Chapter 88: Skin

Question 1

anatomy of skin

Answer 1

Epidermis​

Dermis​

Subcutaneous tissue​

Question 2

topical medication preps

Answer 2

ointment
greatest absorption
good for dry skin, thicken skin, oozing skin

cream
mix of oil and water
not good for ozing skin

lotion
water or alcohol base
good for skin on skin areas

gel
water or alcohol base
liquefies on contact with skin

foam
aerated solutions

powder
talc or corn starch base
reduces friction between skin surfaces

paste
ointment plus powder
good for diaper rash

*more water, less absorption

Question 3

Topical glucocorticoids

Answer 3

(cream, ointment, or gel)​

Uses​
To relieve inflammation and itching​
Drying agent​

Adverse effects​
thinning of skin
Stretch marks​
Purpura​
Telangiectasia​
Hypertrichosis​
Possible systemic toxicity​ -More likely with higher doses and long-term therapy​. Growth retardation in children​, Adrenal suppression

Don’t want to se long term in one area- thin the skin. ​*

administration
Apply in a thin film and gently rub into the skin​
Do not use occlusive bandages (or tight-fitting diapers and plastic pants)​ -Increases absorption ​

Question 4

Keratolytic Agents

Answer 4

Promote shedding of horny layer of the skin​

Primary agents and uses​
Salicylic acid: Warts, corns​
Sulfur: Acne, dandruff, psoriasis, seborrheic dermatitis​
Benzoyl peroxide​

treatment for thickening of ski

Question 5

acne tx

Answer 5

Nondrug therapy​
Cleansing​

Drug therapy​
Benzoyl peroxide​
Antibiotics​: Topical: Clindamycin​, erythromycin. Oral: Tetracycline antibiotics,
PO isotretinoin, hormonal agents​

Retinoids​ -toplical
Tretinoin ​
Adapalene ​
Tazarotene

azelaic acid

most common skin disease.

~85% of all teenagers get acne and it may persist into adulthood

Question 6

acne AB

Answer 6

agents of choice​: Doxycycline [Vibramycin], minocycline [Minocin]​

Alternatives (resistance is common): Tetracycline [Sumycin], erythromycin [Ery-Tab]​

See changes in 3-6m switch to topical for long term use​

Question 7

Isotretinoin

Answer 7

Used to treat severe nodulocystic acne vulgaris​

Teratogenic -> ipledge ​
contraindicated in pregnancy

Triglyceride levels must be monitored​
Potentiated by alcohol

Adverse effects​
nose bleeds, lip inflammation, dry eyes, itching dry skin, muscle pain, stiffness, depression ​

tetracycline increases effects of isotretinoin

​

Question 8

PO acne drugs

Answer 8

Hormonal agents​

Spironolactone [Aldactone]​

 ​

Question 9

Sunscreens (UVA)​

Answer 9

UVA penetrates the epidermis and deep into the dermis​

UVA penetrates much deeper than UVB​

UVA is the primary cause of immunosuppression, photosensitive drug reactions, and photoaging of the skin​

most UV radiation is UVA

Question 10

UVB

Answer 10

UVB penetrates into the epidermis but goes no deeper ​

Tanning and sunburn are caused primarily by UVB​

Question 11

Sunscreens (UVA and UVB)

Answer 11

Both UVA and UVB promote damage to DNA, so both can cause premalignant actinic keratoses, basal cell carcinoma, squamous cell carcinoma, and malignant and nonmalignant melanoma​

Question 12

sunscreens

Answer 12

Impede penetration of UV radiation to viable cells of the skin​

Can protect against sunburn, photoaging of the skin, and photosensitivity reactions to certain drugs (e.g., tricyclic antidepressants, phenothiazines, sulfonamides, sulfonylureas)​

Can also reduce the risk of actinic keratoses, squamous cell carcinoma, and melanoma​

Question 13

organic sunscreens

Answer 13

Also known as chemical screens​

Absorb UV radiation and then dissipate it as heat​

15 of approved sunscreens ​

Must include avobenzo ​

Question 14

inorganic screens

Answer 14

Also known as physical screens​

Scatter UV radiation​

Titanium oxide and zinc oxide​

Now micronized and clear for applying to skin​

Good for nose, tips of ears, lips​

Question 15

Sun Protection Factor (SPF)

Answer 15

SPF is an index of protection against ultraviolet B (UVB) radiation​

SPF does not address ultraviolet A (UVA) protection​

Methods for obtaining SPF are not precise​

Relationship between SPF and protection against sunburn is not linear (SPF 30 is not twice as much protection as SPF 15)​

Question 16

SPF sun protection

Answer 16

SPF of 15 indicates 93% block of uvb ​

SPF 30 is 96.7% block​ of uvb

SPF 40 is only 97.5 % block​

FDA blocks sunscreens from marketing high spf. SPF higher than 50 can only be labeled 50+​

SPF 2-14 only protects from sunburn -have to disclose this on label.

Question 17

broad spectrum sunscreens

Answer 17

covers both UVA and UVB

broad spectrum SPF 15 of higher is protective against sunburn, skin cancer, and photoaging effects

Question 18

sunscreens water/sweat resistance

Answer 18

can’t say sunscreen is waterproof -can say water resistant and have to say how how long it is resistance for on label.

Question 19

safe sun exposure

Answer 19

Sunglasses, hats, protective clothing, avoid the sun 10a-4p, shade, reflective sunburn off water ​

Question 20

Psoriasis

Answer 20

Red patches with silver scales​
Common, chronic inflammatory disorder that follows an erratic course​
Initial episode usually develops in early adulthood​
Subsequent attacks may occur spontaneously or in response to triggers​

Varying degrees of severity​

Symptoms result from:​
Accelerated maturation of epidermal cells​
Excessive activity of inflammatory cells​

Question 21

Treatment for Psoriasis

Answer 21

Topical drugs​

Systemic drugs​

Phototherapy​

Most antipsoriatic drugs suppress activity of inflammatory cells

Question 22

topical psoriasis drugs

Answer 22

Glucocorticoids​

Vitamin D analogs: Calcipotriene, calcitriol ​

Vitamin A derivative: Tazarotene ​

Anthralin​

Tars​

Question 23

systemic drugs for psoriasis

Answer 23

conventional agents:

Methotrexate​

Acitretin ​

Glucocorticoids ​

Cyclosporine ​

Question 24

biologic agents for psoriasis

Answer 24

Etanercept​

Infliximab​

Adalimumab​

Ustekinumab ​

Question 25

procedures for psoriasis

Answer 25

Photochemotherapy​ Coal tar + ultraviolet B irradiation

Question 26

Actinic Keratoses (AKs)​

Answer 26

Rough, scaly, red or brown papules caused by chronic exposure to sunlight​ Half of all skin cancers in the United States begin as AKs​ Drugs for AK​ Fluorouracil​ Diclofenac sodium​ Imiquimod​ Aminolevulinic acid + blue light​

Question 27

atopic ​Dermatitis (Eczema)​

Answer 27

Chronic inflammatory skin disease ​ Dry scaly skin intense itching ​ Underlying cause has to do with T cells​ Keep skin moist with cream drugs Glucocorticoids​ Topical immunosuppressants​ May cause skin cancer or lymphoma​ Second line ​ Only use in folks that do not response to glucocorticoids ​ Tacrolimus​ Pimecrolimus

Question 28

Venereal Warts

Answer 28

Form around, vagina, valva, urethra, glans, anus, anal canal ​ Caused by HPV 6 and 11​ STI ​ Commonly identifying during vaginal exams ​

Question 29

Agents Used to Remove ​Venereal Warts​

Answer 29

Physical measures​ Cryotherapy, electrodesiccation, laser surgery, and conventional surgery​ Topical drugs (must be applied by provider)​ Podophyllin (must be applied by provider) -Needs to be washed off a few hours later, Small areas done at once ​ Bichloroacetic acid (BCA) and trichloroacetic acid (TCA) ​-Destorys wats by chemical coagulation, Can be repeated weekly ​ Topical drugs (can be applied at home)​ Imiquimod-Cream, Stimulates production of interferon alpha tumor necrosis factor, Itching burning, skin at site ​ Podofilox​ Kunecatechins​

Question 30

Common Warts

Answer 30

a vulgaris: Hard, rough, horny papules​ Majority of common warts are caused by just three types of human papillomavirus (HPV): HPV-1, HPV-2, and HPV-3​ Physical measures for removal​ Cryotherapy, electrodesiccation, curettage, and laser therapy​ Topical drugs ​ Salicylic acid, podophyllin, podofilox, imiquimod, trichloroacetic acid, and topical fluorouracil​ ​

Question 31

Antiperspirants

Answer 31

Aluminum chlorohydrate, aluminum chloride, and buffered aluminum sulfate; these agents can reduce the flow of eccrine sweat by 20% to 50% ​

Question 32

Deodorants

Answer 32

Carbanilide, triclocarban, and triclosan inhibit the growth of the surface bacteria that degrade components of apocrine sweat into malodorous products; they do not suppress sweat formation​ ​

Question 33

Drugs for seborrheic dermatitis and dandruff​

Answer 33

Pityrosporum ovale, a microbe in the yeast family​ Symptoms respond rapidly to topical treatment with ketoconazole, an antifungal drug with activity against yeast​

Question 34

Treatment of hair loss

Answer 34

Topical minoxidil –topical direct vasodilation, delays loss of hair and stimulate hair growth, takes several months to develop​ Finasteride [Propecia]​ PO​

Question 35

Treatment of unwanted facial hair

Answer 35

Eflornithine [Vaniqa]​ Available in creams ​ Inhibits enzyme required for hair growth ​ Only moderately effective ​ Benefits develop over 4-8wk and fade within 8wks after stopping med itself

Question 36

Impetigo

Answer 36

Most common bacterial infection of the skin: Staphylococcus aureus​ Usually seen in children 2 to 5 years of age​ Two forms:​ Bullous ​-From toxin in SA, Typically in moist areas of skin ​ Nonbullous​ -Crust ​Hands, feet, legs ​ Impetigo is treated with antibiotics​ PO -cephlexin, dioxcyline, clindamyin, augmentin topical -Bactroban and atabax

Question 37

Local Anesthetics

Answer 37

Can be applied topically to relieve pain and itching associated with skin disorders​ Benzocaine​ Lidocaine​ Pramoxine​