1
Q
Rosacea pop
A
30-50, female
2
Q
rosacea cause
A
Demodex mite may play a role
terrain, genetics, poor digestion, toxic bowels
3
Q
rosacea sx
A
- mainly central face
- rhinophyma (M)
- erythema
- telangiectasia
- papulopustular, nodules, no comedones
4
Q
rosacea associated conditions
A
- 3x migraines
- iritis
- scleritis
- keratitis
- chalazia
- blepharoconjunctivitis
5
Q
rosacea TX
A
topical metronidazole: palliative
azelaic acid
benzoyl peroxide/clindamycin
oral antibiotics
sodium sulfacetamide
topical permethrin
Oral isotretinoin (Accutane)
low-dose doxycycline
topical tretinoin
anti-inflammatory diet
digestive enzymes, probiotics
acupuncture
homeopathy
6
Q
Perioral Dermatitis pop
A
16-45, women
7
Q
Perioral Dermatitis cause
A
unknown, aggravation by fluoride and sodium lauryl sulfate
terrain
8
Q
Perioral Dermatitis sx
A
papulopustular on erythematous base
occasional itching, burning, or feeling of tightness
9
Q
Perioral Dermatitis TX
A
topical-metronidazole, erythromycin, avoid topical glucocorticoids
Systemic- minocycline, doxycycline, tetracycline
avoid toothpaste with fluoride and sodium lauryl sulfate
anti-inflammatory/elimination diet
sauna, fasting
Botanical (Topicals): azelaic acid, green tea, tea tree oil, Calendula succus
Botanical (Internal): Silymarin, Berberine (barbarry, coptis, oregon grape, goldenseal), Chaseberry, Indian Gooseberry
Physical medicine: sun (start with 5 minutes a day), hot/cold contrast bath with green tea, calendula
Supplements to consider zinc/copper, chromium, selenium, omega 3 fatty acids, vitamin D
10
Q
Hidradenitis suppurativa RF
A
Obesity
Female sex
Smoking
Acne vulgaris
Inflammatory bowel disease
Low zinc level
SAD
11
Q
Hidradenitis suppurativa SX
A
Painful, papules and deep-seated nodules
open comedones with 2 or more openings to the surface in intertriginous areas
tender lesion in axillary, inguinal, intermammary and/or anogenital region
symmetrical
12
Q
early Hidradenitis suppurativa symptoms
A
- erythema
- burning
- itching
- discomfort
- hyperhidrosis
13
Q
mild hidradenitis suppurativa sx
A
- solitary nodule
- minimal pain
- no abscess
14
Q
moderate hidradenitis suppurativa sx
A
- multiple recurrent nodules
- pain affecting activities of daily living
- discharge or drainage
- abscess formation
15
Q
severe hidradenitis suppurativa sx
A
- diffuse abscess formation
- chronic draining sinus tracts
- chronic inflammation and scarring
16
Q
hidradenitis suppurativa test
A
consider-bacterial culture
biopsy
17
Q
hidradenitis suppurativa standard of care
A
tralesional injections of triamcinolone
Incise and drain acute abscesses
Oral antibiotics
Prednisone
Oral isotretinoin (Accutane)
18
Q
mild/moderate hidradenitis suppurativa TX
A
- Topical/oral antibiotic
- Consider surgical drainage
- Lifestyle change (Acne protocol)
19
Q
severe hidradenitis suppurativa TX
A
- topical/oral antibiotic
- Consider dapsone and/or prednsone
- Referral for surgical consult
- Lifestyle change (Acne protocol)
20
Q
hidradenitis suppurativa naturopathic tx
A
loose clothing
avoidance of heat, humidity, shaving, depilation, deodorants
warm compresses
elimination/anti-inflammatory diet
Detox: fasting, sauna, chelation
Botanical (Topicals): azelaic acid, green tea, tea tree oil, Calendula succus
Botanical (Internal): Silymarin, Berberine, Chaseberry, Indian Gooseberry
Physical medicine: sun (start with 5 minutes a day), hot/cold contrast bath with green tea, calendula
Supplements: zinc/copper, chromium, selenium, omega 3 fatty acids, vitamin D
21
Q
Contact Irritant Dermatitis cause
A
- Related to irritant exposure; anyone would have a similar reaction
- lime
- lip licking
- oven cleaner
- diesel mechanic chemicals
- diaper
22
Q
Contact Irritant Dermatitis RF
A
Strong skin irritant (acid, alkali, phenol)
Cumulative exposure degreasing protective lipid barrier on skin (i.e. dish pan hands)
White skin
History of Atopic Dermatitis
Occlusion (i.e. wet boots)
Mechanical irritant (i.e. brick layer)
23
Q
Contact Irritant Dermatitis sx
A
Burning and pain
Localized well-defined, redness, papules, swelling, blistering (vesicles/bullae)
24
Q
Contact Irritant Dermatitis DX
A
Natural light-Magnifying glass (10-20X)
Check for infection, lymph nodes
Culture if you suspect bacteria, virus, etc
10% KOH to R/O fungus
Woods lamp
Examine whole body
“Patch testing”, allergies testing, biopsy
25
Contact Irritant Dermatitis prevention
Avoid irritant or caustic chemical(s) by wearing protective gear
If contact does occur, wash with water or weak neutralizing solution
Barrier creams
26
Contact Irritant Dermatitis TX
powder (“Country Comfort Baby Powder”), Ointments (Calendula, Comfrey, vitamin A&D)
use wet soaks containing tap water, saline, colloidal oatmeal
wet dressing using gauze soaked in Burrow's solution
honey, olive oil and beeswax mixture
Topical Corticosteroids
5% urea cream
oral corticosteroids
27
Contact Allergic Dermatitis cause
- linalool
- Nickel sulfate(10-20%)
- Methylisothiazolinone
- Balsam of Peru
- Fragrance mix
- Thimerosal
- Sodium gold thiosulfate
- Formaldehyde
- Quaternium-15
- Cobalt chloride
- Bacitracin
- limonene
- poison oak or ivy
- chromium
- propolis
Type IV hypersensitivity
28
Contact Allergic Dermatitis SX
erythema, scaling, skin swelling, and sometimes blistering and ulceration
pruritus
burning pain
vesiculation to severe swelling with bullae
29
Contact Allergic Dermatitis DX
Natural light-Magnifying glass (10-20X)
Check for infection, lymph nodes
Culture if you suspect bacteria, virus, etc
10% KOH to R/O fungus
Woods lamp
Examine whole body
“Patch testing”, allergies testing, biopsy
30
Poison Ivy sx
- vesicles
- linear lesions
- bullae
31
Poison Ivy Tx
- Wash entire body with copious amounts of water
- Barrier creams (i.e. Stokogard, Ivy-block)
- Use Tecnu cleanser to remove urushiol
- Clothing, pets, etc need to be washed-wear vinyl gloves
- Cool compress-water, water/vinegar, saline
- topical or oral corticosteroid
- Antihistamine
- Trim fingernails
- Blow dryer-dries lesions, relieves itching
- Calendula lotion
- Calamine (zinc and ferric oxide)
- Burrow's solution (aluminum acetate)
- Etoh, Comfrey, mugwort and sea salt
- Oatmeal (Aveeno), starch, or vinegar bath
- Aloe gel/green clay
- Stellaria, Plantago, Impatiens, Grindelia, Sambucus, Hamamelis, Echinacea, lemon
- Homeopathy, acupuncture and moxa
32
Atopic Dermatitis pop
children
33
Atopic Dermatitis cause
inflammation of dermis and epidermis caused by a combination of immune system activation, genetics, environmental triggers, and stress
34
Atopic Dermatitis Sx
pruritus
cubital fosa, popliteal fossa, face, chest, back of arms,
35
infantile Atopic Dermatitis
- face, scalp, extensor surface
- child 2 month- 2 years
- red, finely vesicular, oozing, crusted, extremely pruritic
- excoriation and secondary infections
36
Childhood Atopic Dermatitis
- 2-12 yo
- antecubital and popliteal fossae, post neck
- erythema, papules, scaling, lichenified, patches of hypopigmentation, hair loss
- develop allergic rhinitis and asthma
37
Adult Atopic Dermatitis
- extends to neck, upper chest, hands, feet
- marked drying resembling ichthycosis
- intense pruritus
- itch-scratch-rash cycle
- Dennie-morgan infraorbital fold, thinning lateral eyebrows
38
Atopic Dermatitis associated conditions
- Cataracts
- Chelitis
- conjunctivitis
- Facial pallor or erythema
- Food intolerance
- hand dermatitis
- Ichthyosis
- immediate skin test reactivity
- infections
- Infraorbital fold (Dennie-morgan lines)
- itching when sweating
- keratoconus
- keratosis pilaris
- nipple dermatitis
- orbital darkening
- Pityriasis alba
- White dermographism
- wool allergy
39
Atopic Dermatitis triggers
Temperature Change and Sweating
Decreased Humidity (worse in winter)
Excessive Washing- (esp with Soap)
Contact w/ Irritating Sub (wool, lanolin, smoke, etc.)
Contact Allergy- (consider patch testing)
Aeroallergens- (dust mites, pollen, animals, etc)
Microbic Agents- (staph aureus, Pityrosporum)
Food- (see diet)
Reduced cAMP (polyamines, lack of exercise)
Emotional Stress- (recommend mediation)
40
Atopic Dermatitis ND TX
- Bleach bath or bath
-phage topically
- humidity in the house
- Light therapy
- oral Vit d
Diet
- ant-inflammatory diet
- elimination diet: reduce eggs, peanuts, milk, fish, soy, and wheat
- fasting and vegetarian diet
Supplements/Herbs
- omega-3
- Oolong tea
- Arctium Lappa
- Korean red ginseng
- Perilla leaf-
- St John’s wort
- Chinese herbs to clear heat/dry damp – Rhubarb, coptis, scute, phellodendron
- probiotics
- glutamine
41
Atopic Dermatitis TX
- Topical steroids
- oral steroids
- emollients
- antimicrobial
- topical clcineurin inhibitors
- cyclosporine
- azathioprine
-monoclonal antibody drug
42
Advantages of topical medications
- localized effect
- minimal systemic absorption
- avoids Gi and first-pass metabolism
43
Disadvantages of topical medication
- not an option for several compounds due to poor lipid solubility
- dosing is inaccurate
- formulation sensitives/localizes reactions
44
What effects the absorption of topical meds
- skin thickness at site of application
- total area of application
- frequency of application
- blood flow at the site of application
- chemical and physical properties of the drug and the vehicle
- warm, moist skin
45
Oral meds uses
- topical application is ineffective or unavailable
- systemic effects are desired
- topical application is impractical
46
Advantages of oral meds
- generally safe
- convenient
- economical
47
Disadvantages of oral meds
- some drugs have poor absorption
- systemic effects
- first-pass metabolism
- drug interactions
48
Advantages of Transdermal meds
- by pass first-pass metabolism
- convenient
- ideal for drugs that are lipophilic and have poor oral bioavailability
- ideal for drugs that are quickly eliminated from the body
49
Disadvantages of transdermal med
- localized dermal reactions
- has to be highly lipophilic
- may be delayed in delivery to the site of action
- limited to small dose
50
Corticosteroids MOA
suppression of eicosanoid synthesis by inhibition of phospholipase A2, suppression of immune cell activation and proliferation
51
Corticosteroids use
inflammatory lesions, including keloids, hemangiomas, acne cysts, stubborn psoriatic plaques, alopecia areata, etc.
acne
alopecia areata
atopic dermatitis
bites and stings
bullous pemphigoid
burns
52
route of administration of corticosteroids
topical
oral
intralesional
intranasal
53
AE of topical steroids
- atrophy, purpura
- telangiectasia
- facial eruptions
- hypopigmentation
- hypertrichosis
- withdrawal effects
- striae
- contact dermatitis
- worsening fungal infection
54
AE of oral steroids
- crushing's syndrome
- adrenal suppression
- growth retardation in children
- increased intraocular pressure
- increased risk of nasal and pharyngeal Candida Infection
- the effects of long-term use on bone density and risk of fracture are not clear
55
Corticosteroids in pregnancy
high potency is associated with lower birth weight, considered safe during pregnancy and lactation, based on limited data
56
Which corticosteroid has the lowest potency?
hydrocortisone
57
what are the oral corticosteroid?
prednisone and prednisolone
58
Intralesional corticosteroid uses
keloids
hemangiomas
acne cysts
stubborn psoriatic plaques
alopecia areata
59
intralesional corticosteroid AE
atrophy
hypopigmentation
telangiectasia
sterile abscesses
60
Azaleic acid use
acne
rosacea
hyperpigmentation
61
Azaleic acid MOA
combined anti-inflammatory, anti-bacterial, and keratolytic effects, inhibition of tyrosinase
62
Calcineurin Inhibitors MOA
prevents activation of T cells don’t differentiate or become active
63
Calcineurin Inhibitors use
severe lichen planus, contact allergic dermatitis, dyshidrotic eczema, perioral dermatitis, psoriasis, pyoderma gangrenosum, and vitiligo
atopic dermatitis
severe psoriasis
64
Calcineurin Inhibitors risks
can lead to cancer for long term use
65
Calcineurin Inhibitors oral side effects
nephrotoxic
neurotoxic
66
Biologic DMARDs route of administration
injection
67
Biologic DMARDs MOA
block TNFa
68
Neosporin contains
bacitracin, neomycin, polymyxin B
69
Bacitracin MOA
cell wall synthesis inhibitor
70
Neomycin MOA
bacterial protein synthesis inhibitor
71
polymyxin B MOA
bacterial membrane disruptor
72
Mupirocin drug class
topical antibiotic
73
Mupirocin MOA
binds to tRNA and disrupts protein synthesis
74
Mupirocin use
MRSA
Impetigo
75
Benzoyl peroxide MOA
kills bacteria by creating reactive oxygen species
76
Benzoyl peroxide use
acne
77
Benzoyl peroxide route of administration
topical
78
Sulfacetamide MOA
inhibits folate synthesis
79
Sulfacetamide route of administration
topical
oral
80
Sulfacetamide Use
acne
seborrheic dermatitis
81
Erythromycin MOA
bind to bacterial ribosomes and inhibits protein synthesis
82
Erythromycin Route of Administration
topical
oral
83
Erythromycin use
acne
84
Erythromycin AE
significant GI upset
major inhibitor of CYP3A4
hepatotoxicity
arrhythmia
85
Clindamycin MOA
bind to bacterial ribosomes and inhibit protein synthesis
86
Clindamycin route of administration
topical
oral
87
Clindamycin use
acne
other infections
88
Clindamycin AE
C. difficile
89
Metronidazole MOA
binds to bacterial DNA preventing protein synthesis and inducing DNA breaks
90
Metronidazole Route of Administration
oral
topical
91
Metronidazole side effects
carcinogen
92
Metronidazole cautions
ethanol use can cause abdominal pain, nausea, vomiting, headache, flushing
93
Dapsone use
Acne
Bullous pemphigoid
Pemphigus vulgaris
Dermatitis herpetiformis
Lichen planus
Pustular psoriasis
Pyoderma gangrenosum
94
Dapsone route of administration
oral
topical
95
Diclofenac Sodium drug class
NSAIDs
96
Diclofenac Sodium use
actinic keratosis
97
Diclofenac Sodium Mode of Administration
gel
98
acne vulgaris pop
12-25
99
acne vulgaris pathophysiology
Outlet narrows due to proliferation and accumulation of keratinocytes and skin edema
Sebum (composed of lipids and cell fragments) builds up in blocked follicle
Cutibacterium acnes (formerly Propionibacterium acnes) lives off sebum and proliferates in comedone
Inflammation of comedone results from leakage of sebum into the dermis and secretion of proinflammatory mediators, chemokines, and degradative enzymes by C. acnes
100
acne sx
papules or pustules or nodules or cysts red and central core
face, trunk, arms, back, upper chest, shoulders
101
acne tx ND
Diet: 100% grass fed pastured or wild meats, fish and eggs, vegetables, fruit, nuts, seeds, and tubers
Eliminate/reduce processed foods, diary, grain fed meat, chocolate, sunflower seeds, salt
Anti-inflammatory/elimination diet
Detox: fasting, sauna, chelation
Botanical (Topicals): azelaic acid, green tea, tea tree oil,
Calendula succus
Botanical (Internal): Berberine (barbarry, coptis, oregon grape, goldenseal), Chasteberry, Indian Gooseberry
Physical medicine: sun (start with 5 minutes a day), hot/cold contrast bath with green tea, calendula
Supplements to consider zinc/copper, chromium, selenium, omega 3 fatty acids, vitamin D
102
Acne Standard of Care
103
Seborrheic Dermatitis cause
Pityrosporum yeast (Malassezia), genetics, stress and dietary factors effect onset of disease
Pityosporum/Malassezia lipase activity releases inflammatory free fatty acids and activates the alternative complement pathway
103
Seborrheic Dermatitis pop
males>female (infancy, 20-50y.o.)
104
Seborrheic Dermatitis sx
The rash is red and scaly, except in skin folds, where it is red, smooth and glazed.
Sticky crusts and fissures are common when ear and scalp are involved. Dry or greasy scales.
Infantile (cradle cap) and adult forms (i.e. dandruff)
Scalp, eyebrows, eyelids, nasolabial fold, paranasal area, ears, sternum, inframammary fold, axilla, pubic area, gluteal and inguinal fold, and umbilicus
105
Seborrheic Dermatitis TX
Anti-inflammatory/elimination/detox diet
Zinc
B complex
niacin
biotin
EFA’s
Heliotherapy
Hydrotherapy, acupuncture, homeopathy, mediation
Topical
– Honey with water
- Shampoo: Biotin, selenium sulfide, zinc pyrithione, ketoconazole, tar, tea tree oil
- Gel: Aloe vera or metronidazole
- Cream: hydrocortisone, sulfur, pimecrolimus
- Eyelids: dilute baby shampoo on cotton swab
106
Pompholyx/ Dyshidrotic Eczema pop
female =male, 12-40
107
Pompholyx/ Dyshidrotic Eczema cause
Unknown etiology-possible association with stress, allergens, metals (Ni,Co,Cr)
108
Pompholyx/ Dyshidrotic Eczema sx
sudden onset of deep-seated pruritic, clear “tapioca-like” vesicles on palms and sides of fingers; later, scaling fissures, and lichenification can occur
2-4 weeks
can have infection associated
unilateral
109
Pompholyx/ Dyshidrotic Eczema TX
Anti-inflammatory/elimination/detox diet (Metals)
Wet astringent compresses with dilute vinegar, Hamamelis, or Burow’s soln (aluminum acetate)
Follow with Calendula and stellaria in a hypoallergenic cream (i.e. Eucerin, Nivea, etc.)
Heliotherapy 5min-1 hour daily
Acupuncture, homeopathy, herbal, meditation
Topical or intralesional triamcinolone
Prednisone, antibiotics with infection
110
“Id reaction”/Autosensitization Dermatitis cause
111
“Id reaction”/Autosensitization Dermatitis cause
release of cytokines that develop in a distal primary dermatitis, i.e. tinea pedis, stasis derm, etc.
111
“Id reaction”/Autosensitization Dermatitis sx
An itchy, dyshidrotic-like vesicular eruption on the fingers, forearms, thighs, legs, trunk
unilateral
112
“Id reaction”/Autosensitization Dermatitis tx
find the main cause
prednisone
113
Lichen Simplex Chronicus pop
114
Lichen Simplex Chronicus cause
unknown, stress,
Created and perpetuated by constant scratching and rubbing (itch-scratch-rash)
Initial cause may have been ACD, ICD, fungal, bug bite
115
Lichen Simplex Chronicus sx
Very thick plaques
Usually just one lesion
Severe itching
Last indefinitely
Recurs frequently
Lower legs, Scrotum, vulva, anus, pubis, Wrists, ankle, elbow, Upper eyelids, Back, side of neck, Ear-orifice and fold, and Scalp-picker’s nodules
116
Lichen Simplex Chronicus tx
Must stop “itch-scratch-rash” cycle
Occlusive barrier-unna (Zn oxide dressing-1 wk) and dome (Al) paste boot
Tranquilizer (herbal, nutritional), no coffee
Anti-inflammatory/elimination diet
Psychotherapy, hypnosis, relaxation exercises, mediation, homeopathy
Acupuncture
Topical glucocorticoid gauze dressing
Topical/intralesional Triamcinolone
Other options-Topical doxepin, oral hydroxyzine
117
Nummular Dermatitis Sx
coin-shaped plaques
Initial onset-closely grouped, small vesicles and papules that coalesce into plaques
Extensor aspects of extremities, buttock, breast, and posterior trunk
weeks to months
itching moderate to severe
118
Nummular Dermatitis Tx
- Topical steroids
- oral steroids
- emollients
- antimicrobial
- topical clcineurin inhibitors
- cyclosporine
- azathioprine
-monoclonal antibody drug
119
Nummular Dermatitis ND Tx
- Bleach bath or bath
-phage topically
- humidity in the house
- Light therapy
- oral Vit d
Diet
- ant-inflammatory diet
- elimination diet: reduce eggs, peanuts, milk, fish, soy, and wheat
- fasting and vegetarian diet
Supplements/Herbs
- omega-3
- Oolong tea
- Arctium Lappa
- Korean red ginseng
- Perilla leaf-
- St John’s wort
- Chinese herbs to clear heat/dry damp – Rhubarb, coptis, scute, phellodendron
- probiotics
- glutamine
120
Asteatotic Dermatitis pop
elderly, northern cold climates, low humidity
121
Asteatotic Dermatitis Sx
Dryness of the skin
Erythema, inflammation, and scaling
Lower anterolateral legs, trunk, upper extremity
porcelain pattern
bilateral
122
Asteatotic Dermatitis TX
- Topical steroids
- oral steroids
- emollients
- antimicrobial
- topical clcineurin inhibitors
- cyclosporine
- azathioprine
-monoclonal antibody drug
123
Asteatotic Dermatitis ND TX
- Bleach bath or bath
-phage topically
- humidity in the house
- Light therapy
- oral Vit d
Diet
- ant-inflammatory diet
- elimination diet: reduce eggs, peanuts, milk, fish, soy, and wheat
- fasting and vegetarian diet
Supplements/Herbs
- omega-3
- Oolong tea
- Arctium Lappa
- Korean red ginseng
- Perilla leaf-
- St John’s wort
- Chinese herbs to clear heat/dry damp – Rhubarb, coptis, scute, phellodendron
- probiotics
- glutamine
124
Stasis Dermatitis pop
women
125
Stasis Dermatitis cause
chronic venous insufficiency
HTN
diabetes
standing for long periods
FH
126
Stasis Dermatitis SX
lower extremities, associated with edema, varicosed and dilated veins, and hyperpigmentation
127
Stasis Dermatitis TX
Improve venous return thru cool water dressing, cool water walking, compression stockings, anti-inflammatory diet, herbs (ginkgo, aesculus, Centella)
Bland emollients(vasoline base)
Topical steroids
Oral antihistamines
Consider vein stripping or sclerotherapy
128
venous leg ulcers TX
unna boot
manuka honey
pycnogenol
walking
129
hydroxyzine MOA
blocking H1 receptors on afferent nerve fibers
130
hydroxyzine CI
older patients
131
Diphenhydramine MOA
blocking H1 receptors on afferent nerve fibers
132
Diphenhydramine route
oral
topical
133
Diphenhydramine CI
older patients
134
Hydroxyzine route
oral
135
antihistamines drugs
Hydroxyzine
Diphenhydramine
136
what are antihistamines use for in skin conditions
pruritis
137
antiviral drugs
acyclovir
valcyclovir
138
acyclovir and valcyclovir AE
headache
malaise
GI upset
139
acyclovir and valcyclovir use
HSV
HZV
140
acyclovir and valcyclovir route
topical
oral
141
acyclovir moa
affect viral replication
142
antifungal drugs
azoles
nystatin
gentian violet
griseofulvin
terbinafine
143
azoles
Ketoconazole
Fluconazole
144
fluconazole MOA
inhibit ergosterol synthesis
145
fluconazole use
most effective against Candida
146
Fluconazole route
oral
147
Fluconazole CI/Cautions
strong CYP2C19 inhibitor
moderate 2C9, 3A4/5, UGT inhibitor
148
Fluconazole AE
- GI disturbance
- hepatotoxicity
- drug interactions
149
Ketoconazole MOA
inhibit ergosterol synthesis
150
Ketoconazole route
oral
topical
151
Ketoconazole AE
oral and IV
- GI disturbance
- hepatotoxicity
- drug interactions
topical
- local hypersensitivity reactions
152
Ketoconazole use
Candidiasis
Tinea infections
153
Ketoconazole caution
strong 3A4 inhibitor
154
Nystatin MOA
binds to ergosterol in the cell membrane inducing instability, disrupt cell wall
155
Nystatin route
topical
oral (swish and spit)
156
Nystatin AE
oral
- GI disturbance
topical
- local hypersensitivity reactions
157
Nystatin use
Candida infections
oral candida
vaginal candida
158
Gentian Violet MOA
DNA binding preventing cell division
159
Gentian Violet use
topical for thrush, onychomycosis
active against both bacteria and fungi
160
Griseofulvin MOA
binds to microtubules, thereby preventing cell division
161
Griseofulvin route
oral
162
Griseofulvin use
dermatophytosis of the scalp and hair
163
Terbinafine route
topical
oral
164
Terbinafine use
- tinea pedis
- tinea corporis
- tinea cruris
- tinea versicolor
Oral
- fungal infections of the nail
- tinea capitis
165
antiparasitic
Permethrin
Ivermectin
166
Permethrin route
topical
167
Permethrin uses
rosacea
168
Ivermectin route
topical
oral
169
Ivermectin use
lice
scabies
rosacea- topical
170
Ivermectin AE
pruritis
lymphadenitis
arthralgia
fever
edema
GI upset
increase liver enzyme
171
antineoplastic agents
5-fluorouracil
172
5-fluorouracil moa
nucleotide analog that interferes with DNA synthesis, preventing cell proliferation
173
5-Fluorouracil route
topical
174
5-Fluorouracil use
actinic keratosis
superficial BCC
cutaneous warts
175
5-Fluorouracil AE
- Sinusitis
- Headache
- Pigmented changes
- Edema
- Skin erosion
- Erythema
- Drying
- Scaling
- pregnancy
176
chemical peels
glycolic acid
177
glycolic acid moa
acts as keratolytic
178
Glycolic Acid AE
skin irritation
pruritis
erythema
179
Glycolic Acid use
hyperpigmentation
180
Ethinylestradiol MOA
inhibits ovarian androgens production and may inhibit androgen action in the sebaceous gland
181
Ethinylestradiol use
acne
hidradenitis suppurativa
182
Ethinylestradiol route
oral
183
Ethinylestradiol AE
blood clots
184
Drospirenone use
acne
185
Drospirenone pharm class
progestins
186
Ethinylestradiol pharm class
estrogen
187
Levonorgestrel IUD CI
acne
188
hydroquinone moa
inhibits tryosinase
189
Hydroquinone route
topical
190
Hydroquinone AE
erythema
stinging
desquamation
191
Hydroquinone use
hyperpigmentation
192
Spironolatone MOA
blocks androgen receptors and inhibits androgen biosynthesis
193
Spironolactone use
acne
hirsutism
hidradenitis suppurativa
transgender care
194
Spironolactone AE
hypotension
hyperkalemia
195
Imiquimod moa
binds to TLE7/8 which activates NF-kappa-B, leading to a Th1 response
196
Imiquimod route
topical
197
Imiquimod use
actinic keratosis
warts
superficial BCC
198
Imiquimod AE
local inflammatory reactions
photosensitivity
systemic reactions
caution in patients with autoimmune disease
not used for oral, nasal, intravaginal, or ophthalmic uses
199
Keratolytics drugs
trichloroaceic acid
salicylic acid
methyl aminolevulinate
aminolevulinic acid
200
Trichloroacetic acid MOA
precipitation of intercellular proteins
201
Trichloroacetic acid route
topical- physician performed
202
Trichloroacetic acid AE
chemical burns if applied to health tissue
203
Salicylic acid MOA
solubilization of inter-cellular matrix, reducing cellular adhesions
204
Salicylic acid route
topical
205
Salicylic acid use
acne
callouses and corns
keratosis pilaris
psoriasis
warts
hyperpigmentation conditions
206
Salicylic acid AE
skin sensitivity and burning
tinnitus
confusion
hyperventilation
salicylate hypersensitivity reactions
207
Lidocaine use
pruritis
pain
208
Lidocaine route
topical
209
Lidocaine AE
seizure
cardia arrest
respiratory depression
210
retinoids drugs
tretinoin
isotretinoin
acitretin
211
Tretinoin MOA
bind to intracellular retinoic acid receptors and retinoid x receptors and bound complex causes changes in gene transcription
anti-inflammatory, keratolytic, and reduce sebum production
reduce post-inflammatory hyperpigmentation
212
Tretinoin route
topical
213
Tretinoin use
normalize follicular hyperkeratosis
acne
hidradenitis suppurativa
milia
psoriasis
rosacea
hyperpigmentation
214
Tretinoin AE
skin irritation
dryness
flakiness
pregnancy
215
Isotretinoin MOA
decreasing sebocyte proliferation and causing apoptosis of sebocytes
increase p53 inhibits IGF-1 signaling, inhibit sebocyte differentiation, sebocyte apoptosis, reduce inflammation
216
Isotretinoin route
topical
217
Isotretinoin use
serve recalcitrant nodular acne
cutaneous t-cell lymphomas
neuroblastomas
prevention of SCC
218
Isotretinoin AE
cheilitis
dry skin
dry eyes
pruritis
vision changes
hepatotoxicity
photosensitivity
increased triglyceride levels
myalgias
depression
IBD
pregnancy
219
Acitretin MOA
antiproliferative, anti-inflammatory, and normalizes keratinocyte differentiation
220
Acitretin use
severe psoriasis
221
Acitretin AE
pregnancy
222
calcipotriol moa
bind to Vit D receptors, inhibiting cell proliferation and enhancing cell differentiation
reduce inflammation by inhibiting T cell proliferation and production of cytokines
inhibits keratinocyte proliferation and abnormal differentiation
223
Calcipotriol route
topical
224
Calcipotriol use
psoriasis
225
Calcipotriol AE
skin irritation
hypercalcemia
226
Polymorphous Light Eruption pop
All races, Females>male, around age 20
227
Polymorphous Light Eruption cause
Delayed abnormal reaction to UV radiation
Spring, early summer – 2-24 hours after 1st exposure – last 7-10 days
228
Polymorphous Light Eruption sx
Morphologic skin types can vary: vesicles, papule, erythematous macules, plaques
229
Polymorphous Light Eruption TX
Prevention: sun block should be used, but not always helpful
beta-carotene, 60 mg tid 2 weeks before sun
Niacinamide, 2-3 g/day helped 60% of pts in one study
Vit B-6, 150-200 mg, taken 30 minutes before sun, or 100 mg/hr for 8-10 hours before sun (case reports-Gaby)
Consider antimalarial drugs
phototherapy
230
Drug-related Eczema cause
Any drug, nutriceutical or herb, almost without exception, is capable of causing a skin eruption.
231
Drug-related Eczema SX
Any sudden fixed, symmetrical, or generalized skin eruption should be questioned
232
Drug-related Eczema TX
identify and eliminate
233
psoriasis pop
white, 40, male and female, FH
234
Psoriasis trigger
physical trauma (koebner phenomenon)
infections
stress
systemic glucocorticoids, oral lithium, antimalarial drugs, systemic interferon, Beta blockers, alcohol
incomplete protein digestion
excessive animal protein consumption
food allergies/increased intestinal permeability
bowel toxemia
stressed liver
deficient EFA
deficient vit D and sunlight
235
Plaque psoriasis triggers
genetics
HLA types-HLA-B13, B17,Bw57, HLACw6
Alteration of the cell kinetics of Keratinocytes likely due to abnormal T lymphocyte function/communication
increased cell cycle
236
Plaque Psoriasis Sx
light-skinned: red or pink often silvery white scales
darker-skin: silvery white scale, violet,
papules and plaques, sharply marginated
Removal of scales-reveals punctate bleeding called auspitz’s sign
itching
237
plaque psoriasis complications
develop arthritis
nail pitting, oil spot lesions, onycholysis
238
guttate pop
child or young adult
239
guttate cause
group A streptococcal pharyngitis or viral infection
240
guttate sx
red, scaly, small, teardrop-shaped spots. It doesn't normally leave a scar.
sudden onset
241
guttate psoriasis management
3-4 month self-resolve
no antibiotics
242
Pustular psoriasis sx
skin to redden, swell and become covered by tender, pus-filled blisters that are called pustules. The pus inside pustules is a noninfectious, whitish fluid.
hands and feet
243
inverse psoriasis sx
painful
skin folds, armpits, genitals, under breasts or buttocks
244
Erythrodermic psoriasis sx
peeling rash across the entire surface of the body
itch or burn
spreads quickly
245
Erythrodermic psoriasis cause
severe sunburn, infection, excessive alcohol consumption, taking or stopping oral steroids, skin trauma from surgery or injury, reaction to medication
246
Psoriasis TX
ID and eliminate triggers
reduce bowel toxemia
- bile acids
- HCL
- apple cider vinegar
- bitters
- healthy diet
- bioflavonoids
- Anit-inflammatory diet
- fasting
- vegetarian diet
- Vit A
- probiotics
- chelation
diet
- gluten free diet
- High intake of omega-3, fasting, low-calorie and vegetarian diets
- fasting
supplements
- Vitamin D2
- Fish oil
- Vitamin A
- Vitamin E
- Vitamin C
- Zinc
- Selenium
- Chromium
- Flavonoid extracts
- Bile acids
- Water-soluble fiber (psyllium, pectin, guar gum, etc.): 5g at bedtime (binds endotoxins, decreases bowel transit time)
Botanicals
- Milk Thistle
- curcuma longa
- aloe vera
- nigella sativa
- rubia cordifolia
- smilax china
- thespesia populnea
- wrightia tinctoria
- cassie tora
- scutellaria baicalensis
- pongamia pinnata
- taraxacum
- uritca
- capsaicin
- licorice
- chamomile
- EPO
- castor oil
- honey
Physical modalities
- phototherapy
- natural sunlight
- narrow-band UVB
- PUVA
Pharmaceuticals
- topical
- Vit D3
- steroids
- tar
- retinoids
- anthralin
- salicylic acid
- fumaric acid
- tacrolimus
- pimecrolimus
- internal
- methotrexate
- apremilast
- biologics
- retinoids
- cyclosporine
247
Pityriasis rosea cause
unknown
viral origin
248
Pityriasis rosea pop
10-35 yo
249
Pityriasis rosea sx
pruritus
Herald Patch (80%)1-10 cm, pre-dates the reminder of the other lesions by hours to 14 days
5% have fever, malaise, headache, and arthralgia
250
Pityriasis rosea DX
anti-streptolysin test
251
Pityriasis rosea tx
If mild-severe itch: natural sunlight, UVB, colloidal oatmeal, emollients, topical/oral antihistamines
Severe cases-oral steroids rarely
Acupuncture, homeopathy, herbal, diet, etc.
252
Lichen planus sx
purplish, itchy, flat bumps that develop over several weeks
skin, hair, nails, and mucous membrane
253
Lichen planus cause
fam hx, viral, bacterial, stress, drugs, liver disease
254
Lichen planus pop
30-60, females>males
255
Lichen planus SX
pruritic, planar (flat-topped), polygonal, purple papules, 2-10mm in diameter
Surface scales are lacy (reticulated) fine white lines called “Wickham’s striae”
wrists (mc), forearm, ankles, ant legs, lumbar regions, and genitals
256
Lichen planus TX
ID/Eliminate Triggering Factors
Diet Recommendations (anti-inflammatory diet, increased fish oil, high quality fats,)
Nutritional Supplements (Vit A, Vit E, Zinc, Quercetin, EPA, probiotics)
Physical modalities (phototherapy)
Topical Treatments (topical steroids, cardiospermum cream; Eucerin, Nivea with Calendula oil and Stellaria media; Glycyrrhetinic acid; Chamomile and Witch Hazel preparations; aloe vera (in mouth))
Pharmaceuticals (oral steroids)
257
Lichen planus triggers
viral, bacterial, stress, liver disease, inflammatory diet
mercury amalgam, copper, gold
ACE inhibitors, antiarthritic, antibiotic, antimalarial, antitubercular, chelators, color film developer, diuretic, hypoglycemic agents
258
Erythema Multiforme Syndrome pop
under 20, up to 40, male,
259
Erythema Multiforme Syndrome triggers
Sulfonamides, phenytoin, barbiturates, phenylbutazone, penicillin, allopurinol
Hep B vaccine
ACD-tattoos
Infection: Especially following herpes simplex, mycoplasma, EBV, cytomegalovirus
Idiopathic: more than 50%
260
Erythema Multiforme Syndrome sx
Dull red, Iris or targetlike lesions, macules to papules, localized or generalized, often symmetric
back of hands, palms, face, eyes
can be severe so they can’t swallow
261
Erythema Multiforme Syndrome TX
ID triggers and Tx
topical steroids or oral steroids for moderate-severe
262
Erythema nodosum sx
painful red swollen nodules on the extensor aspect of the extremities.
Prodrome: fever, malaise, later arthralgias, arthritis and hilar adenopathy
263
Erythema nodosum cause
Acute inflammatory/ immunologic rx of subcutaneous fat, bacterial, fungal, viral, drugs, malignancies, misc, and idiopathic(50%)
sore throat triggered
264
Erythema nodosum pop
female, any age, 18-34
265
Erythema nodosum DX
CBC-leukocytosis in most cases
Antistreptolysin-O titer
Chest x-ray
Consider tuberculin skin test
266
Erythema nodosum TX
ID and treat
elevating legs, compression dressings and wet bandages
potassium iodide
Oral steroids
267
Ecthyma
ulcerative impetigo
268
folliculitis
superficial hair follicle
269
furuncles
deeper hair follicle infection
270
Carbuncles
several adjoining follicles
Dermatology
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