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Dermatology > Test 3 > Flashcards

Test 3 Flashcards

1
Q

Rosacea pop

A

30-50, female

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2
Q

rosacea cause

A

Demodex mite may play a role
terrain, genetics, poor digestion, toxic bowels

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3
Q

rosacea sx

A
  • mainly central face
  • rhinophyma (M)
  • erythema
  • telangiectasia
  • papulopustular, nodules, no comedones
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4
Q

rosacea associated conditions

A
  • 3x migraines
  • iritis
  • scleritis
  • keratitis
  • chalazia
  • blepharoconjunctivitis
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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

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6
Q

Perioral Dermatitis pop

A

16-45, women

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7
Q

Perioral Dermatitis cause

A

unknown, aggravation by fluoride and sodium lauryl sulfate
terrain

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8
Q

Perioral Dermatitis sx

A

papulopustular on erythematous base
occasional itching, burning, or feeling of tightness

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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

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10
Q

Hidradenitis suppurativa RF

A

Obesity
Female sex
Smoking
Acne vulgaris
Inflammatory bowel disease
Low zinc level
SAD

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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

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12
Q

early Hidradenitis suppurativa symptoms

A
  • erythema
  • burning
  • itching
  • discomfort
  • hyperhidrosis
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13
Q

mild hidradenitis suppurativa sx

A
  • solitary nodule
  • minimal pain
  • no abscess
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14
Q

moderate hidradenitis suppurativa sx

A
  • multiple recurrent nodules
  • pain affecting activities of daily living
  • discharge or drainage
  • abscess formation
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15
Q

severe hidradenitis suppurativa sx

A
  • diffuse abscess formation
  • chronic draining sinus tracts
  • chronic inflammation and scarring
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16
Q

hidradenitis suppurativa test

A

consider-bacterial culture
biopsy

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17
Q

hidradenitis suppurativa standard of care

A

tralesional injections of triamcinolone
Incise and drain acute abscesses
Oral antibiotics
Prednisone
Oral isotretinoin (Accutane)

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18
Q

mild/moderate hidradenitis suppurativa TX

A
  • Topical/oral antibiotic
  • Consider surgical drainage
  • Lifestyle change (Acne protocol)
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19
Q

severe hidradenitis suppurativa TX

A
  • topical/oral antibiotic
  • Consider dapsone and/or prednsone
  • Referral for surgical consult
  • Lifestyle change (Acne protocol)
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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

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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
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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)

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23
Q

Contact Irritant Dermatitis sx

A

Burning and pain
Localized well-defined, redness, papules, swelling, blistering (vesicles/bullae)

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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

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25
Q

Contact Irritant Dermatitis prevention

A

Avoid irritant or caustic chemical(s) by wearing protective gear
If contact does occur, wash with water or weak neutralizing solution
Barrier creams

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26
Q

Contact Irritant Dermatitis TX

A

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

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27
Q

Contact Allergic Dermatitis cause

A
  • 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
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28
Q

Contact Allergic Dermatitis SX

A

erythema, scaling, skin swelling, and sometimes blistering and ulceration
pruritus
burning pain
vesiculation to severe swelling with bullae

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29
Q

Contact Allergic 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

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30
Q

Poison Ivy sx

A
  • vesicles
  • linear lesions
  • bullae
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31
Q

Poison Ivy Tx

A
  • 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
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32
Q

Atopic Dermatitis pop

A

children

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33
Q

Atopic Dermatitis cause

A

inflammation of dermis and epidermis caused by a combination of immune system activation, genetics, environmental triggers, and stress

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34
Q

Atopic Dermatitis Sx

A

pruritus
cubital fosa, popliteal fossa, face, chest, back of arms,

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35
Q

infantile Atopic Dermatitis

A
  • face, scalp, extensor surface
  • child 2 month- 2 years
  • red, finely vesicular, oozing, crusted, extremely pruritic
  • excoriation and secondary infections
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36
Q

Childhood Atopic Dermatitis

A
  • 2-12 yo
  • antecubital and popliteal fossae, post neck
  • erythema, papules, scaling, lichenified, patches of hypopigmentation, hair loss
  • develop allergic rhinitis and asthma
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37
Q

Adult Atopic Dermatitis

A
  • extends to neck, upper chest, hands, feet
  • marked drying resembling ichthycosis
  • intense pruritus
  • itch-scratch-rash cycle
  • Dennie-morgan infraorbital fold, thinning lateral eyebrows
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38
Q

Atopic Dermatitis associated conditions

A
  • 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
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39
Q

Atopic Dermatitis triggers

A

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)

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40
Q

Atopic Dermatitis ND TX

A
  • 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
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41
Q

Atopic Dermatitis TX

A
  • Topical steroids
  • oral steroids
  • emollients
  • antimicrobial
  • topical clcineurin inhibitors
  • cyclosporine
  • azathioprine
    -monoclonal antibody drug
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42
Q

Advantages of topical medications

A
  • localized effect
  • minimal systemic absorption
  • avoids Gi and first-pass metabolism
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43
Q

Disadvantages of topical medication

A
  • not an option for several compounds due to poor lipid solubility
  • dosing is inaccurate
  • formulation sensitives/localizes reactions
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44
Q

What effects the absorption of topical meds

A
  • 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
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45
Q

Oral meds uses

A
  • topical application is ineffective or unavailable
  • systemic effects are desired
  • topical application is impractical
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46
Q

Advantages of oral meds

A
  • generally safe
  • convenient
  • economical
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47
Q

Disadvantages of oral meds

A
  • some drugs have poor absorption
  • systemic effects
  • first-pass metabolism
  • drug interactions
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48
Q

Advantages of Transdermal meds

A
  • 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
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49
Q

Disadvantages of transdermal med

A
  • localized dermal reactions
  • has to be highly lipophilic
  • may be delayed in delivery to the site of action
  • limited to small dose
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50
Q

Corticosteroids MOA

A

suppression of eicosanoid synthesis by inhibition of phospholipase A2, suppression of immune cell activation and proliferation

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51
Q

Corticosteroids use

A

inflammatory lesions, including keloids, hemangiomas, acne cysts, stubborn psoriatic plaques, alopecia areata, etc.
acne
alopecia areata
atopic dermatitis
bites and stings
bullous pemphigoid
burns

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52
Q

route of administration of corticosteroids

A

topical
oral
intralesional
intranasal

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53
Q

AE of topical steroids

A
  • atrophy, purpura
  • telangiectasia
  • facial eruptions
  • hypopigmentation
  • hypertrichosis
  • withdrawal effects
  • striae
  • contact dermatitis
  • worsening fungal infection
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54
Q

AE of oral steroids

A
  • 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
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55
Q

Corticosteroids in pregnancy

A

high potency is associated with lower birth weight, considered safe during pregnancy and lactation, based on limited data

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56
Q

Which corticosteroid has the lowest potency?

A

hydrocortisone

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57
Q

what are the oral corticosteroid?

A

prednisone and prednisolone

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58
Q

Intralesional corticosteroid uses

A

keloids
hemangiomas
acne cysts
stubborn psoriatic plaques
alopecia areata

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59
Q

intralesional corticosteroid AE

A

atrophy
hypopigmentation
telangiectasia
sterile abscesses

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60
Q

Azaleic acid use

A

acne
rosacea
hyperpigmentation

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61
Q

Azaleic acid MOA

A

combined anti-inflammatory, anti-bacterial, and keratolytic effects, inhibition of tyrosinase

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62
Q

Calcineurin Inhibitors MOA

A

prevents activation of T cells don’t differentiate or become active

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63
Q

Calcineurin Inhibitors use

A

severe lichen planus, contact allergic dermatitis, dyshidrotic eczema, perioral dermatitis, psoriasis, pyoderma gangrenosum, and vitiligo
atopic dermatitis
severe psoriasis

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64
Q

Calcineurin Inhibitors risks

A

can lead to cancer for long term use

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65
Q

Calcineurin Inhibitors oral side effects

A

nephrotoxic
neurotoxic

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66
Q

Biologic DMARDs route of administration

A

injection

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67
Q

Biologic DMARDs MOA

A

block TNFa

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68
Q

Neosporin contains

A

bacitracin, neomycin, polymyxin B

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69
Q

Bacitracin MOA

A

cell wall synthesis inhibitor

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70
Q

Neomycin MOA

A

bacterial protein synthesis inhibitor

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71
Q

polymyxin B MOA

A

bacterial membrane disruptor

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72
Q

Mupirocin drug class

A

topical antibiotic

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73
Q

Mupirocin MOA

A

binds to tRNA and disrupts protein synthesis

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74
Q

Mupirocin use

A

MRSA
Impetigo

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75
Q

Benzoyl peroxide MOA

A

kills bacteria by creating reactive oxygen species

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76
Q

Benzoyl peroxide use

A

acne

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77
Q

Benzoyl peroxide route of administration

A

topical

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78
Q

Sulfacetamide MOA

A

inhibits folate synthesis

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79
Q

Sulfacetamide route of administration

A

topical
oral

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80
Q

Sulfacetamide Use

A

acne
seborrheic dermatitis

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81
Q

Erythromycin MOA

A

bind to bacterial ribosomes and inhibits protein synthesis

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82
Q

Erythromycin Route of Administration

A

topical
oral

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83
Q

Erythromycin use

A

acne

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84
Q

Erythromycin AE

A

significant GI upset
major inhibitor of CYP3A4
hepatotoxicity
arrhythmia

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85
Q

Clindamycin MOA

A

bind to bacterial ribosomes and inhibit protein synthesis

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86
Q

Clindamycin route of administration

A

topical
oral

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87
Q

Clindamycin use

A

acne
other infections

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88
Q

Clindamycin AE

A

C. difficile

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89
Q

Metronidazole MOA

A

binds to bacterial DNA preventing protein synthesis and inducing DNA breaks

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90
Q

Metronidazole Route of Administration

A

oral
topical

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91
Q

Metronidazole side effects

A

carcinogen

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92
Q

Metronidazole cautions

A

ethanol use can cause abdominal pain, nausea, vomiting, headache, flushing

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93
Q

Dapsone use

A

Acne
Bullous pemphigoid
Pemphigus vulgaris
Dermatitis herpetiformis
Lichen planus
Pustular psoriasis
Pyoderma gangrenosum

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94
Q

Dapsone route of administration

A

oral
topical

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95
Q

Diclofenac Sodium drug class

A

NSAIDs

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96
Q

Diclofenac Sodium use

A

actinic keratosis

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97
Q

Diclofenac Sodium Mode of Administration

A

gel

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98
Q

acne vulgaris pop

A

12-25

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99
Q

acne vulgaris pathophysiology

A

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 Propionibacteriumacnes) 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

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100
Q

acne sx

A

papules or pustules or nodules or cysts red and central core
face, trunk, arms, back, upper chest, shoulders

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101
Q

acne tx ND

A

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

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102
Q

Acne Standard of Care

A
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103
Q

Seborrheic Dermatitis cause

A

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

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103
Q

Seborrheic Dermatitis pop

A

males>female (infancy, 20-50y.o.)

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104
Q

Seborrheic Dermatitis sx

A

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

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105
Q

Seborrheic Dermatitis TX

A

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

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106
Q

Pompholyx/ Dyshidrotic Eczema pop

A

female =male, 12-40

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107
Q

Pompholyx/ Dyshidrotic Eczema cause

A

Unknown etiology-possible association with stress, allergens, metals (Ni,Co,Cr)

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108
Q

Pompholyx/ Dyshidrotic Eczema sx

A

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
Q

Pompholyx/ Dyshidrotic Eczema TX

A

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
Q

“Id reaction”/Autosensitization Dermatitis cause

A
111
Q

“Id reaction”/Autosensitization Dermatitis cause

A

release of cytokines that develop in a distal primary dermatitis, i.e. tinea pedis, stasis derm, etc.

111
Q

“Id reaction”/Autosensitization Dermatitis sx

A

An itchy, dyshidrotic-like vesicular eruption on the fingers, forearms, thighs, legs, trunk

unilateral

112
Q

“Id reaction”/Autosensitization Dermatitis tx

A

find the main cause
prednisone

113
Q

Lichen Simplex Chronicus pop

A
114
Q

Lichen Simplex Chronicus cause

A

unknown, stress,

Created and perpetuated by constant scratching and rubbing (itch-scratch-rash)

Initial cause may have been ACD, ICD, fungal, bug bite

115
Q

Lichen Simplex Chronicus sx

A

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
Q

Lichen Simplex Chronicus tx

A

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
Q

Nummular Dermatitis Sx

A

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
Q

Nummular Dermatitis Tx

A
  • Topical steroids
  • oral steroids
  • emollients
  • antimicrobial
  • topical clcineurin inhibitors
  • cyclosporine
  • azathioprine
    -monoclonal antibody drug
119
Q

Nummular Dermatitis ND Tx

A
  • 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
Q

Asteatotic Dermatitis pop

A

elderly, northern cold climates, low humidity

121
Q

Asteatotic Dermatitis Sx

A

Dryness of the skin

Erythema, inflammation, and scaling

Lower anterolateral legs, trunk, upper extremity

porcelain pattern

bilateral

122
Q

Asteatotic Dermatitis TX

A
  • Topical steroids
  • oral steroids
  • emollients
  • antimicrobial
  • topical clcineurin inhibitors
  • cyclosporine
  • azathioprine
    -monoclonal antibody drug
123
Q

Asteatotic Dermatitis ND TX

A
  • 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
Q

Stasis Dermatitis pop

A

women

125
Q

Stasis Dermatitis cause

A

chronic venous insufficiency

HTN

diabetes

standing for long periods

FH

126
Q

Stasis Dermatitis SX

A

lower extremities, associated with edema, varicosed and dilated veins, and hyperpigmentation

127
Q

Stasis Dermatitis TX

A

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
Q

venous leg ulcers TX

A

unna boot
manuka honey
pycnogenol
walking

129
Q

hydroxyzine MOA

A

blocking H1 receptors on afferent nerve fibers

130
Q

hydroxyzine CI

A

older patients

131
Q

Diphenhydramine MOA

A

blocking H1 receptors on afferent nerve fibers

132
Q

Diphenhydramine route

A

oral
topical

133
Q

Diphenhydramine CI

A

older patients

134
Q

Hydroxyzine route

A

oral

135
Q

antihistamines drugs

A

Hydroxyzine
Diphenhydramine

136
Q

what are antihistamines use for in skin conditions

A

pruritis

137
Q

antiviral drugs

A

acyclovir
valcyclovir

138
Q

acyclovir and valcyclovir AE

A

headache
malaise
GI upset

139
Q

acyclovir and valcyclovir use

A

HSV
HZV

140
Q

acyclovir and valcyclovir route

A

topical
oral

141
Q

acyclovir moa

A

affect viral replication

142
Q

antifungal drugs

A

azoles
nystatin
gentian violet
griseofulvin
terbinafine

143
Q

azoles

A

Ketoconazole
Fluconazole

144
Q

fluconazole MOA

A

inhibit ergosterol synthesis

145
Q

fluconazole use

A

most effective against Candida

146
Q

Fluconazole route

A

oral

147
Q

Fluconazole CI/Cautions

A

strong CYP2C19 inhibitor
moderate 2C9, 3A4/5, UGT inhibitor

148
Q

Fluconazole AE

A
  • GI disturbance
  • hepatotoxicity
  • drug interactions
149
Q

Ketoconazole MOA

A

inhibit ergosterol synthesis

150
Q

Ketoconazole route

A

oral
topical

151
Q

Ketoconazole AE

A

oral and IV
- GI disturbance
- hepatotoxicity
- drug interactions

topical
- local hypersensitivity reactions

152
Q

Ketoconazole use

A

Candidiasis
Tinea infections

153
Q

Ketoconazole caution

A

strong 3A4 inhibitor

154
Q

Nystatin MOA

A

binds to ergosterol in the cell membrane inducing instability, disrupt cell wall

155
Q

Nystatin route

A

topical
oral (swish and spit)

156
Q

Nystatin AE

A

oral
- GI disturbance

topical
- local hypersensitivity reactions

157
Q

Nystatin use

A

Candida infections
oral candida
vaginal candida

158
Q

Gentian Violet MOA

A

DNA binding preventing cell division

159
Q

Gentian Violet use

A

topical for thrush, onychomycosis
active against both bacteria and fungi

160
Q

Griseofulvin MOA

A

binds to microtubules, thereby preventing cell division

161
Q

Griseofulvin route

A

oral

162
Q

Griseofulvin use

A

dermatophytosis of the scalp and hair

163
Q

Terbinafine route

A

topical
oral

164
Q

Terbinafine use

A
  • tinea pedis
  • tinea corporis
  • tinea cruris
  • tinea versicolor

Oral
- fungal infections of the nail
- tinea capitis

165
Q

antiparasitic

A

Permethrin
Ivermectin

166
Q

Permethrin route

A

topical

167
Q

Permethrin uses

A

rosacea

168
Q

Ivermectin route

A

topical
oral

169
Q

Ivermectin use

A

lice
scabies
rosacea- topical

170
Q

Ivermectin AE

A

pruritis
lymphadenitis
arthralgia
fever
edema
GI upset
increase liver enzyme

171
Q

antineoplastic agents

A

5-fluorouracil

172
Q

5-fluorouracil moa

A

nucleotide analog that interferes with DNA synthesis, preventing cell proliferation

173
Q

5-Fluorouracil route

A

topical

174
Q

5-Fluorouracil use

A

actinic keratosis
superficial BCC
cutaneous warts

175
Q

5-Fluorouracil AE

A
  • Sinusitis
  • Headache
  • Pigmented changes
  • Edema
  • Skin erosion
  • Erythema
  • Drying
  • Scaling
  • pregnancy
176
Q

chemical peels

A

glycolic acid

177
Q

glycolic acid moa

A

acts as keratolytic

178
Q

Glycolic Acid AE

A

skin irritation
pruritis
erythema

179
Q

Glycolic Acid use

A

hyperpigmentation

180
Q

Ethinylestradiol MOA

A

inhibits ovarian androgens production and may inhibit androgen action in the sebaceous gland

181
Q

Ethinylestradiol use

A

acne
hidradenitis suppurativa

182
Q

Ethinylestradiol route

A

oral

183
Q

Ethinylestradiol AE

A

blood clots

184
Q

Drospirenone use

A

acne

185
Q

Drospirenone pharm class

A

progestins

186
Q

Ethinylestradiol pharm class

A

estrogen

187
Q

Levonorgestrel IUD CI

A

acne

188
Q

hydroquinone moa

A

inhibits tryosinase

189
Q

Hydroquinone route

A

topical

190
Q

Hydroquinone AE

A

erythema
stinging
desquamation

191
Q

Hydroquinone use

A

hyperpigmentation

192
Q

Spironolatone MOA

A

blocks androgen receptors and inhibits androgen biosynthesis

193
Q

Spironolactone use

A

acne
hirsutism
hidradenitis suppurativa
transgender care

194
Q

Spironolactone AE

A

hypotension
hyperkalemia

195
Q

Imiquimod moa

A

binds to TLE7/8 which activates NF-kappa-B, leading to a Th1 response

196
Q

Imiquimod route

A

topical

197
Q

Imiquimod use

A

actinic keratosis
warts
superficial BCC

198
Q

Imiquimod AE

A

local inflammatory reactions
photosensitivity
systemic reactions
caution in patients with autoimmune disease
not used for oral, nasal, intravaginal, or ophthalmic uses

199
Q

Keratolytics drugs

A

trichloroaceic acid
salicylic acid
methyl aminolevulinate
aminolevulinic acid

200
Q

Trichloroacetic acid MOA

A

precipitation of intercellular proteins

201
Q

Trichloroacetic acid route

A

topical- physician performed

202
Q

Trichloroacetic acid AE

A

chemical burns if applied to health tissue

203
Q

Salicylic acid MOA

A

solubilization of inter-cellular matrix, reducing cellular adhesions

204
Q

Salicylic acid route

A

topical

205
Q

Salicylic acid use

A

acne
callouses and corns
keratosis pilaris
psoriasis
warts
hyperpigmentation conditions

206
Q

Salicylic acid AE

A

skin sensitivity and burning
tinnitus
confusion
hyperventilation
salicylate hypersensitivity reactions

207
Q

Lidocaine use

A

pruritis
pain

208
Q

Lidocaine route

A

topical

209
Q

Lidocaine AE

A

seizure
cardia arrest
respiratory depression

210
Q

retinoids drugs

A

tretinoin
isotretinoin
acitretin

211
Q

Tretinoin MOA

A

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
Q

Tretinoin route

A

topical

213
Q

Tretinoin use

A

normalize follicular hyperkeratosis
acne
hidradenitis suppurativa
milia
psoriasis
rosacea
hyperpigmentation

214
Q

Tretinoin AE

A

skin irritation
dryness
flakiness
pregnancy

215
Q

Isotretinoin MOA

A

decreasing sebocyte proliferation and causing apoptosis of sebocytes
increase p53 inhibits IGF-1 signaling, inhibit sebocyte differentiation, sebocyte apoptosis, reduce inflammation

216
Q

Isotretinoin route

A

topical

217
Q

Isotretinoin use

A

serve recalcitrant nodular acne
cutaneous t-cell lymphomas
neuroblastomas
prevention of SCC

218
Q

Isotretinoin AE

A

cheilitis
dry skin
dry eyes
pruritis
vision changes
hepatotoxicity
photosensitivity
increased triglyceride levels
myalgias
depression
IBD
pregnancy

219
Q

Acitretin MOA

A

antiproliferative, anti-inflammatory, and normalizes keratinocyte differentiation

220
Q

Acitretin use

A

severe psoriasis

221
Q

Acitretin AE

A

pregnancy

222
Q

calcipotriol moa

A

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
Q

Calcipotriol route

A

topical

224
Q

Calcipotriol use

A

psoriasis

225
Q

Calcipotriol AE

A

skin irritation
hypercalcemia

226
Q

Polymorphous Light Eruption pop

A

All races, Females>male, around age 20

227
Q

Polymorphous Light Eruption cause

A

Delayed abnormal reaction to UV radiation
Spring, early summer – 2-24 hours after 1st exposure – last 7-10 days

228
Q

Polymorphous Light Eruption sx

A

Morphologic skin types can vary: vesicles, papule, erythematous macules, plaques

229
Q

Polymorphous Light Eruption TX

A

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
Q

Drug-related Eczema cause

A

Any drug, nutriceutical or herb, almost without exception, is capable of causing a skin eruption.

231
Q

Drug-related Eczema SX

A

Any sudden fixed, symmetrical, or generalized skin eruption should be questioned

232
Q

Drug-related Eczema TX

A

identify and eliminate

233
Q

psoriasis pop

A

white, 40, male and female, FH

234
Q

Psoriasis trigger

A

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
Q

Plaque psoriasis triggers

A

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
Q

Plaque Psoriasis Sx

A

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
Q

plaque psoriasis complications

A

develop arthritis
nail pitting, oil spot lesions, onycholysis

238
Q

guttate pop

A

child or young adult

239
Q

guttate cause

A

group A streptococcal pharyngitis or viral infection

240
Q

guttate sx

A

red, scaly, small, teardrop-shaped spots. It doesn’t normally leave a scar.
sudden onset

241
Q

guttate psoriasis management

A

3-4 month self-resolve
no antibiotics

242
Q

Pustular psoriasis sx

A

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
Q

inverse psoriasis sx

A

painful
skin folds, armpits, genitals, under breasts or buttocks

244
Q

Erythrodermic psoriasis sx

A

peeling rash across the entire surface of the body
itch or burn
spreads quickly

245
Q

Erythrodermic psoriasis cause

A

severe sunburn, infection, excessive alcohol consumption, taking or stopping oral steroids, skin trauma from surgery or injury, reaction to medication

246
Q

Psoriasis TX

A

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
Q

Pityriasis rosea cause

A

unknown
viral origin

248
Q

Pityriasis rosea pop

A

10-35 yo

249
Q

Pityriasis rosea sx

A

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
Q

Pityriasis rosea DX

A

anti-streptolysin test

251
Q

Pityriasis rosea tx

A

If mild-severe itch: natural sunlight, UVB, colloidal oatmeal, emollients, topical/oral antihistamines
Severe cases-oral steroids rarely
Acupuncture, homeopathy, herbal, diet, etc.

252
Q

Lichen planus sx

A

purplish, itchy, flat bumps that develop over several weeks
skin, hair, nails, and mucous membrane

253
Q

Lichen planus cause

A

fam hx, viral, bacterial, stress, drugs, liver disease

254
Q

Lichen planus pop

A

30-60, females>males

255
Q

Lichen planus SX

A

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
Q

Lichen planus TX

A

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
Q

Lichen planus triggers

A

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
Q

Erythema Multiforme Syndrome pop

A

under 20, up to 40, male,

259
Q

Erythema Multiforme Syndrome triggers

A

Sulfonamides, phenytoin, barbiturates, phenylbutazone, penicillin, allopurinol
Hep B vaccine
ACD-tattoos
Infection: Especially following herpes simplex, mycoplasma, EBV, cytomegalovirus
Idiopathic: more than 50%

260
Q

Erythema Multiforme Syndrome sx

A

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
Q

Erythema Multiforme Syndrome TX

A

ID triggers and Tx
topical steroids or oral steroids for moderate-severe

262
Q

Erythema nodosum sx

A

painful red swollen nodules on the extensor aspect of the extremities.
Prodrome: fever, malaise, later arthralgias, arthritis and hilar adenopathy

263
Q

Erythema nodosum cause

A

Acute inflammatory/ immunologic rx of subcutaneous fat, bacterial, fungal, viral, drugs, malignancies, misc, and idiopathic(50%)
sore throat triggered

264
Q

Erythema nodosum pop

A

female, any age, 18-34

265
Q

Erythema nodosum DX

A

CBC-leukocytosis in most cases
Antistreptolysin-O titer
Chest x-ray
Consider tuberculin skin test

266
Q

Erythema nodosum TX

A

ID and treat
elevating legs, compression dressings and wet bandages
potassium iodide
Oral steroids

267
Q

Ecthyma

A

ulcerative impetigo

268
Q

folliculitis

A

superficial hair follicle

269
Q

furuncles

A

deeper hair follicle infection

270
Q

Carbuncles

A

several adjoining follicles

Dermatology (11 decks)

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