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Y4 SA - Dermatology > Clinical Therapeutics > Flashcards

Clinical Therapeutics Flashcards

1
Q

Name two common surface overgrowth skin problems

A

Pyotraumatic dermatitis (“hot spots”)
Fold dermatitis

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2
Q

How can you treat ‘hot spots’

A

Look for underlying cause e.g., allergy (FAD) or pruritic/painful trigger; predisposed breed?
- Happen overnight
- Will see an overgrowth of cocci
- Clip and clean with topical antiseptic/antimicrobial
- Systemic anti-inflammatory and pain relief

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3
Q

How would you treat fold dermatitis?

A
  • Topical antiseptics/ anti-microbial and topical/systemic anti-inflammatories
  • Look for underlying cause e.g., obese dogs causing a deep vulvar fold -> weight loss
  • May progress to superficial or deep infection
  • Can occur around the tail base, vulva, lips, etc
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4
Q

Which lesions are seen in superficial pyoderma

A

Pustules, papules, macules, crusts, erythema, staphylococcus, plaques, epidermal collarette

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5
Q

What is staphylococcal folliculitis?

A

Pustule of the hair follicle

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6
Q

How is superficial pyoderma treated?

A

Underlying cause – identify, treat/ manage
Topical treatment is most important
Systemic antibiotics ONLY if severe/ widespread proven infection and/or no response to above - Preferably chosen by swab culture

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7
Q

Topical therapy is the sole therpay for which conditions?

A

Surface infections, otitis externa and many cases of superficial pyoderma

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8
Q

Why is topical therpay used adjunct to systemic therpay?

A

improve efficacy and speed cure

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9
Q

How does Malassezia present?

A

Cobblestone appearance of the ventral neck – skin thickening
Extremely pruritic

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10
Q

What is the first line treatment for Malassezia dermatitis?

A

Shampoo first line treatment
- Chlorhexidine 2% + miconazole 2%
- Chlorhexidine >= 3%

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11
Q

What are the other treatment options for Malassezia dermatitis?

A
  1. Other topical preparations for skin and ears - Clotrimazole, miconazole, nystatin, terbinafine, selenium sulfide
  2. Systemic antifungals - Only if chronic or severe and underlying disease addressed
  3. Allergy vaccine
    - If patient has atopic dermatitis and is hypersensitive
    - Desensitise the patient against the yeast
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12
Q

Which factors help to select treatment for deep skin infections?

A
  • Patient may be more painful that pruritic
  • Can be systemically unwell
  • Can have deep and superficial skin infections simultaneously but need to be treated differently as different parts of the skin are damaged
  • What is the underlying cause?
  • Localised: Topical antiseptics and antibiotics
  • Severe/ widespread, especially if patient systemically unwell: systemic antibiotics always based on culture and susceptibility
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13
Q

When is antimicrobial use is indicated, how they are used appropriately?

A
  • Choice based on cytology +/- culture and susceptibility testing
  • Use correct drug, dose, frequency and duration
  • Give good (written) instructions to owners
  • Drug choice: Pharmacokinetics, pharmacodynamics, susceptibility of the organism, antimicrobial prescribing guidelines and drug cascade
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14
Q

How long are antibiotics needed for superficial pyoderma?

A

2-3 weeks

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15
Q

How long are antibiotics needed for deep pyoderma?

A

4+ weeks
For deep infections there may be an initial rapid response, but then improvement occurs quite slowly; if progress stops repeat culture

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16
Q

Describe the features of 1st line antibiotics

A
  • Not restricted
  • High index of suspicion of, or proven infection
  • Based on likely microbe and C+S
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17
Q

Name some 1st line antibiotics

A

Amoxicillin +/- clavulanate
Tetracycline/doxycycline
Clindamycin
Cephalexin
Metronidazole

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18
Q

Describe the features of 2nd line antibiotics

A
  • Semi-restricted, case by case
  • Only if no 1st line drug
  • Infection evident and C+S uploaded
  • Consent from senior clinician
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19
Q

Name some 2nd line antibiotics

A

Minocycline
Cefovecin
Enrofloxacin/marbofloxacin
Gentamycin

20
Q

Describe the features of 3rd line antibiotics

A
  • Restricted, case by case
  • Only if no 1st or 2nd line drug
  • Infection evident (C+S)
  • Consent from senior clinician
  • Prescription completed
21
Q

Describe the features of 4th line antibiotics

A
  • Only option and good chance of successful outcome
  • Consent from infection control lead
  • Infection evident
  • Prescription completed
22
Q

How would you treat a staphylococcus pseudointermedius infection?

A
  • Intense topical antiseptics
  • Prednisolone
  • Contact owner with culture results and only use antibiotics if needed e.g. cephalexin
  • Re-examine in 2 weeks
23
Q

What are the principles of treatment for immune-mediated skin disease?

A
  1. Removal or treatment of any external triggers - Drugs, UV light, confirmed infections, underlying neoplasia
  2. Control of inappropriate immune response
    - Immunosuppressive/immunomodulatory drugs
    - Topical therapy for mild or localised disease
24
Q

Name the 3 phases of treatment for immune mediated skin disease

A
  • Induction of remission
  • Transition
  • Maintenance
25
Q

Describe the induction of remission phase of treatment for immune mediated skin disease

A
  • Need to do biochem and haematology first to find out basal parameters
  • Days to weeks
  • Aggressive therapy: immunosuppressive doses of steroids
  • May need to change/add treatments if minimal response after 2-4 weeks
  • Try to avoid severe adverse effects
  • Regular treatment monitoring
26
Q

Describe the transmission phase of treatment for immune mediated skin disease

A
  • Weeks to months
  • Taper to lowest effective dose
  • Taper drugs with most risk of adverse effects first
  • Treatment monitoring frequency reduces with time and absence of adverse effects
  • Bloods
  • If no relapse with advanced dose tapering stop treatment to determine cures
27
Q

Describe the maintenance phase of treatment for immune mediated skin disease

A
  • Months to years
  • Cases where relapses have occurred in transition phase
  • Lowest effective dose and monitor for adverse effects
  • Treatment monitoring as determined by treatment and dose
  • Further tapering if disease in remission for many months
  • For idiopathic cases that are lifelong and wont cure
28
Q

How can you monitor patient during treatment and adjust therapy when needed?

A
  • Baseline drug monitoring obtained prior to starting therapy
  • Induction every 7-14 days
  • Transition every 2-6 weeks
  • Maintenance every 1-6 months (case dependant)
29
Q

What is the primary treatment for immune mediated skin disease?

A

Steroids
E.g. Prednisolone 1-2mg/kg/day until stable (1-2 weeks), and then gradually taper every 1-2 weeks until reach minimal effective dose and frequency

30
Q

If a steroid alone is producing a sub-optimal response which treatment might you add to the therpay?

A

Cytotoxic drug
May also need cytotoxic drug to achieve lowest effective steroid dose/frequency to reduce potential drug side effects

31
Q

List some examples of immune mediated skin diseases that are treated with steroids

A
  • Eosinophilic furunculosis of the face
  • Juvenile sterile granulomatous dermatitis and lymphadenitis
  • Vasculitis or vasculopathy (may respond to oclacitinib)
  • Sterile pyogranulomatous dermatitis and panniculitis
  • Pemphigus foliaceus (PF)
  • Uveodermatological syndrome
  • Erythema multiforme
  • Sebaceous adenitis
  • Anal furunculosis
32
Q

Describe physiological dosing of steroids

A

Low dose
- Replace glucocorticoids that are absent in hypoadrenocorticism (adrenal insufficiency)

33
Q

Describe anti-inflammatory dosing of steroids

A

Intermediate dose
Reduce inflammation and pruritus through a variety of mechanisms

34
Q

Describe immunosuppressive dosing of steroids

A

High dose
Severely compromise immune responses to control immune-medicated disease

35
Q

List some common side effects of steroids

A
  • Polydipsia, polyphagia, polyuria
  • Muscle weakness
  • Breathlessness or panting
  • Weight gain and/or abdominal enlargement
  • Alopecia, secondary bacterial infections, calcinosis cutis
36
Q

How long does ciclosporin efficacy take?

A

2-8 weeks

37
Q

Ciclosporin is the main therapy of a number of IMSD - list some examples

A
  • Anal furunculosis (AF)
  • Symmetrical lupoid onychodystrophy (SLO)
  • Cutaneous lupus erythematosus (CLE)
  • Erythema multiforme (EM)
  • Sebaceous adenitis (SA)
  • Cutaneous histiocytosis
  • Adjunct in Pemphigus foliaceus (PF)?
38
Q

What are the side effects of Ciclosporin?

A

Vomiting and diarrhoea
Increased hair and gum growth due to increased TGFb
Immunosuppression
Papilloma growth

39
Q

List some properties of topical agents used in skin disease

A

Cleansing
Keratoplastic - Antiseborrhoeic
Keratolytic - Antiseborrhoeic
Emollient
Antimicrobial
Anti-inflammatory

40
Q

Define keratoplastic

A

Reduce cell turnover in the skin to reduce scale production

41
Q

Define keratolytic

A

Shampoo removes the cells from the surface of the skin e.g. salicylic acid

42
Q

Describe urea as a component of moisturisers

A

Binds water - promotes hydration, antibacterial, keratolytic

43
Q

Describe glycerine as a component of moisturisers

A

Hygroscopic - absorbed into skin

44
Q

Describe propylene glycol as a component of moisturisers

A

Potent softening and hydroscopic agent

45
Q

How would you treat sebaceous adenitis?

A
  1. Ciclosporin to save residual sebaceous glands
  2. Prednisolone until ciclosporin takes effect and to reduce pruritus
  3. Commonly have secondary infections - Topical antiseptics
  4. Sebaceous glands destroyed so loss of oils to the skin and coat
    - Remove thick scales
    - Rehydrate

Y4 SA - Dermatology (6 decks)

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