Week 10: Derm Flashcards
Bacterial infections of the skin usually caused by:
Staph aureus or MRSA Strep pyogenes (group A strep)
Nonpharm care of bacterial skin infections:
Good hygiene
Warm compresses
Elevation of lower extremity
If severe infections: I and D with culture
Topical antibiotics used for bacterial skin infections:
Mupriocin (Bactroban)
Gentamycin
What topical antibiotic is effective against S. Aureus and used to decolonize carriers?
Mupirocin (bactroban)
What topical antibiotic is used for group a strep, s. Aureus, and pseudomonas?
Gentamycin
Folliculitis is a superficial bacterial infection of hair follicle that is primarily caused by?
Staph aureus
Folliculitis in the groin could be caused by?
Candidiasis
Folliculitis from swimming pool/hot tub exposure is caused by?
Pseudomonas
Topical therapy for folliculitis?
Bactroban or clindamycin gel
If folliculitis is severe/diffuse how would you treat?
Cephalexin, keeled, or augmentin for staph
Antibiotics are recommended for abscesses associated with:
Severe or extensive disease(involving multiple sites)
Rapid progression in presence of associated cellulitis
Signs/symptoms of systemic illness
Associated comorbidities
Extremes of age
Abscess in area difficult to drain (face, hands, or genitalia)
Associated septic phlebitis
Lack of response to I and D alone
Antibiotic therapy for abscess:
1st line: broad-spectrum penicillin or first generation cephalosporins (cephalexin)
Second line antibiotic therapy for abscess:
2nd/3rd generation cephalosporins or fluoroquinolones (ciprofloxacin- good for pseudomonas)
Treatment for abrasion:
Clean, apply bacitracin, triple antibiotic ointment and cover until it’s healed
Treatment of abscess with CA-MRSA:
I and D Systemic antibiotics- if there is surrounding inflammation or induration: -bactrim - mino /doxycycline - zyvox - Vancomycin for serious infections
Treatment of mild acne:
BP or topical retinoids or combo of both
Treatment of moderate acne:
Combo of BP+ antibiotic or retinoid or oral antibiotic plus topical retinoid and BP
Pharmacological treatment for acne with comedolytics:
Topical retinoid - core of topical treatment but use at a different time then BP
Benzoyl Peroxide
Side effects of topical retinoids:
Dryness/peeling, erythema, photosensitivity, pregnancy class C
MOA of Azelex:
Interferes with DNA synthesis of P. Acnes, antibacterial and anti inflammatory
Caution with azelex:
Can cause pigment changes in dark skin
Topical antibiotics for acne treatment include:
Erythromycin and clindamycin
MOA of topical antibiotics and acne:
Reduce microbial colonization and decrease inflammatory response, best used in combo with a comedolytic
Oral antibiotics are used in what type of acne?
Moderate to severe
First line oral antibiotic in acne:
Tetracycline- educate of photosensitivty
Other oral antibiotic options in acne:
Erythromycin and bactrim
Adverse events of accurate:
Monitor for lipids, osteoporosis, depression
Dryness, itching of mucous membranes and skin
Muscle aches, corneal opacities
Teratogenic- pregnancy class x- must use 2 forms of birth control!
Cutaneous vascular disorder of increased reaction of capillaries to heat that is present for at least 3 months and starts between the ages of 30-50.
Acne rosacea
First line therapy for acne rosacea:
Topical:
Metronidazole gel/cream/lotion
Sodium sulfacetamide with sulfur
Azelaic acid
Nonpharmacologic treatment of acute dermatitis:
Avoidance of perfumes, irritants such as smoke, detergent, soaps, and bubble bath
Decrease frequency of bathing, temp of water, and duration of shower/bath
Loose/cotton clothing
Cornerstone of atopic dermatitis therapy:
Emollients- 1-4 times daily and after bathing with no alcohol or fragrance
1st line pharmacologic treatment of atopic dermatitis:
Topical steroids: work on immune cells interfering with antigen processing and suppressing the release of proinflammatory cytokines
Where to use low-potency topical steroids:
Face, mucous membranes, genitalia, intertriginous areas
What type of steroids are needed in the palms and soles?
Potent
Ointment and steroid vehicles is more or less potent?
More potent and good for dry rashes
What vehicle for steroids is good for wet rashes?
Creams
Second line therapy for atopic dermatitis?
Topical calcineurin inhibitors: elidel and protopic
Calcineurin inhibitors can be used in ages:
Elidel: infant and up
Protopic: 2 and up (0.3%)
Side effects of calcineurin inhibitors:
Viral infections such as HSV, Molly scum, varicella, warts
Flu-like symptoms, allergic reaction, asthma, cough, fever, headache
Pregnancy cat c
Systemic treatment for atopic dermatitis:
Oral antihistamines
Skin disorder caused by uncontrolled accelerated replication of the basal epidermal cells, causes redness, flaking, and thickened patches.
Psoriasis
Treatment of psoriasis:
Emollients Topical steroids-cornerstone Topical immunosuppressives- elidel/protopic Vitamin D derivatives- dovonex, sorilux Keratolytic agent- salicylic acid
First line treatment in psoriasis:
Emollients
Topical steroids
First line therapy in impetigo:
Mupirocin (Bactoban)
What medication can be used to treatment inflammatory pustular acne?
Oral tetracycline
If you treat a fungus with a steroid cream it will:
Get worse
Oral antifungals should be reserved for:
Severe or extensive cases
Oral antifungals can cause:
Significant hypoglycemia when a patient is on hypoglycemia meds
Preferred agent for tinea capitis and tinea corporis of oral treatment is needed:
Griseofulvin- oral antifungal
Yeast/tinea infection of the nails:
Onychomycosis
Onychomycosis treatment:
Penlac 8% daily application for 48 weeks
MOA of penlac:
Inhibits enzymes responsible for the breakdown of peroxidases within fungal cells,interrupts RNA/DNA synthesis, alternative to systemic treatment for onychomycosis
MOA of topical retinoid:
Decreases the cohesion of epidermal and follicular cells
Griseofulvin should be taken:
With fatty foods to increase absorption, liquid form is easiest for patients to find
Topical antiviral agents:
Acyclovir and pencyclovir
Topical antiviral moa:
Inhibiting viral DNA synthesis which decreases healing time
Systemic antiviral agents:
Acyclovir, famciclovir, valacyclovir
Systemic antivirals are contraindicated in:
Renal disease
Side effects of systemic antivirals:
Headache, vertigo, depression, tremors
Famciclovir dosing:
HSV: 250 TID x 7-10 days (initial); recurrent 1000mg BID for 1 day or 250mg twice a day
Zoster: 500 mg TID x 7 days
Acyclovir dosing:
HSV: 200mg 5 times per day initial; recurrent 200 mg 5 times per day x 5 days
Zoster: 800 mg 5 times per day x 7 days
Valacyclovir dosing:
HSV: initial 1000 mg bid for 10 days
Zoster: 1000 mg TID for 7 days
First line therapy for warts:
Salicylic acid for 8 weeks if not resolved after 8 weeks- cryotherapy
Therapy for genital warts:
Podofilox solution or gel
Imiquimod cream
Practitioner applied:
Cryotherapy
Podophyllin
Trichloroacetic acid
Poison ivy therapy:
May need steroid burst or medrol pack
