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OTC > acne and scaly dermatoses > Flashcards

acne and scaly dermatoses Flashcards

1
Q

define scaly dermatoses

A

rapid turnover of epidermal cells creating scaly lesions; may be caused by microorganism Malassezia

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2
Q

types of scaly dermatoses

A

dandruff, seborrheic dermatitis, psoriasis

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3
Q

exclusions for self treatment of dermatoses

A
  1. less than 2 years of age
  2. worsening or no improvement after 2 weeks
  3. > 5% involvement of BSA
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4
Q

dandruff appears

A

at puberty and peaks during early adulthood

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5
Q

symptoms of dandruff

A

non-inflammatory; diffuse sloughing of the scalp with white/grey scales with or without pruritus; often seen on crown of head

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6
Q

goals of treatment for dandruff

A

reduce epidermal turnover rate, minimize cosmetic embarrassment, minimize itch

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7
Q

non pharm treatment of dandruff

A

wash hair with general purpose non-medicated shampoo leaving 3-5 minutes of contact with scalp and wash every day or every other day

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8
Q

medicated shampoo directions

A
  1. wash hair non-medicated first; leave medicated on for 3-5 minutes, rinsing 2-3 times then repeat
  2. use daily for one week, then 2-3 times weekly for 2-3 weeks, then once weekly or every other week
  3. use non medicated in between days
  4. should see improvement in 1-2 weeks
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9
Q

medicated shampoo examples

A
  • pyrithione zinc
  • selenium sulfide
  • ketoconazole
  • coal tar
  • salicylic acid/sulfur
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10
Q

pyrithione zinc moa

A

anti-malassezia

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11
Q

pyrithione zinc

A

first line - most cost effective, best cosmetic appearance, slower onset than selenium sulfide

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12
Q

selenium sulfide moa

A

anti-malassezia

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13
Q

selenium sulfide

A

rinse well from scalp to avoid staining of hair, ADE: oiliness of scalp, staining hair, eye irritation

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14
Q

ketoconazole moa

A

azole antifungal

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15
Q

ketoconazole application

A

apply to scalp for 3-5 minutes 2x weekly for 4 weeks, then once weekly for prevention (allow three days in between treatments)

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16
Q

ketoconazole

A

expensive and no more effective

ADE: skin irritation/burning, may change appearance/texture of hair, hair loss

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17
Q

coal tar moa

A

cytostatic - inhibits cell growth and multiplication and proliferation

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18
Q

coal tar

A

usually not first line due to AE and limited efficacy

AE: unpleasant odor; may stain hair, skin, and clothing; photosensitivity; irritant contact dermatitis

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19
Q

salicylic acid/sulfur moa

A

keratolytic - loosens and lyses keratin aggregates, facilitating removal or flakes from scalp

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20
Q

salicylic acid/sulfur

A

very limited efficacy, very slow acting

ADE: scalp irritation or burning; sulfur has strong odor; may change appearance/texture of hair

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21
Q

seborrheic dermatitis

A

sub-acute or chronic inflammatory disorder producing red, itchy skin with prominent yellow or oily lesions/scaly patches

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22
Q

seborrheic dermatitis most common in

A

infancy and middle age

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23
Q

goals of treatment for seborrheic dermatitis

A

reduce inflammation/epidermal turnover rate; minimize or eliminate visible erythema and scaling; minimize itch

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24
Q

non medicated shampoo first with 3- 5 minutes of contact (SD)

A

cradle cap: use Johnson’s baby oil followed by J&J shampoo
adults: non medicated shampoo or dawn dishwashing soap to soften and remove scales

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25
Q

medicated shampoo treatment for SD

A

use daily for first 1-2 weeks then 2-3 times per week for 4 weeks; apply once weekly to prevent relapse

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26
Q

SD of the skin

A

hydrocortisone cream 0.5-1% cream or ointment for inflammation/itching of the skin, apply 1-2 times daily up to 7 days

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27
Q

ointment formulation for SD of the skin preferred when

A

thick crusts/scales present

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28
Q

psoriasis

A

chronic, relapsing, inflammatory disease; accelerated epidermal proliferation leads to excessive scaling, causing raised flat plaques with a silver-white scale

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29
Q

t/f psoriasis is typically symmetrical

A

true

30
Q

psoriasis treatment goals

A

control/eliminate signs and symptoms and prevent/minimize flare-ups

31
Q

non pharm treatment of psoriasis

A
  • avoid psychological stress; avoid physical, chemical, or UV injury
  • bathe with lubricating bath products 2-3 times per week, remove scales with soft cloth
  • apply emollients 4 times daily, within 3 minutes of bathing
32
Q

pharm treatment to loosen scalp psoriasis

A

salicylic acid or coal tar

33
Q

salicylic acid most useful in psoriasis if

A

thick scales are present; soak in warm water for 10-20 min before applying product

34
Q

use of coal tar in psoriasis

A

typically last line and most useful for psoriasis of the scalp; apply coal tar at bedtime followed by bathing in the am

35
Q

inflammation of the skin in psoriasis

A

topical hydrocortisone ointment 0.5-1% for inflammation, apply BID for up to 7 days; good for acute flares

36
Q

acne definition

A

common skin condition, especially in adolescence; often goes into spontaneous remission, but can progress in adulthood and lead to scarring

37
Q

comedones

A

open (blackhead) or closed (whitehead); often seen in early stages of puberty; often start on the forehead but can progress to the chest and back; typically little or no inflammation

38
Q

papules

A

characterized by redness and inflammation in and around the follicular canal

39
Q

pustules

A

have the same qualities as papules, but have visible purulence in the center of the lesion

40
Q

nodules

A

result from disruption of the follicular wall and release of its contents into the surrounding dermis

41
Q

exclusions for self-treatment

A
  1. moderate to severe acne
  2. exacerbating factors
  3. possible rosacea
42
Q

moderate acne

A

many erythematous papules and pustules and prominent scarring

43
Q

severe acne

A

extensive pustules, erythematous papules, and multiple nodules in an inflamed background

44
Q

non pharm treatment of acne

A
  1. eliminate/minimize exacerbating factors
  2. stay hydrated
  3. cleanse skin 2x daily with warm water and mild soap
45
Q

non pharm physical treatments of acne

A
  1. self applied acrylate glue-based material strips can aid in the extraction of comedones
  2. professional comedo extraction
  3. light based treatments
46
Q

standard of care for acne

A

topical therapy

47
Q

properties of acne agents

  1. antibacterial
  2. keratolytic
  3. comedolytic
  4. retinoid
  5. anti-inflammatory
A
  1. against skin P. acnes
  2. exfoliates skin by causing sloughing/peeling
  3. resolves existing comedones
  4. modulates epithelial cell differentiation, keratinization, and inflammation
48
Q

first line topical agent for acne treatment

A

adapalene (differin)

49
Q

MOA of differin

A

modulates epithelial cell differentiation, keratinization, and inflammation

50
Q

ADE for differin

A

redness, scaling, dryness, itching, burning; increased photosensitivity

51
Q

application of differin

A

apply thin layer once daily; full effect in 8-12 weeks; acne may worsen at first

52
Q

differin and pregnancy

A

do not use

53
Q

most effective and widely used topical agent for acne

A

benzoyl peroxide

54
Q

BP properties

A

keratolytic and antibacterial

55
Q

t/f BP high concentration have same antibacterial effect of low concentration

A

true, but high causes more skin irritation

56
Q

BP application

A

15-20 minutes after washing; after initial 1-2 weeks of treatments then applications can be increased up to 2-3 times per day

57
Q

AE of BP

A

mild erythema, stinging and peeling in first few days; avoid contact with hair or clothes bc of bleaching; 3-6 weeks for full effect

58
Q

hydroxy acid properties

A

keratolytic; BHA also has mild comedolytic properties

59
Q

agent reserved for use in pts who can not tolerate other topicals

A

Hydroxy acids

BHA - salicylic acid

60
Q

AHAs are natural

A

exfoliating acids (may be used as a light chemical peel)

61
Q

BHA available in

A

05.-2% creams or gels; used 1-3 times daily

62
Q

BHA contraindicated in

A

diabetes and patients with poor circulation disorders

63
Q

BHA absorbed

A

systemically, can lead to salicylate poisoning and Drug Interactions

64
Q

ADE for hydroxy acids

A

dryness, itching, redness, peeling

65
Q

sulfur properties

A

keratolytic

66
Q

sulfur application

A

thin film to area 1-3 times daily

67
Q

ADE of sulfur

A

odor, yellow chalky color, can stain clothes and fabrics, dry skin, can produce reversible dark brown scale on darker skinned individuals

68
Q

gel products are

A

usually most effective because they remain on the skin the longest

69
Q

creams and loti9ons are

A

less irritating

70
Q

acne medications and pregnancy

A

generally avoid

OTC (22 decks)

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