Test 3 Flashcards
Rosacea pop
30-50, female
rosacea cause
Demodex mite may play a role
terrain, genetics, poor digestion, toxic bowels
rosacea sx
- mainly central face
- rhinophyma (M)
- erythema
- telangiectasia
- papulopustular, nodules, no comedones
rosacea associated conditions
- 3x migraines
- iritis
- scleritis
- keratitis
- chalazia
- blepharoconjunctivitis
rosacea TX
topical metronidazole: palliative
azelaic acid
benzoyl peroxide/clindamycin
oral antibiotics
sodium sulfacetamide
topical permethrin
Oral isotretinoin (Accutane)
low-dose doxycycline
topical tretinoin
anti-inflammatory diet
digestive enzymes, probiotics
acupuncture
homeopathy
Perioral Dermatitis pop
16-45, women
Perioral Dermatitis cause
unknown, aggravation by fluoride and sodium lauryl sulfate
terrain
Perioral Dermatitis sx
papulopustular on erythematous base
occasional itching, burning, or feeling of tightness
Perioral Dermatitis TX
topical-metronidazole, erythromycin, avoid topical glucocorticoids
Systemic- minocycline, doxycycline, tetracycline
avoid toothpaste with fluoride and sodium lauryl sulfate
anti-inflammatory/elimination diet
sauna, fasting
Botanical (Topicals): azelaic acid, green tea, tea tree oil, Calendula succus
Botanical (Internal): Silymarin, Berberine (barbarry, coptis, oregon grape, goldenseal), Chaseberry, Indian Gooseberry
Physical medicine: sun (start with 5 minutes a day), hot/cold contrast bath with green tea, calendula
Supplements to consider zinc/copper, chromium, selenium, omega 3 fatty acids, vitamin D
Hidradenitis suppurativa RF
Obesity
Female sex
Smoking
Acne vulgaris
Inflammatory bowel disease
Low zinc level
SAD
Hidradenitis suppurativa SX
Painful, papules and deep-seated nodules
open comedones with 2 or more openings to the surface in intertriginous areas
tender lesion in axillary, inguinal, intermammary and/or anogenital region
symmetrical
early Hidradenitis suppurativa symptoms
- erythema
- burning
- itching
- discomfort
- hyperhidrosis
mild hidradenitis suppurativa sx
- solitary nodule
- minimal pain
- no abscess
moderate hidradenitis suppurativa sx
- multiple recurrent nodules
- pain affecting activities of daily living
- discharge or drainage
- abscess formation
severe hidradenitis suppurativa sx
- diffuse abscess formation
- chronic draining sinus tracts
- chronic inflammation and scarring
hidradenitis suppurativa test
consider-bacterial culture
biopsy
hidradenitis suppurativa standard of care
tralesional injections of triamcinolone
Incise and drain acute abscesses
Oral antibiotics
Prednisone
Oral isotretinoin (Accutane)
mild/moderate hidradenitis suppurativa TX
- Topical/oral antibiotic
- Consider surgical drainage
- Lifestyle change (Acne protocol)
severe hidradenitis suppurativa TX
- topical/oral antibiotic
- Consider dapsone and/or prednsone
- Referral for surgical consult
- Lifestyle change (Acne protocol)
hidradenitis suppurativa naturopathic tx
loose clothing
avoidance of heat, humidity, shaving, depilation, deodorants
warm compresses
elimination/anti-inflammatory diet
Detox: fasting, sauna, chelation
Botanical (Topicals): azelaic acid, green tea, tea tree oil, Calendula succus
Botanical (Internal): Silymarin, Berberine, Chaseberry, Indian Gooseberry
Physical medicine: sun (start with 5 minutes a day), hot/cold contrast bath with green tea, calendula
Supplements: zinc/copper, chromium, selenium, omega 3 fatty acids, vitamin D
Contact Irritant Dermatitis cause
- Related to irritant exposure; anyone would have a similar reaction
- lime
- lip licking
- oven cleaner
- diesel mechanic chemicals
- diaper
Contact Irritant Dermatitis RF
Strong skin irritant (acid, alkali, phenol)
Cumulative exposure degreasing protective lipid barrier on skin (i.e. dish pan hands)
White skin
History of Atopic Dermatitis
Occlusion (i.e. wet boots)
Mechanical irritant (i.e. brick layer)
Contact Irritant Dermatitis sx
Burning and pain
Localized well-defined, redness, papules, swelling, blistering (vesicles/bullae)
Contact Irritant Dermatitis DX
Natural light-Magnifying glass (10-20X)
Check for infection, lymph nodes
Culture if you suspect bacteria, virus, etc
10% KOH to R/O fungus
Woods lamp
Examine whole body
“Patch testing”, allergies testing, biopsy
Contact Irritant Dermatitis prevention
Avoid irritant or caustic chemical(s) by wearing protective gear
If contact does occur, wash with water or weak neutralizing solution
Barrier creams
Contact Irritant Dermatitis TX
powder (“Country Comfort Baby Powder”), Ointments (Calendula, Comfrey, vitamin A&D)
use wet soaks containing tap water, saline, colloidal oatmeal
wet dressing using gauze soaked in Burrow’s solution
honey, olive oil and beeswax mixture
Topical Corticosteroids
5% urea cream
oral corticosteroids
Contact Allergic Dermatitis cause
- linalool
- Nickel sulfate(10-20%)
- Methylisothiazolinone
- Balsam of Peru
- Fragrance mix
- Thimerosal
- Sodium gold thiosulfate
- Formaldehyde
- Quaternium-15
- Cobalt chloride
- Bacitracin
- limonene
- poison oak or ivy
- chromium
- propolis
Type IV hypersensitivity
Contact Allergic Dermatitis SX
erythema, scaling, skin swelling, and sometimes blistering and ulceration
pruritus
burning pain
vesiculation to severe swelling with bullae
Contact Allergic Dermatitis DX
Natural light-Magnifying glass (10-20X)
Check for infection, lymph nodes
Culture if you suspect bacteria, virus, etc
10% KOH to R/O fungus
Woods lamp
Examine whole body
“Patch testing”, allergies testing, biopsy
Poison Ivy sx
- vesicles
- linear lesions
- bullae
Poison Ivy Tx
- Wash entire body with copious amounts of water
- Barrier creams (i.e. Stokogard, Ivy-block)
- Use Tecnu cleanser to remove urushiol
- Clothing, pets, etc need to be washed-wear vinyl gloves
- Cool compress-water, water/vinegar, saline
- topical or oral corticosteroid
- Antihistamine
- Trim fingernails
- Blow dryer-dries lesions, relieves itching
- Calendula lotion
- Calamine (zinc and ferric oxide)
- Burrow’s solution (aluminum acetate)
- Etoh, Comfrey, mugwort and sea salt
- Oatmeal (Aveeno), starch, or vinegar bath
- Aloe gel/green clay
- Stellaria, Plantago, Impatiens, Grindelia, Sambucus, Hamamelis, Echinacea, lemon
- Homeopathy, acupuncture and moxa
Atopic Dermatitis pop
children
Atopic Dermatitis cause
inflammation of dermis and epidermis caused by a combination of immune system activation, genetics, environmental triggers, and stress
Atopic Dermatitis Sx
pruritus
cubital fosa, popliteal fossa, face, chest, back of arms,
infantile Atopic Dermatitis
- face, scalp, extensor surface
- child 2 month- 2 years
- red, finely vesicular, oozing, crusted, extremely pruritic
- excoriation and secondary infections
Childhood Atopic Dermatitis
- 2-12 yo
- antecubital and popliteal fossae, post neck
- erythema, papules, scaling, lichenified, patches of hypopigmentation, hair loss
- develop allergic rhinitis and asthma
Adult Atopic Dermatitis
- extends to neck, upper chest, hands, feet
- marked drying resembling ichthycosis
- intense pruritus
- itch-scratch-rash cycle
- Dennie-morgan infraorbital fold, thinning lateral eyebrows
Atopic Dermatitis associated conditions
- Cataracts
- Chelitis
- conjunctivitis
- Facial pallor or erythema
- Food intolerance
- hand dermatitis
- Ichthyosis
- immediate skin test reactivity
- infections
- Infraorbital fold (Dennie-morgan lines)
- itching when sweating
- keratoconus
- keratosis pilaris
- nipple dermatitis
- orbital darkening
- Pityriasis alba
- White dermographism
- wool allergy
Atopic Dermatitis triggers
Temperature Change and Sweating
Decreased Humidity (worse in winter)
Excessive Washing- (esp with Soap)
Contact w/ Irritating Sub (wool, lanolin, smoke, etc.)
Contact Allergy- (consider patch testing)
Aeroallergens- (dust mites, pollen, animals, etc)
Microbic Agents- (staph aureus, Pityrosporum)
Food- (see diet)
Reduced cAMP (polyamines, lack of exercise)
Emotional Stress- (recommend mediation)
Atopic Dermatitis ND TX
- Bleach bath or bath
-phage topically - humidity in the house
- Light therapy
- oral Vit d
Diet - ant-inflammatory diet
- elimination diet: reduce eggs, peanuts, milk, fish, soy, and wheat
- fasting and vegetarian diet
Supplements/Herbs - omega-3
- Oolong tea
- Arctium Lappa
- Korean red ginseng
- Perilla leaf-
- St John’s wort
- Chinese herbs to clear heat/dry damp – Rhubarb, coptis, scute, phellodendron
- probiotics
- glutamine
Atopic Dermatitis TX
- Topical steroids
- oral steroids
- emollients
- antimicrobial
- topical clcineurin inhibitors
- cyclosporine
- azathioprine
-monoclonal antibody drug
Advantages of topical medications
- localized effect
- minimal systemic absorption
- avoids Gi and first-pass metabolism
Disadvantages of topical medication
- not an option for several compounds due to poor lipid solubility
- dosing is inaccurate
- formulation sensitives/localizes reactions
What effects the absorption of topical meds
- skin thickness at site of application
- total area of application
- frequency of application
- blood flow at the site of application
- chemical and physical properties of the drug and the vehicle
- warm, moist skin
Oral meds uses
- topical application is ineffective or unavailable
- systemic effects are desired
- topical application is impractical
Advantages of oral meds
- generally safe
- convenient
- economical
Disadvantages of oral meds
- some drugs have poor absorption
- systemic effects
- first-pass metabolism
- drug interactions
Advantages of Transdermal meds
- by pass first-pass metabolism
- convenient
- ideal for drugs that are lipophilic and have poor oral bioavailability
- ideal for drugs that are quickly eliminated from the body
Disadvantages of transdermal med
- localized dermal reactions
- has to be highly lipophilic
- may be delayed in delivery to the site of action
- limited to small dose
Corticosteroids MOA
suppression of eicosanoid synthesis by inhibition of phospholipase A2, suppression of immune cell activation and proliferation
Corticosteroids use
inflammatory lesions, including keloids, hemangiomas, acne cysts, stubborn psoriatic plaques, alopecia areata, etc.
acne
alopecia areata
atopic dermatitis
bites and stings
bullous pemphigoid
burns
route of administration of corticosteroids
topical
oral
intralesional
intranasal
AE of topical steroids
- atrophy, purpura
- telangiectasia
- facial eruptions
- hypopigmentation
- hypertrichosis
- withdrawal effects
- striae
- contact dermatitis
- worsening fungal infection
AE of oral steroids
- crushing’s syndrome
- adrenal suppression
- growth retardation in children
- increased intraocular pressure
- increased risk of nasal and pharyngeal Candida Infection
- the effects of long-term use on bone density and risk of fracture are not clear
Corticosteroids in pregnancy
high potency is associated with lower birth weight, considered safe during pregnancy and lactation, based on limited data
Which corticosteroid has the lowest potency?
hydrocortisone
what are the oral corticosteroid?
prednisone and prednisolone
Intralesional corticosteroid uses
keloids
hemangiomas
acne cysts
stubborn psoriatic plaques
alopecia areata
intralesional corticosteroid AE
atrophy
hypopigmentation
telangiectasia
sterile abscesses
Azaleic acid use
acne
rosacea
hyperpigmentation
Azaleic acid MOA
combined anti-inflammatory, anti-bacterial, and keratolytic effects, inhibition of tyrosinase
Calcineurin Inhibitors MOA
prevents activation of T cells don’t differentiate or become active
Calcineurin Inhibitors use
severe lichen planus, contact allergic dermatitis, dyshidrotic eczema, perioral dermatitis, psoriasis, pyoderma gangrenosum, and vitiligo
atopic dermatitis
severe psoriasis
Calcineurin Inhibitors risks
can lead to cancer for long term use
Calcineurin Inhibitors oral side effects
nephrotoxic
neurotoxic
Biologic DMARDs route of administration
injection
Biologic DMARDs MOA
block TNFa
Neosporin contains
bacitracin, neomycin, polymyxin B
Bacitracin MOA
cell wall synthesis inhibitor
Neomycin MOA
bacterial protein synthesis inhibitor
polymyxin B MOA
bacterial membrane disruptor
Mupirocin drug class
topical antibiotic
Mupirocin MOA
binds to tRNA and disrupts protein synthesis
Mupirocin use
MRSA
Impetigo
Benzoyl peroxide MOA
kills bacteria by creating reactive oxygen species
Benzoyl peroxide use
acne
Benzoyl peroxide route of administration
topical
Sulfacetamide MOA
inhibits folate synthesis
Sulfacetamide route of administration
topical
oral
Sulfacetamide Use
acne
seborrheic dermatitis
Erythromycin MOA
bind to bacterial ribosomes and inhibits protein synthesis
Erythromycin Route of Administration
topical
oral
Erythromycin use
acne
Erythromycin AE
significant GI upset
major inhibitor of CYP3A4
hepatotoxicity
arrhythmia
Clindamycin MOA
bind to bacterial ribosomes and inhibit protein synthesis
Clindamycin route of administration
topical
oral
Clindamycin use
acne
other infections
Clindamycin AE
C. difficile
Metronidazole MOA
binds to bacterial DNA preventing protein synthesis and inducing DNA breaks
Metronidazole Route of Administration
oral
topical
Metronidazole side effects
carcinogen
Metronidazole cautions
ethanol use can cause abdominal pain, nausea, vomiting, headache, flushing
Dapsone use
Acne
Bullous pemphigoid
Pemphigus vulgaris
Dermatitis herpetiformis
Lichen planus
Pustular psoriasis
Pyoderma gangrenosum
Dapsone route of administration
oral
topical
Diclofenac Sodium drug class
NSAIDs
Diclofenac Sodium use
actinic keratosis
Diclofenac Sodium Mode of Administration
gel
acne vulgaris pop
12-25
acne vulgaris pathophysiology
Outlet narrows due to proliferation and accumulation of keratinocytes and skin edema
Sebum (composed of lipids and cell fragments) builds up in blocked follicle
Cutibacterium acnes(formerly Propionibacteriumacnes) lives off sebum and proliferates in comedone
Inflammation of comedone results from leakage of sebum into the dermis and secretion of proinflammatory mediators, chemokines, and degradative enzymes by C. acnes
acne sx
papules or pustules or nodules or cysts red and central core
face, trunk, arms, back, upper chest, shoulders
acne tx ND
Diet: 100% grass fed pastured or wild meats, fish and eggs, vegetables, fruit, nuts, seeds, and tubers
Eliminate/reduce processed foods, diary, grain fed meat, chocolate, sunflower seeds, salt
Anti-inflammatory/elimination diet
Detox: fasting, sauna, chelation
Botanical (Topicals): azelaic acid, green tea, tea tree oil,
Calendula succus
Botanical (Internal): Berberine (barbarry, coptis, oregon grape, goldenseal), Chasteberry, Indian Gooseberry
Physical medicine: sun (start with 5 minutes a day), hot/cold contrast bath with green tea, calendula
Supplements to consider zinc/copper, chromium, selenium, omega 3 fatty acids, vitamin D
Acne Standard of Care
Seborrheic Dermatitis cause
Pityrosporum yeast (Malassezia), genetics, stress and dietary factors effect onset of disease
Pityosporum/Malassezia lipase activity releases inflammatory free fatty acids and activates the alternative complement pathway
Seborrheic Dermatitis pop
males>female (infancy, 20-50y.o.)
Seborrheic Dermatitis sx
The rash is red and scaly, except in skin folds, where it is red, smooth and glazed.
Sticky crusts and fissures are common when ear and scalp are involved. Dry or greasy scales.
Infantile (cradle cap) and adult forms (i.e. dandruff)
Scalp, eyebrows, eyelids, nasolabial fold, paranasal area, ears, sternum, inframammary fold, axilla, pubic area, gluteal and inguinal fold, and umbilicus
Seborrheic Dermatitis TX
Anti-inflammatory/elimination/detox diet
Zinc
B complex
niacin
biotin
EFA’s
Heliotherapy
Hydrotherapy, acupuncture, homeopathy, mediation
Topical
– Honey with water
- Shampoo: Biotin, selenium sulfide, zinc pyrithione, ketoconazole, tar, tea tree oil
- Gel: Aloe vera or metronidazole
- Cream: hydrocortisone, sulfur, pimecrolimus
- Eyelids: dilute baby shampoo on cotton swab
Pompholyx/ Dyshidrotic Eczema pop
female =male, 12-40
Pompholyx/ Dyshidrotic Eczema cause
Unknown etiology-possible association with stress, allergens, metals (Ni,Co,Cr)