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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
Q

SSSS

A

Anti-staphs meds (diclox/ceph)

No steroids

Avoid touching skin

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26
Q

Kawasaki (mucocutaneous lymph node syndrome)

A

Watch for cardiac stuff

High dose IVIG

ASA

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27
Q

TSS

A

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

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28
Q

Pretibial myxedema

A

Topical steroids under occlusion

Compression stockings

Intralesional triamcinolone

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29
Q

Vitiligo

A

Goal is to stimulate melanocytes

Phototherapy 
Topical steroids
Topical calcineurin inhibitors
Vit D3 analogues
Excimer laser
Camouflage
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30
Q

Cushings

A

Stop using steroids

Correct underlying etiology

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31
Q

Acanthosis nigricans

A

Txt the problem (many etiologies for this)

Lesions usually asxs (do not require txt)

Ammonium lactate cream softens lesions

Tretinoin cream (txts hyperkeratotic skin)

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32
Q

Xanthomas

A

Eat better, exercise, stop smoking

Txt the dyslipidemia

TCA (trichloroacetic acid) for cosmetic txt

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33
Q

Granuloma annulare

A

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

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34
Q

Sarcoidosis

A

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

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35
Q

Necrobiosis lipoidica

A

Topical / intralesional steroids

Systemic steroids

Trental

ASA

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36
Q

Kaposi’s sarcoma (KS)

A

Liquid nitrogen cryotherapy

Excisional surgery

Intralesional chemotherapy

Radiotherapy

HAART if extensive

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37
Q

Acne vulgaris (primary conservative txt)

A

Skin care mods

Midl exfoliation

Avoid occlusion

Less caffeine, sugar, stress

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38
Q

Acne vulgaris medical txt

A

Comedogenesis

  • retinoids
  • other acne washe/abx etc

P. Acnes

  • abx
  • retnoids
  • BP

Sebum production

  • retinoids
  • OCPs

Inflammatory

  • oral ABX
  • retinoids
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39
Q

Nodulocystic acne

A

Isotretinoin (Accutane) - oral retinoid - makes sebaceous glands calm the fuck down - but, significant SE profile

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40
Q

Pomade acne / acne cosmetica

A

Stop using all that hair product

Add tretinoin topical

Avoid PO abx

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41
Q

Adult female acne

A

OCP’s

Tretinoin cream

Erythromycin enteric coated if all else fails

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42
Q

Steroid acne

A

D/c the steroids

Txt with benzoyl peroxide and/or sulfacetamide/sulfur lotion

Hydroxyzine or benadryl for itching

Should heal fine without scarring

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43
Q

Staphylococcus folliculitis

A

Erythromycin or diclox PO

If recurrent - cehpalexin PO x 2 weeks / bactroban to nares

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44
Q

Perioral dermatitis

A

Doxycycline 100mg PO for 2-4 weeks - once clearing achieved, taper

Topical metronidazole reduces papules

Stop using facial moisturizers and cosmetics

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45
Q

Acne rosacea

A

Metronidazole topical

Doxycycline

Minocycline for resistant-cases - expensive

Sunscreen

Avoid triggers

If severe - accutane

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46
Q

Hidradenitis suppurativa

A

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

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47
Q

Pseudofolliculitis barbae (PFB)

A

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)

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48
Q

Acne keloidalis nuchae (AKN)

A

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

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49
Q

Epidermal inclusion cyst

A

If asxs leave it alone

Excision (intact, if possible - if inflamed, inject TAC then remove)

If ruptured - I and D, THEN remove

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50
Q

Milia

A

If solitary, excise and extract (cannot be expressed)

Multiple - tretinoin cream

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51
Q

Miliaria

A

Self-limited

Remove from warm environment

Cool compress

Antihistamines

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52
Q

Pilar cyst (wen)

A

Excision

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53
Q

Teacher: why is paper blank?

A

Student: sometimes silence is the best answer

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54
Q

Seborrheic Keratosis?

A

No tx required

  • liquid N2
  • curettage
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55
Q

Dermatosis papulosis nigra

A

no tx required

  • freezing - hypopigmentation
  • shave
  • ED and C
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56
Q

Stucco keratosis

A

No tx required/desired

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57
Q

Acrochordon

A

(Skin tags)

Scissor excision
Electrodessication
Cryosurgery

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58
Q

Dermatofibroma?

A

Punch/excision biopsy

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59
Q

Sebaceous hyperplasia

A

No tx required

  • curette
  • shave bx
  • EDandC
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60
Q

Lipoma

A

No tx required

- Excision

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61
Q

Syringoma

A

Young
- none (scarring risk)

Really want it done

  • ED and C
  • scissors
  • shave w 11 blade
62
Q

Neurofibroma

A

No tx required

- Excision

63
Q

Hypertropic scar/keloid

A 
IL steroid
Surgery + IL steroid
Cryo
Silicone gel sheeting
Intralesional 5-FU
lasers
64
Q

Keratoacanthoma

A

Excision (cosmetic, diagnositc, functional)
- send to path (r/o SCC)

Multiple

  • 5-FU
  • Methotrexate
65
Q

Actinic keratosis

A

Photo-protection
Complete skin exam

Few lesions
- cryo

Multiple lesions

  • 5-FU
  • imiquimod

Thick crust or indurated
- excision(shave)

66
Q

Bowens disease (SCC in situ)

A

Small lesion

  • ED and C
  • Cryo
  • excision

Larger lesion

  • excision
  • 5-FU
  • imiquimod
67
Q

Erythroplasia of queyrat?

A

(SCC/Bowens disease of mucous membrane)

  • 5-FU
  • imiquimod (aldara)
  • laser
68
Q

SCC

A 
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
Q

BCC

A

Early detection
- excise w small defect

Late detection
- Mohs micrographic surgery

70
Q

Melanocytic nevus (common mole)

A

Follow ABCDE
- >100 nevi q 6-12 mo checks

Excision for anything suspicious

71
Q

Congenital melanocytic nevi

A

Small
- leave alone

Medium
- remove after puberty

Large
- remove (still has large MM risk)(2-3%)

72
Q

Nevus spilus

A

No tx needed

73
Q

Becker’s nevus

A

Remove hair and pigmentation w laser

74
Q

Halo nevus

A

Teens

  • none needed
  • excise any atypia in central lesion

Adults

  • woods lamp (vitiligo)
  • biopsy if suspect MM
75
Q

Mongolian spot

A

Usually fades in first few years

76
Q

Nevus of ota

A

Laser dark spots
Send to optho
- glaucoma risk

77
Q

Spitz nevus

- aka benign juvenile melanoma

78
Q

Blue nevus

A

Removal

  • Piece of mind
  • cosmetic
79
Q

Labial melanotic macule

A

No tx needed but:

  • Cryo
  • Laser
80
Q

Dysplastic nevus

A 
Excisional bx w margins
Pt education 
- self exam
- sun protection
Baseline pictures
F/U q 6-12 mo
- Screen family too
81
Q

MM

A

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
Q

Various photoaging d/o

A 
Topical retinoids 
- tretinoin
- tazarotene
Resurfacing
- chemical peel
- dermabrasion
- lasers
83
Q

Pellagra

A

PO Niacin
- premedicate w ASA

Niacinmide (fewer SE)

Contraindications to. Tx:

  • active hepatic disease
  • active peptic ulcer disease
  • arterial hemorrhage
  • gout
84
Q

Polymorphous light eruption

A 
Corticosteroids
- group II-V topicals
- oral (widespread pruritis)
Sun protection
Desentization w phototherapy
Psoralen UVA (PUVA)
Antimalarial drugs 
- hydroxychloroquine
85
Q

Actinic prurigo (hereditary PLE)

A

Same as PLE

Corticosteroids
- group II-V topicals
- oral (widespread pruritis)
Sun protection
Desentization w phototherapy
Psoralen UVA (PUVA)
Antimalarial drugs 
- hydroxychloroquine
86
Q

Phototoxicity

A 
ID and avoid agent
Sunscreen
PUVA
Topical steroids
Systemic steroids
87
Q

Melasma

A

No good tx

Sun protection
Hypo-pigmenting agents
Chemical peels
Lasers
Cosmetics

Tri-luma cream x 8 weeks QD

  • hydroquinone
  • tretinoin
  • fluocinolone
88
Q

Solar lentigo

A

No tx needed

  • cryo
  • topical retinoids
  • lasers
  • tri-luma
89
Q

Idiopathic guttate hypomelanosis

A

No tx needed (or effective)

  • tretinoin cream
  • low potency steroids
  • Cryo
  • dermabrasion
  • make-up
90
Q

Betahemolytic strep - non bullous impetigo

A 
Cool/warm soaks (remove crust)
Mupirocin
Systemic abx
- dicloxacillin/cephalexin
Bandage
Isolate pt
91
Q

Erysipleas (betahemolytic strep)

- aka st anthony’s fire

A

Systemic abx

  • cephalexin
  • diclox

Strep coverage

92
Q

Cellulitis (beta hemolytic strep)

A

Cool compress
Extremity elevation

Outpatient
- dicloxacillin/cephalexin

Inpatient

  • IV nafcillin
  • IV vancomycin (PCN allergy)

Pseudomonas (DM)
- aminoglycosides

H. Flu
- cephalosporins

93
Q

Blistering distal dactylitis (B-hemolytic strep)

A

I/D

anti-strep abx x 10 days

94
Q

Bullous impetigo (staph)

A 
Hand washing
Warm/cool soaks (remove crusts)
Mupirocin
Systemic abx
- dicloxacillin
- cephalexin
- erythromycin
95
Q

Staphy scalded skin syndrome

A 
Its more diffuse form of bullous impetigo so same tx: 
 Hand washing
Warm/cool soaks (remove crusts)
Mupirocin
Systemic abx
- dicloxacillin
- cephalexin
- erythromycin
96
Q

Folliculitis - staph

A

Remove irritant
Skin hygiene
Benzoyl peroxide
Systemic abx if deep (sycosis barbe)

Sycosis barbe
- new razor each shave

97
Q

Furnuncle/carbuncle

A

I/D
Moist heat
Systemic abx

98
Q

MRSA

A

Septra

Clindamycin

99
Q

Ecthyma (staph) (jungle sores)

A 
Warm/cool soaks (crusts removal)
Good hygiene
Dry dressing
Mupirocin 
Systemic abx
- Dicloxacillin
- cephalexin
100
Q

Pseudomonas folliculitis (hot tub folliculitis)

A

Self limiting

  • antihistamine (itch)
  • vinegar/domeboro/burrows

Ciprofloxacin if really bad

101
Q

Pseudomonas cellulitis

A

DM pts - blood sugar monitoring

Acetic acid/domeboro soaks

Systemic abx

  • PO ciprofloxacin
  • IV aminoglycosides

Severe
- clinafloxacin IV

102
Q

Pseudomonas toe web infection

A

Clean and dry feet

Acetic acid soaks
Drysol to feet

103
Q

Corynebacterium trichomycosis axillaris

A 
Shave
Topical 
- erythromycin
- naftifine (naftin) (for tinea)
Control hyperhydrosis
104
Q

Erythrasma (c. Minutissimum infection 4th web space)

A

Clean and dry

Systemic

  • erythromycin
  • clarithromycin

Topical

  • erythromycin
  • clindamycin
  • miconazole
  • clotrimazole
105
Q

Pitted keratolysis

A

Clean and dry
Drysol

Topical

  • erythromycin
  • clindamycin
  • mupirocin

Oral
- if unresponsive to topicals

106
Q

Warts

A 
Cryo
Electrocautery
Salicylic acid
Imiquimod
Blunt dissection
107
Q

Filiform warts (finger like)

A

Curettage
Electro
Cryo

108
Q

Flat warts

A

Imiquimod
Cryo (careful)
5-FU
Tretinoin

109
Q

Plantar warts

A

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
Q

Genital warts

A

Provider tx

  • TCA
  • podophyllum resin
  • dryo
  • ED/C
  • CO2 laser

Pt applied

  • podofilox gel
  • imiquimod
  • 5-FU
111
Q

Bowenoid papules

A

Same as warts

112
Q

Molluscum contagiosum

A

Self limiting

Babies/small kids
- tretinoin (then rub off)

Older kids

  • curette
  • LN2
  • tretinoin
  • TCA (acid)
113
Q

HSV

A

Cyclovir

Penciclovir or abrevia for labialis

114
Q

Varicella

A

Cool baths
Antihistamines
Tylenol

Acyclovir w/in 24 hrs if:

  • > 13 non pregnant
  • chronic skin disease
  • steroids/immunocompromised
115
Q

Zoster

A

Cyclovir
TCA for nerve pain
Opiate pain meds
Capsaicin cream

Opthalmology if near eye

Zostavax prevention

116
Q

Human scabies

A 
Permethrin
- Days 1 and 7 
Lindane 
Ivermectin (norweigan and HIV)
- failed topical therapy

Burn everything

117
Q

Lice tx

A 
Body lice
- permethrin
Head lice (pediculosis capitus)
- permethrin 
Crabs (P. Pubis)
- permetherin shampoo on body

Burn everything

118
Q

Cutaneous larval migrans

A 
Topical
- steroid
Oral
- ivermectin
- albendazole
119
Q

Fleas

A

Symptomatic

  • antihistamine
  • topical abx
  • topical steroid
120
Q

Bed bugs

A

Burn everything

Symptomatic
- antihistamines

121
Q

Chiggers

A

OTC chigger med
Nail polish
Symptomatic tx

122
Q

Fire ants

A

Watch for anaphylaxis

Symptomatic

  • cool compress
  • sarna lotion
  • antihistamines
  • steroids
123
Q

Cat scratch fever (bartonella)

A

Mild dz
- self limiting (4-6 wks)

Mod-severe

  • z pack
  • erythromycin
  • doxy

Suppurative nodules drained (needle aspiration)

124
Q

Candida

A

Oral DOC
- fluconazole
(No preggos)

Topical azoles or nystatin (preggos)

125
Q

Tinea/pityriasis versicolor

A

TOC

  • ketaconazole shampoo
  • selenium sulfide (2nd line)

Oral

  • ketaconazole (exercise - no shower)
  • itraconazole
  • fluconazole
126
Q

Dermatophytes (tinea)

A

Topicals - 1 week after rash is gone

  • terbinifine
  • other azoles

Orals

  • fluconazole
  • ketaconazole
  • griseofluvin
  • terbinavine
127
Q

Tinea barbae

A

Oral azole only

128
Q

Kerion?

A

Griseofluvin
terbinafine

Prednisone

129
Q

Sporotrichosis (rose handlers disease)

A

Itraconazole

130
Q

Telogen effluvium

A

Reassurance

131
Q

Androgenic alopecia male pattern

A

Minoxidil
Finasteride
Dutasteride
Transplant

132
Q

Androgenic alopecia female pattern

133
Q

Alopecia areata

A

< 10 yrs

  • minoxidil
  • steroid
  • anthralin

10+ yrs

  • IL steroid
  • minoxidil
  • anthralin
  • toplical immunotherapy
  • systemic corticosteroids
134
Q

Trichorrexis nodosa

A

Stop all hair tx

Check thyroid

135
Q

Traction alopecia

A

Stop doing that

136
Q

Hirsutism

A

Suppression therapy only

  • OCP
  • corticosteroids
  • spironolactone
  • eflornithine HCL (vaniqa)
  • laser/electrolysis
137
Q

Psoriasis of the nail

A

Treat the psoriasis

Systemic

  • cyclosporin
  • methotrexate
  • acitretin

Local/topical

  • IL kenalog
  • calcipotriol
  • tazarotene gel (retinoid)
  • anthralin ointment
138
Q

Lichen planus

A

IL kenalog

Prednisone

139
Q

Onchomycosis

A

Oral

  • terbinafine (DOC)
  • itraconazole
  • fluconazole
  • griseofluvin

Topical

  • ciclopirox nail lacquer (pelac)
  • efinaconazole (jubia)
140
Q

Chronic nail exposure

A

Rehydrate the nail
B complex
Biotin

141
Q

Oncholysis

A

Remove nail

142
Q

Hangnail

A

Remove skin

143
Q

Subungal hematoma

A

Trephination ASAP

- burny hole thing

144
Q

Pincher nails

A

Wear better shoes

145
Q

Paronychia

A

Drain abscess

Antistaphylococcal drugs

146
Q

Chronic paronychia

A

Prob candida

- azole

147
Q

Pseudomonas on the nail

A

Bleach, water or vinegar

Ciprofloxacin

148
Q

Beaus lines

A

Tincture of time

149
Q

Yellow nail syndrome

A

Vitamin e

- or treat their aids/resp disease

150
Q

Finger clubbing

151
Q

Koilonychia (spoon nails)

152
Q

Mee’s lines

A

Treat

  • sepsis
  • renal failure
  • arsenic
  • liver failure
  • hepatic
  • CHF
  • chemo

Senior - Derm 1 (7 decks)

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