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acne and scaly dermatoses Flashcards

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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
medicated shampoo treatment for SD
use daily for first 1-2 weeks then 2-3 times per week for 4 weeks; apply once weekly to prevent relapse
26
SD of the skin
hydrocortisone cream 0.5-1% cream or ointment for inflammation/itching of the skin, apply 1-2 times daily up to 7 days
27
ointment formulation for SD of the skin preferred when
thick crusts/scales present
28
psoriasis
chronic, relapsing, inflammatory disease; accelerated epidermal proliferation leads to excessive scaling, causing raised flat plaques with a silver-white scale
29
t/f psoriasis is typically symmetrical
true
30
psoriasis treatment goals
control/eliminate signs and symptoms and prevent/minimize flare-ups
31
non pharm treatment of psoriasis
- 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
pharm treatment to loosen scalp psoriasis
salicylic acid or coal tar
33
salicylic acid most useful in psoriasis if
thick scales are present; soak in warm water for 10-20 min before applying product
34
use of coal tar in psoriasis
typically last line and most useful for psoriasis of the scalp; apply coal tar at bedtime followed by bathing in the am
35
inflammation of the skin in psoriasis
topical hydrocortisone ointment 0.5-1% for inflammation, apply BID for up to 7 days; good for acute flares
36
acne definition
common skin condition, especially in adolescence; often goes into spontaneous remission, but can progress in adulthood and lead to scarring
37
comedones
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
papules
characterized by redness and inflammation in and around the follicular canal
39
pustules
have the same qualities as papules, but have visible purulence in the center of the lesion
40
nodules
result from disruption of the follicular wall and release of its contents into the surrounding dermis
41
exclusions for self-treatment
1. moderate to severe acne 2. exacerbating factors 3. possible rosacea
42
moderate acne
many erythematous papules and pustules and prominent scarring
43
severe acne
extensive pustules, erythematous papules, and multiple nodules in an inflamed background
44
non pharm treatment of acne
1. eliminate/minimize exacerbating factors 2. stay hydrated 3. cleanse skin 2x daily with warm water and mild soap
45
non pharm physical treatments of acne
1. self applied acrylate glue-based material strips can aid in the extraction of comedones 2. professional comedo extraction 3. light based treatments
46
standard of care for acne
topical therapy
47
properties of acne agents 1. antibacterial 2. keratolytic 3. comedolytic 4. retinoid 4. anti-inflammatory
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
first line topical agent for acne treatment
adapalene (differin)
49
MOA of differin
modulates epithelial cell differentiation, keratinization, and inflammation
50
ADE for differin
redness, scaling, dryness, itching, burning; increased photosensitivity
51
application of differin
apply thin layer once daily; full effect in 8-12 weeks; acne may worsen at first
52
differin and pregnancy
do not use
53
most effective and widely used topical agent for acne
benzoyl peroxide
54
BP properties
keratolytic and antibacterial
55
t/f BP high concentration have same antibacterial effect of low concentration
true, but high causes more skin irritation
56
BP application
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
AE of BP
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
hydroxy acid properties
keratolytic; BHA also has mild comedolytic properties
59
agent reserved for use in pts who can not tolerate other topicals
Hydroxy acids | BHA - salicylic acid
60
AHAs are natural
exfoliating acids (may be used as a light chemical peel)
61
BHA available in
05.-2% creams or gels; used 1-3 times daily
62
BHA contraindicated in
diabetes and patients with poor circulation disorders
63
BHA absorbed
systemically, can lead to salicylate poisoning and Drug Interactions
64
ADE for hydroxy acids
dryness, itching, redness, peeling
65
sulfur properties
keratolytic
66
sulfur application
thin film to area 1-3 times daily
67
ADE of sulfur
odor, yellow chalky color, can stain clothes and fabrics, dry skin, can produce reversible dark brown scale on darker skinned individuals
68
gel products are
usually most effective because they remain on the skin the longest
69
creams and loti9ons are
less irritating
70
acne medications and pregnancy
generally avoid

OTC (22 decks)

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