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Senior - Derm 1 > Treatments (1st-lines) > Flashcards

Treatments (1st-lines) Flashcards

1
Q

Chronic plaque psoriasis (a lot, nothing says “first line”, really)

A

Keralytic (salicylic acid) can be used prior to steroid to remove scale

< 5% BSA - topicals I or II, taper to triamcinolone as plaque thins. Topical vitamin D. Tazarotene (topical retinoid)

> 5% BSA - systemic - methotrexate, soriatane, cyclosporine, biologics, UVA)

Scalp? Keratolytic gel, tar shampoo, taclonex lotion if diffuse and thick

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2
Q

Guttate psoriasis

A

UVB 6-8 weeks = first line

Topicals impractical

Keep moist with emollients

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3
Q

Pustular psoriasis

A

Class I topical (clobetasol) - wean with improvement, consider plastic occlusion

NO ORAL STEROIDS

Emollients
Retinoid
Cyclosporine
Methotrexate

Nothing specifically “first-line”

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4
Q

Seborrheic dermatitis

A

OTC anti-dandruff shampoos

Topical steroids (avoid overuse)

Dicloxacillin for secondary infx

If severe - oral antifungals

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5
Q

Atopic derm

A

Topical triamcinolone for inflammation

Hydroxyzine for itching

Pimecrolimus cream

Tacrolimus ointment

No “first-line” listed

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6
Q

Acute eczema

A

Cold wet compress

PO or topical steroids

Antihistamine

ABX if secondarily infected

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7
Q

Subacute eczema

A

Topical steroids

Emollients after

Antihistamine

Abx if secondaru inx

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8
Q

Chronic eczema

A

Topical steroids with occlusion

No systemic steroids

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9
Q

Dyshidtrotic eczema (pomphyolyx)

A

Lifestylemods

  • avoid water and irritants
  • use emolents

Steroids for flares
Diet
PUVA
Methotrexate

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10
Q

Asteatotic eczema

A

Conservative, mild temp showers, mild soap, emollients

Short term III-IV topical steroids if necessary

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11
Q

Nummular eczema

A

Potent steroids for 4-6 weeks, group III

Correct dryness of skin and environment

Anti-pruritic as necessary

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12
Q

Lichen simplex chronicus (LSC)

A

Txt the underlying disorder, break the itch-scratch cycle (behavior mod)

If really thick may require intralesional steroids

Emollients for dryness

Antihistamines for the scratching

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13
Q

Pityriasis rosea (PR)

A

Most do not require txt

Group V and antihistamines

If severe: UVB, oral acyclovir

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14
Q

Lichen planus (LP)

A

Control itching with hydroxyzine

Local:
Group I or II with occlusion, intralesional steroid injection q3-4 weeks

Mucus membrane - steroids in an adhesive base (i.e. clobetasol)

Generalized:
PO steroids

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15
Q

Irritant dermatitis

A

Avoid the cause

Cool compress

Emollients

If severe, topical roids

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16
Q

Allergic contact derm:

A

Avoid the allergen

Antihistamines

Wet compress

Topical or PO roids (short-term)

Triamcinolone spray

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17
Q

Drug eruption

A

Stop the causative med

Antihistamines

PO or topical class III-IV (i.e. betamethasone)

Be alert for anaphylaxis

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18
Q

Urticaria

A

Acute:
IM or PO benadryl
PO steroids
If anaphylactic - IM or SQ epi

Chronic:
2nd gen antihistamine
H2 blockers
PO steroids
Restrictive diet
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19
Q

Angioedema

A

Basically same as urticaria

IM or PO antihistamines
PO steroids
Have epi ready for anaphylaxis

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20
Q

Leukocytoclastic (hypersensitivity) vasculitis

A

Find the cause

Txt the underlying condition / stop the offending med

Topical steroids / abx cream

Prednisone

Colchicine for chronic dz

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21
Q

HSP

A

Self-limiting
Watch for GI bleeds and blood loss

NSAIDs and PO steroids - short course

Occasionally dapsone or plasmophoresis

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22
Q

Erythema multiforme

A

Symptomatic

No txt if mild

Prednisone 1-3 weeks with taper

If herpes-induced -> valacyclovir

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23
Q

SJS

A

Steroids? Controversial

Control itching and pain

IVF

If severe -> burn unit

Ophthal consult

ABX if secondary infx

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24
Q

TEN

A

Burn unit ASAP

No steroids

Cyclosporine A, Cyclophosphamide, Plasma exchange, IVIG

Avoid infx (MCC of death in TRN)

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25
SSSS
Anti-staphs meds (diclox/ceph) No steroids Avoid touching skin
26
Kawasaki (mucocutaneous lymph node syndrome)
Watch for cardiac stuff High dose IVIG ASA
27
TSS
Take out the tampon, ya nasty girl Beta-lactamase resistant abx (ox, naf, cef, vanc/clin) Manage other organ system issues Increased hydration Vasopressors if needed
28
Pretibial myxedema
Topical steroids under occlusion Compression stockings Intralesional triamcinolone
29
Vitiligo
Goal is to stimulate melanocytes ``` Phototherapy Topical steroids Topical calcineurin inhibitors Vit D3 analogues Excimer laser Camouflage ```
30
Cushings
Stop using steroids Correct underlying etiology
31
Acanthosis nigricans
Txt the problem (many etiologies for this) Lesions usually asxs (do not require txt) Ammonium lactate cream softens lesions Tretinoin cream (txts hyperkeratotic skin)
32
Xanthomas
Eat better, exercise, stop smoking Txt the dyslipidemia TCA (trichloroacetic acid) for cosmetic txt
33
Granuloma annulare
Nothing - slide literally says “treatment - nothing” If the appearance bothers the patient, steroids with occlusion or intralesional steroid in papular ring inly PUVA for disseminated GA
34
Sarcoidosis
Oral steroids for widespread skin manifestations, active ocular dz, pulm dz, heart dz Intralesional steroids (triamcinolone) for smaller lesions If PO steroids fail: Methotrexate (low dose) for widespread skin and systemic involvement
35
Necrobiosis lipoidica
Topical / intralesional steroids Systemic steroids Trental ASA
36
Kaposi’s sarcoma (KS)
Liquid nitrogen cryotherapy Excisional surgery Intralesional chemotherapy Radiotherapy HAART if extensive
37
Acne vulgaris (primary conservative txt)
Skin care mods Midl exfoliation Avoid occlusion Less caffeine, sugar, stress
38
Acne vulgaris medical txt
Comedogenesis - retinoids - other acne washe/abx etc P. Acnes - abx - retnoids - BP Sebum production - retinoids - OCPs Inflammatory - oral ABX - retinoids
39
Nodulocystic acne
Isotretinoin (Accutane) - oral retinoid - makes sebaceous glands calm the fuck down - but, significant SE profile
40
Pomade acne / acne cosmetica
Stop using all that hair product Add tretinoin topical Avoid PO abx
41
Adult female acne
OCP’s Tretinoin cream Erythromycin enteric coated if all else fails
42
Steroid acne
D/c the steroids Txt with benzoyl peroxide and/or sulfacetamide/sulfur lotion Hydroxyzine or benadryl for itching Should heal fine without scarring
43
Staphylococcus folliculitis
Erythromycin or diclox PO If recurrent - cehpalexin PO x 2 weeks / bactroban to nares
44
Perioral dermatitis
Doxycycline 100mg PO for 2-4 weeks - once clearing achieved, taper Topical metronidazole reduces papules Stop using facial moisturizers and cosmetics
45
Acne rosacea
Metronidazole topical Doxycycline Minocycline for resistant-cases - expensive Sunscreen Avoid triggers If severe - accutane
46
Hidradenitis suppurativa
Stop smoking (it’s a major trigger... hashtag triggered) Long-term ABX = mainstay of txt Hot compress I and D large abscesses Intralesional steroids for smaller cysts If extensive dz - surgerize
47
Pseudofolliculitis barbae (PFB)
Modify shaving technique Wash with benzoyl peroxide Leave shaving cream on for five mins then shave with the grain Rx - topical abx after shaving, PO abx if pustules persist Permanent solution = laser hair removal (or just don’t shave - can have permanent profile within regs for army)
48
Acne keloidalis nuchae (AKN)
No short/shaved haircuts If pustular -> cx, txt with appropriate abx 3-step approach: 1. Topical clindamycin 2. Fluocinonide 3. Tretinoin cream Also, oral steroids, intralesional steroid injections, laser therapy, surgerize
49
Epidermal inclusion cyst
If asxs leave it alone Excision (intact, if possible - if inflamed, inject TAC then remove) If ruptured - I and D, THEN remove
50
Milia
If solitary, excise and extract (cannot be expressed) Multiple - tretinoin cream
51
Miliaria
Self-limited Remove from warm environment Cool compress Antihistamines
52
Pilar cyst (wen)
Excision
53
Teacher: why is paper blank?
Student: sometimes silence is the best answer
54
Seborrheic Keratosis?
No tx required - liquid N2 - curettage
55
Dermatosis papulosis nigra
no tx required - freezing - hypopigmentation - shave - ED and C
56
Stucco keratosis
No tx required/desired
57
Acrochordon
(Skin tags) Scissor excision Electrodessication Cryosurgery
58
Dermatofibroma?
Punch/excision biopsy
59
Sebaceous hyperplasia
No tx required - curette - shave bx - EDandC
60
Lipoma
No tx required | - Excision
61
Syringoma
Young - none (scarring risk) Really want it done - ED and C - scissors - shave w 11 blade
62
Neurofibroma
No tx required | - Excision
63
Hypertropic scar/keloid
``` IL steroid Surgery + IL steroid Cryo Silicone gel sheeting Intralesional 5-FU lasers ```
64
Keratoacanthoma
Excision (cosmetic, diagnositc, functional) - send to path (r/o SCC) Multiple - 5-FU - Methotrexate
65
Actinic keratosis
Photo-protection Complete skin exam Few lesions - cryo Multiple lesions - 5-FU - imiquimod Thick crust or indurated - excision(shave)
66
Bowens disease (SCC in situ)
Small lesion - ED and C - Cryo - excision Larger lesion - excision - 5-FU - imiquimod
67
Erythroplasia of queyrat?
(SCC/Bowens disease of mucous membrane) - 5-FU - imiquimod (aldara) - laser
68
SCC
``` Small lesion (from AK’s) - ED/C ``` Larger lesion or on lip - excise w margin Examine lymph nodes 5-FU q 12 months for life Photoprotection
69
BCC
Early detection - excise w small defect Late detection - Mohs micrographic surgery
70
Melanocytic nevus (common mole)
Follow ABCDE - >100 nevi q 6-12 mo checks Excision for anything suspicious
71
Congenital melanocytic nevi
Small - leave alone Medium - remove after puberty Large - remove (still has large MM risk)(2-3%)
72
Nevus spilus
No tx needed
73
Becker’s nevus
Remove hair and pigmentation w laser
74
Halo nevus
Teens - none needed - excise any atypia in central lesion Adults - woods lamp (vitiligo) - biopsy if suspect MM
75
Mongolian spot
Usually fades in first few years
76
Nevus of ota
Laser dark spots Send to optho - glaucoma risk
77
Spitz nevus | - aka benign juvenile melanoma
Shave
78
Blue nevus
Removal - Piece of mind - cosmetic
79
Labial melanotic macule
No tx needed but: - Cryo - Laser
80
Dysplastic nevus
``` Excisional bx w margins Pt education - self exam - sun protection Baseline pictures F/U q 6-12 mo - Screen family too ```
81
MM
Biopsy - excision w narrow margins (2-3mm) for diagnosis - much larger when confirmed F/U q - 3-4 mo x 1 yr - 6 mo thereafter
82
Various photoaging d/o
``` Topical retinoids - tretinoin - tazarotene Resurfacing - chemical peel - dermabrasion - lasers ```
83
Pellagra
PO Niacin - premedicate w ASA Niacinmide (fewer SE) Contraindications to. Tx: - active hepatic disease - active peptic ulcer disease - arterial hemorrhage - gout
84
Polymorphous light eruption
``` Corticosteroids - group II-V topicals - oral (widespread pruritis) Sun protection Desentization w phototherapy Psoralen UVA (PUVA) Antimalarial drugs - hydroxychloroquine ```
85
Actinic prurigo (hereditary PLE)
Same as PLE ``` Corticosteroids - group II-V topicals - oral (widespread pruritis) Sun protection Desentization w phototherapy Psoralen UVA (PUVA) Antimalarial drugs - hydroxychloroquine ```
86
Phototoxicity
``` ID and avoid agent Sunscreen PUVA Topical steroids Systemic steroids ```
87
Melasma
No good tx ``` Sun protection Hypo-pigmenting agents Chemical peels Lasers Cosmetics ``` Tri-luma cream x 8 weeks QD - hydroquinone - tretinoin - fluocinolone
88
Solar lentigo
No tx needed - cryo - topical retinoids - lasers - tri-luma
89
Idiopathic guttate hypomelanosis
No tx needed (or effective) - tretinoin cream - low potency steroids - Cryo - dermabrasion - make-up
90
Betahemolytic strep - non bullous impetigo
``` Cool/warm soaks (remove crust) Mupirocin Systemic abx - dicloxacillin/cephalexin Bandage Isolate pt ```
91
Erysipleas (betahemolytic strep) | - aka st anthony’s fire
Systemic abx - cephalexin - diclox Strep coverage
92
Cellulitis (beta hemolytic strep)
Cool compress Extremity elevation Outpatient - dicloxacillin/cephalexin Inpatient - IV nafcillin - IV vancomycin (PCN allergy) Pseudomonas (DM) - aminoglycosides H. Flu - cephalosporins
93
Blistering distal dactylitis (B-hemolytic strep)
I/D | anti-strep abx x 10 days
94
Bullous impetigo (staph)
``` Hand washing Warm/cool soaks (remove crusts) Mupirocin Systemic abx - dicloxacillin - cephalexin - erythromycin ```
95
Staphy scalded skin syndrome
``` Its more diffuse form of bullous impetigo so same tx: Hand washing Warm/cool soaks (remove crusts) Mupirocin Systemic abx - dicloxacillin - cephalexin - erythromycin ```
96
Folliculitis - staph
Remove irritant Skin hygiene Benzoyl peroxide Systemic abx if deep (sycosis barbe) Sycosis barbe - new razor each shave
97
Furnuncle/carbuncle
I/D Moist heat Systemic abx
98
MRSA
Septra | Clindamycin
99
Ecthyma (staph) (jungle sores)
``` Warm/cool soaks (crusts removal) Good hygiene Dry dressing Mupirocin Systemic abx - Dicloxacillin - cephalexin ```
100
Pseudomonas folliculitis (hot tub folliculitis)
Self limiting - antihistamine (itch) - vinegar/domeboro/burrows Ciprofloxacin if really bad
101
Pseudomonas cellulitis
DM pts - blood sugar monitoring Acetic acid/domeboro soaks Systemic abx - PO ciprofloxacin - IV aminoglycosides Severe - clinafloxacin IV
102
Pseudomonas toe web infection
Clean and dry feet Acetic acid soaks Drysol to feet
103
Corynebacterium trichomycosis axillaris
``` Shave Topical - erythromycin - naftifine (naftin) (for tinea) Control hyperhydrosis ```
104
Erythrasma (c. Minutissimum infection 4th web space)
Clean and dry Systemic - erythromycin - clarithromycin Topical - erythromycin - clindamycin - miconazole - clotrimazole
105
Pitted keratolysis
Clean and dry Drysol Topical - erythromycin - clindamycin - mupirocin Oral - if unresponsive to topicals
106
Warts
``` Cryo Electrocautery Salicylic acid Imiquimod Blunt dissection ```
107
Filiform warts (finger like)
Curettage Electro Cryo
108
Flat warts
Imiquimod Cryo (careful) 5-FU Tretinoin
109
Plantar warts
Pare and soak - salicylic acid - Imiquimod - Cantharidin w occlusion - Blunt dissection Alternatives - laser - ED/C - chemo (bichloracetic acid) - blemoycin sulfate (intralesional) Avoid cryo (painful)
110
Genital warts
Provider tx - TCA - podophyllum resin - dryo - ED/C - CO2 laser Pt applied - podofilox gel - imiquimod - 5-FU
111
Bowenoid papules
Same as warts
112
Molluscum contagiosum
Self limiting Babies/small kids - tretinoin (then rub off) Older kids - curette - LN2 - tretinoin - TCA (acid)
113
HSV
Cyclovir Penciclovir or abrevia for labialis
114
Varicella
Cool baths Antihistamines Tylenol Acyclovir w/in 24 hrs if: - >13 non pregnant - chronic skin disease - steroids/immunocompromised
115
Zoster
Cyclovir TCA for nerve pain Opiate pain meds Capsaicin cream Opthalmology if near eye Zostavax prevention
116
Human scabies
``` Permethrin - Days 1 and 7 Lindane Ivermectin (norweigan and HIV) - failed topical therapy ``` Burn everything
117
Lice tx
``` Body lice - permethrin Head lice (pediculosis capitus) - permethrin Crabs (P. Pubis) - permetherin shampoo on body ``` Burn everything
118
Cutaneous larval migrans
``` Topical - steroid Oral - ivermectin - albendazole ```
119
Fleas
Symptomatic - antihistamine - topical abx - topical steroid
120
Bed bugs
Burn everything Symptomatic - antihistamines
121
Chiggers
OTC chigger med Nail polish Symptomatic tx
122
Fire ants
Watch for anaphylaxis Symptomatic - cool compress - sarna lotion - antihistamines - steroids
123
Cat scratch fever (bartonella)
Mild dz - self limiting (4-6 wks) Mod-severe - z pack - erythromycin - doxy Suppurative nodules drained (needle aspiration)
124
Candida
Oral DOC - fluconazole (No preggos) Topical azoles or nystatin (preggos)
125
Tinea/pityriasis versicolor
TOC - ketaconazole shampoo - selenium sulfide (2nd line) Oral - ketaconazole (exercise - no shower) - itraconazole - fluconazole
126
Dermatophytes (tinea)
Topicals - 1 week after rash is gone - terbinifine - other azoles Orals - fluconazole - ketaconazole - griseofluvin - terbinavine
127
Tinea barbae
Oral azole only
128
Kerion?
Griseofluvin terbinafine Prednisone
129
Sporotrichosis (rose handlers disease)
Itraconazole
130
Telogen effluvium
Reassurance
131
Androgenic alopecia male pattern
Minoxidil Finasteride Dutasteride Transplant
132
Androgenic alopecia female pattern
Minoxidil
133
Alopecia areata
< 10 yrs - minoxidil - steroid - anthralin 10+ yrs - IL steroid - minoxidil - anthralin - toplical immunotherapy - systemic corticosteroids
134
Trichorrexis nodosa
Stop all hair tx | Check thyroid
135
Traction alopecia
Stop doing that
136
Hirsutism
Suppression therapy only - OCP - corticosteroids - spironolactone - eflornithine HCL (vaniqa) - laser/electrolysis
137
Psoriasis of the nail
Treat the psoriasis Systemic - cyclosporin - methotrexate - acitretin Local/topical - IL kenalog - calcipotriol - tazarotene gel (retinoid) - anthralin ointment
138
Lichen planus
IL kenalog | Prednisone
139
Onchomycosis
Oral - terbinafine (DOC) - itraconazole - fluconazole - griseofluvin Topical - ciclopirox nail lacquer (pelac) - efinaconazole (jubia)
140
Chronic nail exposure
Rehydrate the nail B complex Biotin
141
Oncholysis
Remove nail
142
Hangnail
Remove skin
143
Subungal hematoma
Trephination ASAP | - burny hole thing
144
Pincher nails
Wear better shoes
145
Paronychia
Drain abscess Antistaphylococcal drugs
146
Chronic paronychia
Prob candida | - azole
147
Pseudomonas on the nail
Bleach, water or vinegar Ciprofloxacin
148
Beaus lines
Tincture of time
149
Yellow nail syndrome
Vitamin e | - or treat their aids/resp disease
150
Finger clubbing
No tx
151
Koilonychia (spoon nails)
Treat IDA
152
Mee’s lines
Treat - sepsis - renal failure - arsenic - liver failure - hepatic - CHF - chemo

Senior - Derm 1 (7 decks)

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