Week 3 - Dermatological Therapeutics Flashcards
What are the actions, uses and adverse effects of corticosteroids?
Actions: anti-inflammatory, immunosuppressive, anti-proliferative, vasoconstrictive
Uses: eczema, contact dermatitis, psoriasis, itch, lichen planus
Adverse effects: Skin atrophy/thinning, acne, striae
How do retinoids work?
Vitamin A analogs - work through nuclear receptors on DNA causing alteration of gene transcription
What are retinoids used for?
Acne, psoriasis, cosmetic skin improvement
What are adverse effects of retinoids?
dryness, irritation, sun sensitivity
What are the actions of retinoids?
Regulate cell growth, inhibit carcinogenesis, alter enzymes involved with cellular differentiation
How does Calcipotriene work? What is it used for and what are some adverse effects of it?
Ex: Donovex
A vitamin D analog that acts through DNA receptors to alter skin differentiation
Uses: psoriasis, eczema
Adverse effects: irritation, increased serum calcium
What are some topical antimicrobials and what are they used for?
Clindamycin, erthyromycin gels, benzoyl peroxide gel or wash, terbinafine, oxiconazole creams,
Uses: acne, rosacea, wounds, fungal infections
How do Topical Calcineurin Inhibitors (TCIs) work?
They work through calcineurin to alter T-cell activation
What are TCIs used for and why are they controversial?
- Work well for eczema (atopic dermatitis)
- May cause limited local irritation or burning
- Has FDA warning because it caused lymphomas in animal studies
What is atopic dermatitis?
Eczema!
What is dermatitis?
Inflammation of the skin
What does broad spectrum mean? And how much of the suns rays does SPF 30 block?
- covers all wavelengths
- blocks 97% of sun’s UV rays
How does an imiquimod work?
- Aldara cream
- ramps up the immune system to attack something in skin (immune response modifier)
- works through toll receptors to activate immune cascades locally
- Used for actinic keratosis, BCC
What is topical 5-Fluorouracil?
It inhibits thymidylate synthase, resulting in reduced DNA synthesis. It acts selectively in actinic damaged skin cells
How should you take care of wounds?
-Keep wound covered with a nonstick dressing to allow natural cytokines to facilitate healing (don’t want to ‘air out’ as this increases scarring)
What are systemic retinoids used for and how do they work?
They are used for acne, psoriasis, ichthyosis, chemopropholaxis of skin –> repair disordered keratinization (Accutane)
- They are vitamin A analogs that bind to nuclear retinoid receptors to alter cell differentiation
- They have many adverse effects and need to be monitored closely (government regulates accutane)
What can systemic retinoids do?
They can cure/remove acne permanently and they are used for psoriasis that has multiple spots
What is dapsone used for?
Leprosy therapy!
-Dermatitis herpiformis, linear IgA disease, bullous lupus, spider bites
What is methotrexate (systemic drug) used for?
Psoriasis & lupus
How does methotrexate work?
Dihydrofolate reductase inhibitor that disrupts DNA synthesis to block cell division. Immunosuppressive
What are systemic biological therapies?
Biogenetically engineered proteins which disrupt/inhibit focused portions of the immune system involved in psoriasis
-Used to treat psoriasis, psoriatic arthritis, (RA)
What are some cons to using biological therapies?
VERY Expensive
- Injection site irritation
- Risk of infection
- Our bodies can develop antibodies to these
How are biological therapies given?
They are given as a vaccination every other week.
What is ultraviolet light therapy used for?
Anti-inflammtory, immunosuppresive
- Used for psoriasis, pruritis, ezcema, CTCL (cutaneous T cell lymphoma)
What does ultraviolet therapy do?
It forms pyrimidine dimers in DNA and reduces langerhans cell and leukocytes
What is minoxidil best used for?
Alopecia - It’s rogaine
Action: vasodilation & direct stimulation of hair shaft growth
What is finasteride used for?
Male pattern baldness - Androgenetic Alopecia
Action: blocks 5-alpha reductase enzyme in follicles to inhibit the conversion of testosterone to dihydrotestosterone
What do alpha hydroxy acids do?
They exfoliate, thicken epidermis, stimulate collagen growth, increase skin profusion - result in fewer wrinkles, more pliable skin, with better hydration
-Cosmetic product
What are the three stages of normal hair cycle? How many hairs are lost each day?
100-150 hairs each day
Anagen -> Catagen -> Telogen
What is the cause of Androgenetic alopecia and what treatments are usually used?
It’s caused by genetically determined miniaturization of follicles triggered by androgens. Usually occurs on the top of the scalp.
Treatment: Minoxidil, Finasteride, Hair transplants
What is telogen effluvium?
It is stress hair loss. It is caused by disrupted growth cycle of hairs causing premature shift from anagen to telogen. It’s triggered by pregnancy, surgery, high fever, extreme diet
How does Telogen effluvium effect the hair? What is the treatment?
Area: diffuse scalp involvement - “coming out in bunches”
Treatment: Remove the trigger, Minoxidil?, Time, Reassurance
What causes Alopecia areata?
It’s AUTOIMMUNE - can be associated with other immune diseases (vitiligo, diabetes)
- T cells attack the hair bulb - “swarm of bees”
- HLA/genetically determined
- Circular patches on scalp or beard
What are treatments for Alopecia areata?
Watch, wait, topical or IL steroids - Minoxidil
A. Totalis =
A. Universalis =
all scalp hair lost
all body hair lost
What is secondary alopecia and what causes it?
Diffuse hair thinning as a complication of an existing medication or medical problem
Causes: Chemotherapy, Meds, Thyroid disease, Iron deficiency, Nutritional disorders, Renal or Hepatic failure, other chronic illnesses
How do you treat secondary alopecia?
Remove the cause, Minoxidil??
What causes Tinea capitis and in what population is it most common?
It is fungus growth on scalp and hair shafts, caused by trichophyton tonsurans mostly.
-Most common in African Americans
What is the standard treatment for Tinea capitis?
Griseofulvin
-Tinea capitis can cause scarring!
What type of hair loss does lupus cause? What are the treatments?
Dicoid lupus of the scalp results in destruction of hair units
- Often scarring
- Area: Discoid (round) patches with redness, scale, scarring anywhere on scalp or beard
- Treatment: Topical or systemic steroids, hydroxychloroquine
What is pediculosis?
Head lice & Pubic Lice
What is used to treat pediculosis?
Permethrin, GBH, Malathion, Vaseline, Cetaphil, Remove nits, hot water and dryer for clothes and bedding, unwashables in bag for 2 weeks
What is paronychia?
Inflammation of nail folds, can be infectious and non-infectious
What can cause acute and/or chronic paronychia?
Trauma, bacteria, contact dermatitis, acute eczema, flair, irritant contact dermatitis, eczema, psoriasis, Candida
How to treat ingrown nails?
- Always cut nails straight across
- Don’t tear or pull
- Can get infected
- Proper fitting shoes
- Soaks, Antibiotics, Surgery
What is onychomycosis?
It’s caused by fungal growth on or under the nail. It’s commonly caused by Trichophyton rubrum or T. mentagrophytes.
Treatment: Terbinafine (Lamisil), Itraconazole (Sporonox), Ciclopirox (penlac lacquer)
