice?
- Chemical drugs = permethrin 1%, pyrethrine/piperonyl butoxide
- Physical drugs = dimeticone 50% (NYDA) or Isopropylmyristate/dimeticone (Resultz)
MoA of chemical drugs for treatment of lice?
neurotoxic to lice
Resistance may occur
which drugs are the 1st line of choice for lice? 2nd line?
1st line - permethrin 1%, pyrethrins/pip butoxide
2nd line - dimeticone 50% aka NYDA or isoprop/dimeticone aka Resultz (preferred in resistant cases since it does not cause resistance)
Which drug option is safe to use in children > 2 months?
chemical products - permethin 1% or pyrethrins/pip butoxide
Which drug option is to be avoided in children LESS THAN 2 YEARS?
physical products - resultz or nyda
if a patient has ragweed and/or chrysanthemum allergies and has difficulty breathing, which head lice product is recommended?
resultz or nyda
if a patient has ragweed and/or chrysanthemum allergies and has difficulty breathing, which head lice product is to be AVOIDED?
chemicals - permethrin 1% or pip butoxide/pyrethrins
headlice products safe for pregnancy?
chemical products can be used in pregnancy.
physical products have no safety data in pregnancy.
which head lice product is applied on dry hair?
physical - nyda/resultz
which head lice product is applied on wet hair?
chemical products - nix
MoA of pyrethrin/pip butoxid
chemical product
pyrethrin - natural insecticide, kills the lice. pip butoxide inhibits lice’s detoxifying enzymes
MoA of physical agents (nyda or resultz) for head lice treatment
Resultz: damages the skeletal system of lice, causes disruption to the wax layer of their skeleton, causing them to dehydrate and die due to loss of moisture.
NYDA: coats lice and eggs, suffocates them, disrupts their structure leading to death
Patient comes in the pharmacy with complaints of pubic lice. It has also affected his eyelashes. Which agents should you avoid recommending?
Permethrin and Pyrethrins/Piperonyl Butoxide - these chemical agents are typically used for lice on the scalp or body but should be avoided near the eyes due to their potential for severe eye irritation.
Recommended treatment for eyelash lice?
- Vaseline (petrolatum ointment) applying thick layers will suffocate the lice
- manual removal using fine-tipped tweezers or a nit comb, use after applying ointment
Symptoms of a Sunburn
redness
warm skin
swelling and painful
blistering in severe cases
desquamation (skin peeling) when healing
Who is at higher risk for sunburn?
fair skin
blue/green eyes
freckles burn more quickly
infants and children
tanning beds, sun lamps
sun exposure during peak hours
Red flag symptoms for Sunburn
severe sunburn
puss
oozing
fever
Tips to prevent sunburn
-hydration
-sunscreen
-sunglasses with 100%
-UV protection
-avoid peak hours (10am-4pm)
-umbrellas: reduce UV radiation, but don’t protect against reflected radiation
which foods can increase the risk of sun exposure?
alcohol
how much SPF does the environment provide?
forests: SPF 6-100
single trees: SPF 2-50
how often should sunscreen be reapplied?
every 2 hours, and after swimming or sweating
when should you first apply sunscreen?
15-30 mins before exposure to improve coverage and sun protection.
how much sunscreen should be applied?
2 mg/cm squared - to all surfaces exposed including lips, top of ears, top of feet.
do topical corticosteroids help with sunburn?
it does not reduce skin damage, but it can reduce redness by causing vasoconstriction
C comes to the pharmacy with an infant who is 3 months. She is asking for a recommendation for sunscreen. what would you recommend?
no sunscreen is safe for < 6 months.
recommend PHYSICAL BARRIERS = hat, clothing, zinc oxide or titanium dioxide-based sunscreens (cautiously use) to small areas. they sit on the skins surface and wont be absorbed.
For total body application, what form of sunscreen is preferrred?
lotion > gel or alcoholic lotion
for nose, cheeks and shoulders –> physical sunscreen recommended (with zinc)
what sunscreen ingredient is harmful to children’s skin?
PABA
-also avoid PABA in pts with allergies to sulfonamides/ester type anesthetics.
PABA (sunscreen ingredient) cautions
-avoid in children
-avoid in allergies to sulfonamides/ester type analgesics
-when exposed to sun, it can cause yellow stain on fabric
What does a higher SPF mean?
longer sunscreen effects
what is the recommended SPF on a cloudy day?
SPF 30 at minimum
Does SPF protect against UVB and UVA rays?
No, it protects only UVB.
Choose products that are labelled as “broad-spectrum” to know it protects against both.
T/F - spf multiplies with more applications
false.
however, reapplication is crucial after 2 hrs because it can wear off
For a patient that typically gets a sunburn in 10 minutes (without sunscreen applied), how long will SPF 30 protect him/her for?
Protection Time = SPF * Time to burn without protection
= 30*10 = 300 minutes = 5 hours
The person will begin to burn after 300 minutes of sun exposure if sunscreen is applied correctly (and re-applied when needed in between)
what does SPF 30 mean?
the sunscreen increases the time it takes for UVB rays to cause sunburn by 30 times
self-care measures to treat a sunburn?
cool colloidal oatmeal bath
wet compress (tap water or saline) for 20 min QID x 4-6 days
drink lots of fluids
can a person wear sunscreen after they get a sunburn?
yes
pharmacotherapy to treat sunburn
- calamine lotion or pramoxine 1%
- tylenol, or advil or indomethacin
- if open wound, cover with sterile gauze
- topical vitamin E
AVOID topical anesthetic sprays
what NOT to do after a sunburn
- Avoid systemic corticosteroids or topical anesthetic sprays (risk of sensitization).
- Avoid sun exposure for at least 1 week.
- Don’t continue to expose skin to sun. Instead, use broad-spectrum sunscreen (SPF 15–30).
- Do not unroof blisters; skin protects against infection.
goals of treatment for mouth conditions
improve symptoms
prevent transmission
prevent acquiring infection
symptoms of cold sores
- prodromal symptoms: mild burning, itching, single or group of blisters around the lips
- small vesicles filled with clear fluid, which eventually ruptures and crust over
-symptoms last for 3-10 days.
cause of cold sores
activation of latent herpes simplex virus type 1 (HSV-1)
when should treatment be started with antiviral medications for cold sores?
within < 72 hours of onset of symptoms
Are oral medications more effective than topical antivirals?
yes
How long do cold sores remain for?
7 to 14 days
When to refer if a patient presents with cold sores?
if redness, fever, or swollen glands,
if no improvement > 14 days, or if it occurs > 6 times per year
How to avoid spreading cold sores?
avoid touching, kissing.
apply topical products with a Qtip and not directly.
Use vaseline to prevent drying/cracking.
Use sunscreen with SPF30 to prevent cold sores in those who are triggered by sun exposure
Docasonal 10% efficacy and safety in cold sore use
not convenient - has to be used 5 times daily.
effective only on face.
-start within 12 hrs of onset.
-reduces the time taken to heal by only 0.75 hrs
-helps prevent HSV spread to healthy cells
How to relieve pain from cold sores?
ice cool compress
When would antiviral prophylaxis be useful in cold sores?
if patient experiences cold sores more than 6 times per year
What is a canker sore (aphthous ulcer)?
painful ulcer in the oral mucosa, inside lips, tongue and inside cheek.
lesions are 3-10 mm shallow, round with a white centre and red halo
persists for 7-14 days
cause of canker sores?
partially caused by streptococcus sanguis,
or an autoimmune mechanism (20%)
who is at risk for canker sores?
women 2x more likely than men.
-hereditary
who should be referred to a MD if they present with canker sores?
if no improvement, or persists > 14 days
if occurs > 6 times per year
worsens or skin becomes swollen
non-pharmacological treatment of canker sores
-avoid spicy food, chili pepper, citrusy drinks, hard/crunchy foods
-rinse mouth w/ salt water multiple times/day
Rx treatment for canker sores
- benzydamine mouth rinse- x 30 seconds TID to QID
- chlorhexidine (gingival hyperplasia)
- mucosal protectants (form a physical barrier over the sore to prevent irritation by food/drinks). Ex 1. carboxymethylcellulose like ORABASE PASTE
Ex. 2 - Oracort (topical steroid) - triamcinolone acetonide - has addition of anti-inflammatory effects to speed healing
OTC options for canker sores
- orajel (caution with mehemoglobinemia - symptoms are: pale, dizziness, SOB)
- topical anesthetics ex. benzocaine upto 20% - most common
For patients with recurrent canker sores, what type toothpaste should be avoided?
Toothpastes that contain SODIUM LAURYL SULFATE - its a foaming agent to create lather. It irritates the oral mucosa, stripping away protective mucin layer = worsens the sore
Look for toothpastes that are “gentle” or formulated for “sensitive mouths”
recommended treatment for cold sore
if it occurs > 5 times per year, oral > topical antiviral is recommended.
options: acyclovir, valacyclovir, famciclovir
dosing for antivirals in cold sores (herpes labialis)
acyclovir 400 mg 5 times per day x 5 days
Valacyclovir 2g BID for 1 day
Famciclovir 750 mg BID or 1500 mg as a single dose x 1 day
without treatment of cold sores, how long is the healing time on its own?
7-10 days
HSV prophylaxis/suppressive antiviral therapy is indicated for which group of patients?
recurrent oral herpes labialis > 6 episodes per year
