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Naplex > Common Skin Conditions > Flashcards

Common Skin Conditions Flashcards

1
Q

What are the natural products for skin conditions and their uses?

A
  • Aloe vera (soothing effect): sunburn and psoriasis
  • Tea tree oil: acne
  • Lysine (tablet, capsule or topical): Cold sore (herpes simplex labialis) preventionn and treatment
  • Biotin: hair loss and brittle nails
  • Topical vitamin D: diaper rash and psoriasis
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2
Q

List drugs that can discolor skin and secretions

A

Brown
* Entacapone

  • Levodopa
  • Methyldopa

Brown/Black/green
* Iron (black stool)

  • Methocarbamol

Brown/Yellow
* Nitrofurantoin

Purple/Orange/Red
* Chlorzoxazone

Orange/Yellow
* Sulfasalazine

Yellow-Green
* Propofol

Red-Orange
* Phenazopyridine

  • Rifampin

Red
* Anthracyclines

Blue
* Methylene blue

  • Mitoxantrone

Blue-Gray
* Amiodarone

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3
Q

What causes acne?

A
  • Androgens (male sex hormone) are the primary determinant of acne
  • Cutibacterium acnes (formerly known as propionibacterium acnes)
  • Fatty acids (sebum) present in oil (sabeceous) glands
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4
Q

What are the teratment options for acne?

A
  • Benzoyl peroxide (OTC)
  • Salicylic acid (OTC)
  • Retinoids
    • Teratogenic, must be avoided in pregnancy and breastfeeding
    • They are vitamin A derivatives, the mechanism is primarily to reduce adherence of the keratinocytes in the oil gland
    • Apply daily at night with the correct (pea-sized) amount
    • Can take 4-12 weeks to work
  • Systemic isotretinoin
    • Oral retinoid isotretinoin has many safety considerations
    • FDA-approved for severe, recalcitrant nodular acne only
    • Cholesterol and pregnancy tests are required
  • Topical or systemic (oral) antibiotics
  • Oral contraceptive pills
  • Azelaic acid (Azelex, Finacea) (OTC/Rx)
  • Clascoterone (Winlevi)
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5
Q

What are acne treatment options by severity?

A

Mild
* First-line: Topicals - BPO and/or retinoid

  • Alternative - add topical retinoid or BPO, switch to another retinoid, topical dapsone or clascoterone

Moderate
* First-line: Topicals - combination or PO antibiotic + BPO + topical retinoid (+/- topical antibiotic)

  • Alternative - other combination, switch PO antibiotic, add combined OCP or spironolactone (females) or PO isotretinoin

Severe
* First-line: Topicals - combination + PO antibiotic or PO isotretinoin

  • Alternative - switch PO antibiotic, add combined OCP or spirinolactone (females) or PO isotretinoin (if not previously tried)

Topical combination therapy: BPO + topical antibiotic, BPO + retinoid or BPO + retinoid + topical antibiotic

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6
Q

Topical retinoids and acne products - brand/generic, safety/counseling

A
  • Tretinoin (Atralin, Renova, retin-A, Retin-A Micro)
  • Adapalene (Differin)
  • Retin-A Micro and Avita: slower release, less skin irritation
  • Tazarotene: CI in pregnancy
    * Topical retinoids should be avoided in pregnancy
    * Limit sun exposure
    * Apply daily, usually at bed time, about 20 minutes after washing face
* If irritation occurs, use lower strenght, or every other night
* A pea-sized amount is sufficient 
* Takes 4-12 weeks to see response; may worsen acne inititally
  • Benzoyl peroxide (BPO) - can bleach clothing
  • Salicylic acid
  • Azelaic acid (Rx, OTC)
  • Dapsone gel (Aczone) (Rx) - avoid in G6PD deficiency
  • Clascoterone cream (Winlevi) (Rx) - HPA axis suppression
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7
Q

Oral retinoids - brand/generic, safety/counseling

A

Isotretinoin (Absorica, Amnesteem) (Rx - capsules)
* Only FDA-approved for severe, refractory nodular acne

  • Female patients must sign informed consent form about birth defects if the fetus is exposed to isotretinoin; must have had 2 negative pregnancy tests prior to starting Tx
  • Cannot get pregnant for 1 month before, while taking the drug, or for 1 month after the drug stopped
  • BW: birth defects have been documented
  • Can only be dispensed by a pharmacy registered and activated with the pregnancy REMS (iPLEDGE) program. 1 month Rx at a time
  • SEs: dry skkin, chapped lips, dry eyes/eye irritation
  • 2 forms of birth control are required (cannot use a progestin-only pill)
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8
Q

Antibiotics used for acne - brand/generic, safety/counseling

A

Minocycline (Minocin, Solodyn) (Rx)
* XR formulations: only approved for use in patients >= 12 years

  • Can cause photosensitivity, fetal harm if administered during pregnancy, discoloration in teeth if used when teeth are forming (up to 8 years of age)
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9
Q

What causes cold sores and what are the symptoms?

A
  • Cold sores ( herpes simplex labialis) is an infection usually due to HSV-1
  • The virus spreads mostly with active lesions; kissing and sharing drinks
  • Sore eruption is preceded by prodromal symptoms; tingling, itching, soreness
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10
Q

Which drugs are used for treatment of cold sores? include safety/counseling points

A
  • Docosanol (Abreva) (OTC) - apply 5x daily at first sign of outbreak, continue until healed
  • Acyclovir topical cream/ointment (Zovirax) (Rx) - apply 5x daily for 4 days (can be used on genital sores)
  • Lysine for prevention and treatment (natural product)
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11
Q

What drugs are used for dandruff?

A

OTC:
* Ketoconazole 1% shampoo (Nizoral A-D)
* Apply twice weekly, for up to 8 weeks
* Do not use if open sores on scalp
* Can cause skin irritation

  • Selenium sulfide (Selsun)
  • Pyrithione zinc (Head&Shoulders)
  • Coal tar shampoos (T/Gel)

Rx:
* Ketoconazole 2% shampoo (Nizoral)

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12
Q

What drugs and conditions can contribute to alopecia?

A
  • Chemotherapeutics (primarily because hair cells are rapidly dividing and are affected by the treatment)
  • Valproate
  • Spironolactone
  • Heparin
  • Zinc and vitamin D deficiency
  • Hypothyroidism
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13
Q

What drugs are used to treat alopecia? Include safety/counseling points

A

Finasteride (Proscar) - 5-alpha reductase type 2 inhibitor also approved for BPH
Finasteride (Propecia)
* Rx: tablet

  • Take 1 mg daily; can take >= 3 months to begin to see effect
  • CI: pregnancy
  • Warning: hazardous drug for females of childbearing age - can harm a male fetus
  • Do not dispense to patients taking finasteride (Proscar) for BPH

Minoxidil tablets
* Rx: Indicated for HTN (very rarely used)

Minoxidil topical (Rogaine)
* OTC: 5% foam, 2% and 5% solution

Bimaprost (Latisse)
* Rx: solution

  • For thinning eyelashes (hypotrichosis)
  • Do not use with PG analogs used for glaucoma (IOP may increase)
  • Apply nightly to the skin at the base of the upper eyelashes only
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14
Q

What is eczema? What are the treatment options?

A
  • Eczema is a general term for many types of skin inflammation
  • Presents as skin rashes, which become crusty and scaly; blisters can develop
  • The rash is itchy, red, dry and sore
  • Hydration is essential; use moisturizers
  • Treatment incudes topical steroids (occasional oral courses, if needed), antihistamines (for itching), calcineurin inhibitors (if topical steroids with hydration are not adequeate)
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15
Q

List Drugs and safety/counseling points for eczema

A

OTC
* Moisturizers with petrolatum, lanolin (Aquaphor, Eucerin)

Rx - Treat first with topical steroids and only use the drugs below if steroids failed;

  • Topical Calcineurin Inhibitors: Tacrolimus (Protopic) - ointment, Pimecrolimus (Elidel) - cream
  • Topical Phosphodiesterase-4 Inhibitor: Crisanorole (Eucrisa) - 2% ointment
  • Monoclonal Antibody (IL-4 antagonist): Dupilumab (Dupixent) - injection

Safety/Counseling
* All topical products - wash hands after application

  • Topical calcineurin inhibitors - do not use in children < 2 years of age; associated with lymphoma and skin cancer; use only as second-line drugs for short-term, intermittent treatment
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16
Q

What is hyperhidrosis and treatment?

A
  • It is an excessive sweating
  • OTC - Antiperspirants (Secret Clinical Strength, Certain Dri)
  • Rx - Glycopyrronium topical (Qbrexza)
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17
Q

What is athlete’s foot (Tinea Pedis)? What are the symptoms?

A
  • It is a fungal infection of the foot caused by various fungi.
  • Common infection among those using public pools, showers and locker rooms
  • Symptoms include feet itching, peeling, redness, mild burning
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18
Q

Jock itch (Tinea Cruris) affects genitals, inner thighs and __ . The rash is __, __, and can be ring-shaped.

Fill in the blanks

A
  • Buttocks
  • Red
  • Itchy
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19
Q

What is ringworm (Tinea Corporis)?

A
  • It is not a worm, but a fungal skin infection
  • It presents as a circular, red, flat sores
  • Occasionally the ring-like presentation is not present - just itchy red skin
  • The outer part of the sore can be raised while the skin in the middle appears normal
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20
Q

T/F: Tinea capitis is “ringworm” on the scalp

A

TRUE

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21
Q

What is cutaneous (skin) candida infections?

A
  • Topical Candida infections cause red, itchy rashes, most commonly in the groin, armpits or anywhere the skin folds
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22
Q

List drugs and safety/counseling points for treatment of fungal infections

A

OTC
* Terbinafine (Lamisil AT) - cream, gel, spray

  • Butenafine (Lotrimin Ultra) - cream
  • Clotrimazole (Lotrimin AF) - cream
  • Miconazole (Lotrimin AF) - powder, spray
  • Tolnaftate (Tinactin) - cream, powder, spray
  • Undecylenic acid (Toelieva)

Rx
* Betamethasone/Clotrimazole (Lotrisone: used for tinea with inflammation/itching - cream, lotion

  • Ketoconazole (Extina) - cream, foam

Safety/Counseling
* If infection on the foot, do not walk barefoot (to avoid spreading it)

  • Apply medicine 1-2 inches beyond the rash
  • Use for at least 2-4 weeks, even if it appears healed
  • Reduce moisture to the infected area
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23
Q

Onychomycosis is a fungal infection of the __.

Fill in the blank

A
  • Nail
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24
Q

Topical drugs are limited to mild cases and patients who cannot toleratesystemic therapies. They are not __ enough to cure most infections

Fill in the blank

A
  • Potent
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25
Q

__ and __ are two drugs approved for fungal infections on the toenails and fingernails

Fill in the blanks

A
  • Itraconazole (Sporanox)
    • Avoid use in HF
  • Terbinafine (Lamisil) - oral
    • Lamisil AT; topical, used for fungal skin infections
    • Risk of hepatotoxicity
26
Q

__ therapy (intermittent) can be used for fungal infections of nails to reduce costs and possibly __, but may not be as __.

Fill in the blanks

A
  • Pulse
  • Toxicity
  • Effective
27
Q

T/F: A 20% potassium hydroxide (KOH) smear is essential for diagnosis as other conditions can produce a similar presentation

A

TRUE

28
Q

A pH > __ consistent with bacterial vaginosis or trichomoniasis infection.

Fill in the blank

A
  • 4.5
29
Q

OTC test kits are available to test vaginal __.

Fill in the blank

A
  • PH
30
Q

___ or ___ with active ___ is thought to reduce infection occurence. However, this is rated as “possibly ineffective” by the Natural Medicines Database

Fill in the blanks

A
  • Lactobacillus
  • Yogurt
  • Cultures
31
Q

List drugs for treatment of vaginal fungal infections

A

Mild - moderate, infrequent infection
* 1, 3 or 7 day treatment with vaginal cream, ointment or vaginal suppository/tab

OTC, topical
* Clotrimazole (Gyne-Lotrimin)

  • Miconazole (Monistat 3)

Rx, topical
* Butoconazole (Gynazole-1)

  • Terconazole (Terazol 7)

Rx, oral
* Fluconazole (Diflucan) - 150 mg PO x 1

Complicated infections, pregnancy: 7-10 days Tx, or refer to healthcare provider

32
Q

What are the prevention and treatment strategies in diaper rash?

A

Prevention
* Use skin protectant - petrolatum ointment, petrolatum with zinc oxide (a desiccant, used to dry out the skin)

Treatment
* Nystatin, clotrimazole, miconazole: for stubborn rashes, if yeast is thought to be involved

  • OTC: Petrolatum (A&D Ointment), Petrolatum/zinc oxide (Desitin)
  • Rx: Miconazole/zinc oxide/petrolatum (Vusion)
33
Q

What are treatment options for hemorrhoids?

A
  • If dietary fiber intake is not optimal, increasing fiber intake help reduce straining
  • Products such as psyllium will mix with the stool to make it easier to push out
  • A stool softener (such as docusate) will reduce straining
  • Phenylephrine (Preparation H) is a vasocontrictor that shrinks the hemorrhoid and reduces burning and itching
  • Hydrocortisone (Anusol-HC, Preparation H) comes in anal suppositories and various topicals. These reduce itching and inflammation
  • Witch hazel (Tucks Medicated Cooling Pads) is a mild astringent that can relieve mild itching
34
Q

What is pinworm (Vermicularis)? Include diagnosis, treatment and safety/counseling points

A
  • It is an infection commonly occurs in children and presents as anal itching
  • The “tape” test is used to identify eggs: stick a piece of tape around the anus in the morning prior to voiding and bring it to the healthcare provider, who examines it under the microscope to look for eggs
  • It can take up to three morning tape tests to identify the eggs

Drugs - Anthelmintics
* OTC: Pyrantel pamoate (Reese’s Pinworm Medicine, Pamix, Pin-X) - suspension

  • Rx (systemic worm infections, many types): Albendazole (Albenza), Mebendazole (Emverm)
    • Both cause headache, nausea and are hepatotoxic
  • Txs for systemic worm infections are toxic. In some cases, such as treating CNS infections, steroids and AEDs will be given with the anthelmintic (i.e., worm drug)
  • When treating systemic infections, albendazole must be taken with high-fat meal to increase absorption
35
Q

T/F: Lice, pediculus humanus capitis, occurs most commonly in elementary school-age children

A

TRUE

36
Q

T/F: Topical pyrethrins and permethrin are the OTC drugs of choice for lice and scabies

A

TRUE

37
Q

Elimite is a 5% permethrin cream used to treat ___, while Nix is a ___% ___ used to treat ___.

Fill in the blanks

A
  • Scabies
  • 1
  • Lotion
  • Lice
38
Q

Lindane shampoo 1% is no longer recommended due to ___.

Fill in the blank

A
  • Neurotoxicity
39
Q

Malathion lotion 0.5% (Ovide) is an organophosphate only for use on persons 6 years of age and older. can irritate the ___ and is ___.

Fill in the blanks

A
  • Skin
  • Flammable
40
Q

Topical ivermectin (Sklice) is approved to treat ___ lice.

Fill in the blank

A
  • Head
41
Q

T/F: After each treatment for removing the nits, check the hair and use a nit comb to remove nits and lice every 2-3 days

A

TRUE

42
Q

List drugs for treatment of Lice and scabies. Include safety/counseling

A

Lice - OTC
* Permethrin (Nix), ages 2+ months

  • Pyrethrin/Piperonyl butoxide (RID), ages 2+ months
  • Ivermectin lotion (Sklice), ages 6 + months
  • DOC: Permethrin and pyrethrin/Piperonyl butoxide. Repeat treatment on day 9

Scabies - Rx
* Permethrin cream (Elimite)

  • Ivermectin oral (Stromectol)
43
Q

Describe first degree, second degree and third degree burns

A
  • First degree: red/painful, minor swelling
  • Second degree: thicker, very painful, produce blisters
  • Third degree: damage to all layers of skin, appears white or charred
44
Q

Ointments (80% oil 20% water, such as Aquaphor) should be used for skin protection over a ___ burn to hold in ___ and reduce ___ risk.

Fill in the blanks

A
  • Minor
  • Moisture
  • Scarring
45
Q

Silver sulfadiazine (Silvadene; SSD) can be used topically to reduce ___ risk and promote ___.

Fill in the blanks

A
  • Infection
  • Healing
46
Q

List drugs for treatment of burns

A

OTC
* Polymyxin/bacitracin/neomycin

  • Triple antibiotic ointment (Neosporin Original)
  • For neomycin allergy, use Polysporin (bacitracin and polymyxin) or bacitracin alone; either is sufficient

Rx
* Mupirocin (Bactroban) is an antibiotic cream or ointment; very good staph and strep coverage, including MRSA

  • Bacitracin/neomycin/polymyxin B/hydrocortisone (Cortisporin ointment) - superficial skin infections
47
Q

What is poison ivy, oak or sumac poisoning?

A
  • Allergic reaction that results from touching the sap of these plants, which contain the toxin urushiol
48
Q

List drugs for treatment of poison ivy, oak and sumac poisoning. include safety/counseling points

A

OTC
* Aluminum acetate solution (Boro-Packs, Domeboro Soothing Soak) - astringent (drying agent)

  • Colloidal oatmeal (Aveeno)
  • Calamine lotion/pramoxine (anesthetic):(Caladryl, IvaRest)
  • Zanfel works by binding urushiol (this is the toxin) - low evidence for efficacy

Note: Topical or oral steroids will help (oral needed in severe rash)

49
Q

The primary treatment for skin irritation is topical steroids. Two strenghts of hydrocortisone (HC) are available OTC are ___% and ___%; all other topical steroids are Rx only.

Fill in the blanks
Inflammation and Rash

A
  • 0.5
  • 1
50
Q

T/F: The steroid vehicle influences the strength of the medication

Inflammation and Rash

A

TRUE

51
Q

Rank the potency of steroid formulations from highest to lowest

Inflammation and Rash

A

Ointments > creams > lotions > solutions > gels > sprays

52
Q

List the very high potency topical steroids

Inflammation and Rash

A
  • Clobetasol propionate 0.05% lotion/shampoo/spray (Lobex), cream/ointment (Temovate), foam (Olux), gel
  • Fluocinonide 0.1% cream (Vanos
53
Q

List the high potency topical steroids

Inflammation and Rash

A
  • Betamethasone dipropionate 0.05% cream (Diprolene AF)
  • Fluocinonide furoate 0.1% ointment (Lidex)
  • Mometasone furoate 0.1% ointment (Elocon)
54
Q

List the high-medium potency topical steroids

Inflammation and Rash

A
  • Fluocinonide 0.05% cream (Lidex-E)
55
Q

List the medium potency topical steroids

Inflammation and Rash

A
  • Mometasone furoate 0.1% cream (Elocon)
  • Triamcinolone acetonide 0.1% cream (Triderm), 0.147 mg/g spray (Kenalog)
56
Q

List the lowest potency topical steroids

Inflammation and Rash

A
  • Hydrocortisone cream: 0.5%, 1% (Cortaid, Cortizone-10)
57
Q

T/F: Hydroxyzine (Vistaril is used for general urticaria (hives) with severe itching. Side effects include sedation and dry mouth

Inflammation and Rash

A

TRUE

58
Q

What is “fingertip” unit is used for?

Inflammation and Rash

A
  • To estimate amaount: from the fingertip to the 1st joint provides enough medication to cover one adult hand
  • Encourage patient not to use topical steroids more than directed as overuse has risks
  • Do not apply for longer than 2 weeks
59
Q

What is the formula for time to burn (TTB)?

A

TTB (with sunscreen in min) = SPF X TTB (without sunscreen)

60
Q

T/F: Sunscreen labeling is no longer permitted to use “waterproof” or “sweatproof” but sunscreen can claim to be “water-resistant” but only for 40-80 minutes

A

TRUE

61
Q

Apply sunscreen liberally and at least every ___ hours and reapply after ___ or sweating. The AAP recommends keeping babies less than ___ months old out of the sun.

Fill in the blanks

A
  • 2
  • Swimming
  • 6

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