Therapeutics > Dermatology > Flashcards

Dermatology Flashcards

(46 cards)

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1
Q

Advantages (4) + Disadvantages of Cream

A

Advantages: good hydration, drug delivery, can apply to most areas, high pt acceptance
Disadvantages: none?????

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2
Q

Advantages (3) + Disadvantages (3) of Ointment

A

Advantages: best for hydration, drug delivery, removes scales
Disadvantages: greasy, low pt acceptance, not ideal for hairy areas

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3
Q

Advantages (3) + Disadvantages (2) of Lotion

A

Advantages: watered-down creams, easy to apply, good pt acceptance
Disadvantages: requires frequent applications, not ideal for very dry skin

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4
Q

Advantages (3) + Disadvantages (1) of Gel

A

Advantages: good for EtOH soluble drugs, can apply to most areas, high pt acceptance
Disadvantages: can be drying

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5
Q

Advantages (2) + Disadvantages (4) of Foam/Solution

A

Advantages: can apply to most areas, easy to apply
Disadvantages: can be drying, not ideal for hydration, requires frequent application, not ideal drug delivery

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6
Q

What 4 factors are necessary to choose a base for a skin condition?

A

1) Condition of the skin
2) Area of application
3) Patient acceptability
4) The nature of incorporated medication (bioavailability/stability/compatibility)

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7
Q

How do we layer creams? (3)

A

1) Emollient (non-pharm)
- protects barrier against irritant, bacteria, and scratching
- rehydrate skin allowing it to heal
2) Topical steroid (pharm)
- reduce itching, redness, swelling, and inflammation
3) Antibiotic/Antifungal (pharm)
- treat infections

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8
Q

Treatment options for dry skin (xerosis)

A
  • emollients (vaseline/aquaphor/cetaphil)
    • first line, restores barrier + function, use at least TID
  • add agents for itching
  • alter bathing habits
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9
Q

What 4 agents reduce itching?

A

1) Menthol + Camphor -> cooling sensation
2) Pramoxine -> local anesthetic
3) Aluminum Acetate -> alter C fiber nerve transmission
4) Hydrocortisone -> anti-inflammatory

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10
Q

4 key points about xerosis

A
  • common as you age
  • external environment impacts severity
  • frequent use of emollients is encourages
  • greasier feeling -> better results!
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11
Q

Dermatitis Classifications

A

Acute (contact derm/poison ivy)
- red patch, bumpy surface or blisters, intense itching!!!
Sub-acute (atopic derm/eczema)
- dry, less red, crusty and ooze, thickening, less intense itch!!!
Chronic (long standing derm)
- scaling, lichenification, less itch

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12
Q

Poison Ivy

A
  • dermatitis occurs in 24-48 hrs
  • pruritis intense
  • topical therapy okay if < 10% BSA involved!!
    Treatment:
    limited rash*
    remove source, calamine lotion, topical + oral antihist, OTC topical hydrocortisone
    wide spread
    avoid dose packs! start prednisone 40-60 mg/day, taper q3d, min of 10-14 days
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13
Q

What is the MOA of topical corticosteroids?

A
  • anti-inflammatory
  • anti-mitotic ()
  • immunosuppressive
    oral: 10-14 days
    topical: apply bid-qid for 3-14 days
    • start with medium potency
    • frequency varies
    • always treat 1 day beyond resolution
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14
Q

4 key points about contact dermatitis

A
  • focus on location and extent of rash
  • identify and avoid causative agents
  • diffuse rashes require systemic therapy
  • mid-potency TCS used most frequently
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15
Q

Atopic Dermatitis

A

eczema
- usually presents in infancy
- 1 in 5 children, 1 in 12 adults
- 80% mild, 20% mod-severe
- significant QOL issues with severe disease (sleep, depression, anxiety, productivity)

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16
Q

Atopic Triad

A
  • often first disease of atopic/allergic triad to be observed (atopic)
  • 50-75% of children also develop allergic rhinitis and/or asthma
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17
Q

Atopic Dermatitis Presentation

A

pruritis
- symmetrical red papules or plaques
- scaling
- overall dryness of the skin!!
- red/inflamed
- hx of allergic disease
- risk of 2nd infection

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18
Q

Where is atopic dermatitis located in infants/children/adults and how does it appear?

A

Infant: red skin on cheeks and skin, lesions later appear on neck, trunk and groin
Children: skin appears dry/flaky, face/neck/creases of arms and legs, greater risk of secondary infections, sleep disturbance common
Adults: excoriation + lichenification from chronic scratching, hands, neck, flexor surfaces of arms and legs

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19
Q

What are 2 common triggers of atopic dermatitis?

Study These Flashcards
A

detergents & infections

20
Q

When choosing a topical corticosteroid, what 4 things are you basing your vehicle choice on?

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A
  • location of lesions
  • type of lesions
  • severity of lesion/degree of inflammation
  • degree of skin penetration desired
21
Q

Rank TCS based on their absorption (best to worst)

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A

ointment (least water content = better steroid absorption)
cream
lotion
solution
gel
spray (most water content = worse steroid absorption)

22
Q

Topical corticosteroid classifications

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A

Very High Potency (Class 1)
- halobetasol, clobetasol
- betamethasone diprop OINT
- don’t use on face, avoid super potent agents > 2 weeks
High Potency (Class 2)
- fluocinonide cr, gel, oin
- betamethasone diprop CREAM
- same comments as very high potency
Mid Potency (Class 3-5)
- bethamethasone val, triamcinolone, mometasone
- betamethasone diprop LOTION
- used on most skin surfaces for exacerbations
Low Potency (Class 6-7)
- hydrocortisone, desonide
- use on face, groin, genitals, axilla
- safe for long-term maintenance

23
Q

Topical Calcineurin Inhibitors

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A

**pimecrolimus/Tacrolimus
MOA: blocks pro-inflammatory cytokine genes
- can be used on any area
- equivalent to mid potency TCS
- no risk of atrophy
- fewer SE -> burning
- expensive
- intermittent use only, 2nd line

24
Q

Crisaborole 2% Ointment

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A
  • PDE4 inhibitor
  • alternative to TCS and TCI (steroid phobia)
  • mild/moderate AE
  • BID 28 days
  • expensive
25
Ruxolitinib
- mild-mod atopic dermatitis MOA: JAK inhibitor - apply thin layer BID up to 20% of BSA - short term use - max 60 mg/day - avoid in immunocompromised pts
26
7 key points about atopic dermatitis
- common autoimmune disorder that generally presents during childhood - location of lesions varies with age - avoid triggers - mid-potency TCS tx of choice for most pts - SE may be associated with chronic use of TCS - alternative tx options now available at a higher cost
27
Seborrhic dermatitis
*dandruff 2.0* - linked to overgrowth of Malassezia yeast - inflammation - often triggered by stress, cold weather, hormone changes - hairline, scalp, neck, ears, chest, back Signs/Sx: flakey skin, yellow and greasy scales, red rash, dandruff, itchiness
28
What are the treatment options for seborrhic dermatitis?
- Medicated shampoos -> removes scales, reduces cell turnover - use 2-3 times/week - critical contact time!!! - rx strength is 2x - Prescription medicated shampoo antifungals -> ketoconazole, selenium, ciclopirox corticosteroid -> clobetasol keratolytic -> salicylic acid PDE4 inhibitor -> roflumilast - Topical Corticosteroids - hydrocortisone -> ideal for lesions on face??? check slide 66
29
4 key points about seborrheic dermatitis?
- dandruff on steroids - greasy lesions along hairline with age - use OTC dandruff shampoos first, then rx is necessary - TCS useful for itching or resistant rash
30
What are the 4 factors that exacerbate acne?
- oil-based cosmetics - emotional stress - irritation/physical pressure - drugs (androgenic steroids)
31
2 categories of acne
Non-inflammatory: white/blackheads (mild) Inflammatory: papules and pustules (moderate), nodules/cysts (severe)
32
What are the 5 goals of therapy for acne treatment?
- long-term control - relieve discomfort - improve skin appearance - minimize psychological stress - prevent scars
33
What is the MOA of acne therapy?
- antimicrobial - anti-inflammatory - decrease sebum production Keratolytic: compounds that break down the outer layers of the skin, decrease thickness, and promote sloughing (salicylic acid/urea/a-hydroxyl acid) Comedolytic/Retinoids: medication reducing cohesion of epithelial cells, increasing cell turnover, inhibits the formation of comedones (tretinoin/adapalene/azelaic acid)
34
Acne Treatment Therapy
Non-inflammatory -> topical retinoids Mild-mod papulopustular -> adapalene + BP or clindamycin + BP Severe papulopustular and Nodular -> oral tretinoin Maintenance Therapy -> adapalene
35
Cost analysis of Acne Therapy
Low Cost: topical retinoid Medium Cost: oral antibiotics, anti-androgens, oral corticosteroids High Cost: isotretinoin, anti-androgens, tazarotene combo products
36
Oral Antibiotics for Acne Treatment
*Minocycline, Doxycycline, Erythromycin, Azithromycin, TMP/SMX* - decreases bacteria and inflammation - most effective when inflammation is present
37
Oral Anti-Androgen Therapy
Hormone therapy (Spironolactone) -> ideal for females whose acne flares during menstrual cycle Topical Hormone Therapy (Clascoterone cream) -> androgen receptor inhibitor
38
Severe Acne Treatment
Isotretinoin: used for either severe acne or when pts have tried and failed other treatments or when it relapses soon after discontinuing other therapies - acne gets worse before it gets better - 0.5-2mg/kg/day with food?? for 15-20 weeks AE -> category X? depression/suicide
39
What are the 6 key points about acne?
- most common during adolescence when androgen levels are highest - good skin hygiene is essential - most therapies take weeks to months to obtain max benefit - milder forms can be treated with OTC meds - most topical meds associated with extreme dryness oof skin - inflammatory lesions usually require use of antibiotic tx - most severe forms require tx with isotretinoin - isotretinoin requires special prescribing and close monitoring
39
Acne follow-up after treatment
2-6 months
40
Characteristics of Rosacea
- based on vascular instability - facial flushing/blushing - telangiectasia - 25-70 yrs old - women>men - chronic, persisting for yrs with periods of exacerbation and remission
41
Types of Rosacea
Telangiectatic: visibly dilated blood vessels, very red skin Papulopustular: resembles acne, "adult acne" Phytmatous: nose specific, more common in males, enlarged sebaceous glands Ocular: watery, bloodshot eyes
42
Trigger factors of Rosacea (5)
- temperature/sun! - drugs (vasodilators) - food - weather - medical conditions
43
Rosacea Treatment
Lifestyle Modifications (avoid triggers -> sun) Mild: avoid triggers, topical antibiotics and retinoids Moderate: oral antibiotics, topical retinoids Severe: oral isotretinoin, laser treatments
44
Rosacea Treatment categories
**treatment of choice** topical antibiotics -> Metronidazole 1% **t topical retinoids -> azelaic acid 15% gel Brimonidine: tx for persistent facial erythema
45
What are the 5 key points of rosacea?
- most common in adults with fair skin - dilated blood vessels most common lesion - lifestyle modifications are essential - retinoids and topical antibiotics are tx of choice - most severe cases treated like acne
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