Common Skin Conditions Flashcards
(217 cards)
1
Q
What can aloe possibly treat?
A
Aloe is a natural product produced from the aloe vera plant that is used for many skin conditions, including sunburn and psoriasis. It has little proven efficacy, but if used as a gel or lotion, it may provide a soothing effect
2
Q
What can tea tree oil possibly treat?
A
Tea tree oil is used for a variety of skin conditions, such as acne. It may be helpful for onychomycosis symptoms (depending on the dose and application schedule) but will not eradicate the infection in most patients
3
Q
What can lysine be possibly used for?
A
Lysine, taken as a tablet, capsule or applied topically, is used for cold sore (herpes simplex labialis) prevention and treatment
4
Q
What can biotin be possibly used for?
A
Biotin is a vitamin used for hair loss and brittle nails
5
Q
What can topical vitamin D be possibly used for?
A
Topical vitamin D is used in skin conditions, such as diaper rash and psoriasis
6
Q
What are some examples of drugs that can discolor skin and secretions to the color brown?
A
Entacapone, Levodopa, Methyldopa
7
Q
What are some examples of drugs that can discolor skin and secretions to the colors brown/black/green?
A
Iron (black stool), methocarbomol
8
Q
What are some examples of drugs that can discolor skin and secretions to the colors brown/yellow?
A
Nitrofurantoin, Metronidazole, Tinidazole, Riboflavin (B2)
9
Q
What are some examples of drugs that can discolor skin and secretions to the colors purple/orange/red?
A
Chlorzoxazone
10
Q
What are some examples of drugs that can discolor skin and secretions to the colors orange/yellow?
A
Sulfasalzine
11
Q
What are some examples of drugs that can discolor skin and secretions to the colors yellow-green?
A
Propofol, Flutamide
12
Q
What are some examples of drugs that can discolor skin and secretions to the colors red-orange?
A
Phenazopyridine, Rifampin, Rifapentine
13
Q
What are some examples of drugs that can discolor skin and secretions to the color red?
A
Anthracyclines, Deferasirox (urine)
14
Q
What are some examples of drugs that can discolor skin and secretions to the color blue?
A
Methylene blue, Mitoxantrone
15
Q
What are some examples of drugs that can discolor skin and secretions to the color blue-gray?
A
Amiodarone, chloroquine
16
Q
What are the primary determinants of acne?
A
Androgens, along with the presence of the bacteria, Cutibacterium acnes and fatty acids (sebum) present in oil (sebaceous) glands
17
Q
How are acne lesions classified?
A
Acne lesions are classified as whiteheads (closed comedones), blackheads (open comedones), papules, pustules and nodules (sometimes called “cysts”)
18
Q
How is acne treatment determined?
A
Treatment is determined by severity: mild (few, occasional pimples), moderate (inflammatory papules) or severe (nodules)
19
Q
What are the primary group of medications to treat acne?
A
Acne is treated with these primary groups of medications: OTC benzoyl peroxide and salicylic acid, retinoids, topical or systemic (oral) antibiotics and systemic isotretinoin
20
Q
What is considered first-line treatment for mild acne?
A
Topicals: BPO and/or retinoid
21
Q
What are alternative treatments for mild acne?
A
Add topical retinoid or BPO, switch to another retinoid, topical dapsone or clascoterone
22
Q
What is the first-line treatment for moderate acne?
A
Topicals: combination (BPO + topical antibiotic, BPO + retinoid or BPO + retinoid +topical antibiotic)
or
PO antibiotic + BPO + topical retinoid (+/- topical antibiotic)
23
Q
What are alternative treatments for moderate acne?
A
Other combination therapy, switch PO antibiotic, add combined OCP or spironolactone (females) or PO isotretinoin
24
Q
What are first-line treatment for severe acne?
A
Topical combination + PO antibiotic or oral isotretinoin
25
What are alternative treatments for severe acne?
Switch PO antibiotic, add combined OCP or spironolactone (females) or PO isotretinoin (if not previously tried)
26
What is benzoyl peroxide?
Benzoyl peroxide (BPO) is an effective OTC medication and is recommended for most patients with acne. It is also available by prescription, including in combinations with hydrocortisone, the retinoid adapalene or with the antibiotics erythromycin or clindamycin
27
How is salicylic acid supplied?
Salicylic acid is available OTC and is supplied in several different formulations, including washes, "medicated pads" and lotions
28
What are retinoids used for?
Retinoids, primarily topical tretinoin and derivatives, are the usual prescription drug of choice and are also used to reduce wrinkles
29
What is a warning about retinoids?
Retinoids are teratogenic. They must be avoided in pregnancy or breastfeeding
30
What is the mechanism of retinoids?
Retinoids are vitamin A derivatives. The mechanism is primarily to reduce adherence of the keratinocytes (outer skin cells) in the oil gland
31
What are some counseling points about retinoids?
- They are well-tolerated when used topically, with mild skin irritation (redness, drying) and photosensitivity possible. Retinoids should be applied daily at night with the correct (pea-sized_ amount. Thus can be decreased to every other night if irritation occurs. A moisturizer, followed by sunscreen, should be used each morning
- Retinoids take 4-12 weeks to work, and acne can worsen initially. Minocycline can be used with topical retinoids to help reduce worsening. Tazarotene often works better than tretinoin; it is used for difficult cases
32
What is required for the used of oral retinoid isotretinoin?
The oral retinoid isotretinoin has many safety considerations. Isotretinoin is FDA-approved for severe, recalcitrant nodular acne only, though it is also used off-label for moderate, treatment-resistant acne. Cholesterol and pregnancy tests are required, among other monitoring
33
What is the benefit of oral contraceptive pills for the treatment of acne?
Some women find benefit with oral contraceptive pills, especially if acne occurs around the menstrual cycle or if irregular menses or symptoms of androgenic excess are present
34
What is the benefit of using spironolactone for the treatment of acne?
Spironolactone is an aldosterone receptor antagonist with antiandrogen effects. It is not FDA-approved for acne, but is recommended as a useful treatment for some females
35
What is azelaic acid and what can it be used for?
Azelaic acid (Azelex, Finacea) is a topical dicarboxylic acid cream or gel available OTC and prescription for acne and rosacea
36
What is clascoterone used for?
Clascoterone (Winlevi) is a recently-approved topical androgen receptor inhibitor. It can be used as an alternative for the treatment of mild acne in patients age 12 and older
37
What are some examples of topical retinoids and acne products?
Tretinoin, Adapalene, Tazarotene, Trifarotene, Benzoyl peroxide, topical antibiotics and combinations, salicylic acid, azelaic acid, Dapsone, Winlevi
38
What is note applicable to all topical retinoids?
Topical retinoids should be avoided in pregnancy
39
What is a note about Retin-A Micro and Avita?
Slower release, less skin irritation
40
What is a note about Tazarotene?
Contraindicated in pregnancy, lotion is approved in individuals aged 9 years and older
41
What is a note about Altreno?
0.05% lotion form of tretinoin, less irritating
42
What is a note about Fabior?
Stronger, more irritating
43
What are some safety/counseling points of topical retinoids?
- Limit sun exposure
- Apply daily, usually at bedtime, about 20 minutes after washing face
- If irritation occurs, use lower strength or every other night. May need to reduce contact initially (was off if skin is irritated)
- A pea-sized amount is sufficient (for facial application); it should be smoothed over the entire surface of the face, not just on acne
- Avoid salicylic acid scrubs or astringents; will worsen irritation
- Wash only with mild soap twice daily
- Takes 4-12 weeks to see response; may worsen acne initially
44
What are some notes about Benzamycin and BenzaClin?
Add indicated amount of purified water to the vial (70% ethyl alcohol for Benzamycin) and immediately shake to completely dissolve medication (use additional purified water to bring level up to mark if needed). Add solution in the vial to the gel; stir until homogenous (1 to 1.5 minutes). Place a 3-month expiration date on the label foloowing mixing
*Benzamycin is kept refrigerated and BenzaClin is kept at room temperature
45
What are some notes about Winlevi?
- Keep refrigerated before dispensing; store at room temperature after dispensing
- Expires 180 days after dispensing if unopened or 1 month after opening the container, whichever is sooner
46
What are some safety/counseling points about BPO?
- Can bleaching clothing and hair
- Start with 2.5-5% BPO, generally adequate and less irritating than the higher strengths
- Limit sun exposure
47
What are some safety/counseling points about Clindamycin topicals?
- Clean face, shake (if lotion), apply a think layer once or twice daily. Avoid contact with eyes; if contact, rinse with cold water
- Takes 2-6 weeks for effect and up to 12 weeks for full benefit
48
What is a counseling point about Dapsone gel?
Avoid in G6PD deficiency
49
What is a counseling/safety point about Clascoterone?
- HPA axis suppression may occur during or after treatment; more likely with use over a large surface area, prolonged use, and use with occlusive dressings
- Apply a thin layer twice daily after washing and drying the skin
50
What is an example of an oral retinoid?
Isotretinoin
51
What are some notes about Isotretinoin?
- Only FDA-approved for severe, refractory nodular acne
- Female patients must sign patient information/informed consent form about birth defects if the fetus is exposed to isotretinoin. Must have had 2 negative pregnancy tests prior to starting treatment
- Cannot get pregnant for 1 month before, while taking the drug, or for 1 month after the drug is stopped. Do not breastfeed or donate blood until at least 1 month has passed after the drug is stopped
- Do not use with vitamin A supplements, tetracyclines, steroids, progestin-only contraceptives or St. John's wort
- Must swallow capsule whole, or puncture and sprinkle on applesauce or ice cream (may irritate the esophagus)
52
What are some boxed warnings about Isotretinoin?
- Birth defects have been documented; must not be used by women who are pregnant or may become pregnant
- Can only be dispensed by a pharmacy registered and activated with the pregnancy REMS (iPLEDGE) program. 1-month Rx at a time, fill within 7 days with yellow sticker attached
53
What are some warnings about isotretinoin?
Dry skin, chapped lips, dry eyes/eye irritation (may cause difficulty wearing contact lenses), decreased night vision (may be permanent), arthralgia, skeletal hyperostosis (calcification of ligaments that attach to the spine), osteoporosis, psychiatric issues (depression, psychosis, risk of suicide), increased cholesterol and BF=G
54
What are some counseling points of isotretinoin?
Pregnancy testing must be repeated on a monthly basis. 2 forms of birth control are required (cannot use a progestin-only pill). Carry bottled water, eye drops and lip balm
55
What are some antibiotics used for acne?
Doxycycline, Sulfamethoxazole/trimethoprim, Sarecycline, Erythromycin
56
What are some notes about antibiotics used for acne?
- Doxycycline and minocycline are more effective than tetracycline in eradicating C. acnes
- Sulfamethoxazole/trimethoprim is also used. Erythromycin is used less commonly due to resistance
- Sarencycline is a tetracycline derivative for non-nodular moderate to severe acne
57
What are some safety/counseling points of antibiotics used for acne?
- Can cause photosensitivity, rash in susceptible patients, dizziness, diarrhea, somnolence
- Like other tetracyclines, can cause fetal harm if administered during pregnancy
- May cause permanent discoloration in teeth if used when teeth are forming (up to 8 years of age)
58
What type of virus causes cold sores?
Cold sores are usually due to herpes simplex virus type-1 (HSV-1) but can be caused by HSV-2 when due to oral/genital sex
59
How does the herpes simplex virus spread?
The virus spreads mostly with active lesions; kissing and sharing drinks can transmit the infection
60
When and where does the sore occur?
Sore eruption is preceded by prodromal symptoms (e.g. tingling, itching, soreness). In most patients, the sore appears in the same location repeatedly. The most common site is the junction between the upper and lower lip
61
What are some triggers that instigate sore outbreaks?
Triggers that instigate sore outbreaks include fatigue, stress, stress to the skin (e.g. sun exposure, acid peels) and dental work
62
What is the prodromal period?
The prodromal period is the optimal time to start treatment (topical or oral) to reduce blister duration
63
What can be done if recurrences of cold sores are frequent?
If recurrences are frequent (>4 times/year), chronic suppression, taken daily, can be used
64
How many days does OTC and prescription topicals shorten the duration of cold sores?
OTC and prescription topicals shorten the duration by up to one day
65
How many days does oral (systemic) antivirals shorten the duration of cold sores?
Oral (systemic) antivirals shorten the duration by up to two days
66
What natural product is used commonly for cold sore prevention and treatment?
Lysine
67
What products are available for the treatment of cold sores?
- OTC: Docosanol (Abreva)
- RX: Acyclovir topical cream/ointment (Zovirax), Acyclovir buccal tablets (Sitavig), Penciclovir topical cream (Denavir)
68
What are some counseling points of Abreva cream?
Apply 5x daily at first sign of outbreak, continue until healed
69
What are some counseling points of Zovirax cream?
Apply 5x daily for 4 days (can be used on genital sores)
70
What are some counseling points of Sitavig tablets?
Apply one 50 mg tablet as a single dose to upper gum region
71
What are some counseling points of Denavir cream?
Apply every 2 hours during waking hours for 4 days
72
When does dandruff occur?
Dandruff occurs when the scalp is itchy and/or scaling with white oily flakes (dead skin) in the hair and on the shoulders, back or clothing
73
What can dandruff be caused by?
Dandruff can be due to either eczema or fungal (yeast) overgrowth, and is worsened by hormones, the weather or shampoo
74
What is seborrheic dermatitis?
Seborrheic dermatitis is a common form of eczema that causes flaking, itchy skin on the face, back, chest or head. If it is on the scalp, it is commonly referred to as dandruff
75
What are some products to treat dandruff?
- OTC: Ketoconazole 1% shampoo, selenium sulfide, pyrithione zinc, coal tar shampoos
- RX: Ketoconazole 2% shampoo
76
What are some safety/counseling points for antifungal shampoo?
- Rub shampoo in well, leave in for 5 minutes, then rinse out
- Shampoo daily. If the shampoo stops working switch products
77
What are some safety/counseling points of Nizoral A-D?
- Apply twice weekly, for up to 8 weeks
- Do not use if open sores on scalp
- Can cause skin irritation
78
What is the most common cause of hair loss?
The most common cause of hair loss is hereditary male-pattern baldness and less commonly, female-pattern baldness
79
What are some less common causes of hair loss?
Hormonal changes in women that can result in hair loss are usually associated with pregnancy, childbirth or menopause
80
What medical conditions can cause hair loss?
Medical conditions that cause hair loss include hypothyroidism, alopecia areata (an autoimmune condition), scalp infections and some other conditions including lupus, zinc and vitamin D deficiency
81
What drugs can contribute to alopecia?
Various chemotherapeutics, valproate, spironolactone, heparin, warfarin, clomiphene, hydroxychloroquine, interferons, lithium, some types of oral contraceptives, levonorgestrel and procainamide
82
What is a medication that can be used to treat alopecia?
Finasteride, Minoxidil, Bimatoprost
83
What are some notes about Finasteride?
- Must be used indefinitely or condition reappears
| - Do not dispense to patients taking finasteride for BPH
84
What is a contraindication of Finasteride?
Pregnancy
85
What is a warning of Finasteride?
Hazardous drug for females of childbearing age - can harm a male fetus
86
What are some side effects of Finasteride?
Lower dose than Proscar; lower risk of sexual side effects
87
What are some notes about Minoxidil?
- 5% strength is ore effective but causes more facial hair growth
- Must be used indefinitely or condition reappears
88
What are some safety/counseling points of Minoxidil?
- Flammable; do not use near a heat source
| - Can be used by males or females
89
What is a note about Bimatoprost?
Do not use with PG analogs used for glaucoma
90
What are some safety/counseling about Bimatoprost?
- May cause itchy eyes and/or eye redness. Eyelid skin darkening may occur, may be reversible
- Hair growth may occur in other skin areas that the solution frequently touches
- Apply nightly, with applicator brush, to the skin at the base of the upper eyelashes only. Blot any excess. Repeat on other eye. Dispose of applicator after one use. If stopped, lashes will return to their previous appearance
91
What is eczema?
Eczema is a general term for many types of skin inflammation and is used interchangeably with the term atopic dermatitis
92
How does eczema typically present?
Eczema presents as skin rashes, which becomes crusty and scaly; blisters can develop. The rash is itchy, red, dry and sore
93
Where are common sites affected for eczema?
Common sites affected include the elbows, behind the knees/ears, face (often the cheeks), buttocks, hands and feet
94
What should patients with eczema avoid?
Patients should avoid triggers such as environmental irritants, allergens (soaps, perfumes), pollution, stress or weather changes
95
What is essential to reduce disease severity of eczema?
Hydration is essential to reduce disease severity. Use moisturizers. Maintain adequate humidity in the home
96
What are treatment options for eczema?
Treatment can include topical steroids (occasional oral courses, if needed), antihistamines (for itching) or immunosuppresant calcineurin inhibitors (if topical steroids with hydration are not adequate)
97
What are treatment options for severe, refractory cases of eczema?
Oral immunosuppresants (cyclosporine, MTX), or monoclonal antibody drugs can be used.
98
What is Dupilumab approved for?
Dupilumab (Dupixent) is approved for moderate to severe eczema and is administered by subcutaneous injection every other week
99
What are examples of treatment options for eczema?
- OTC: moisturizers with petrolatum, lanolin (Aquaphor, Eucerin, Keri or store brands)
- RX: treat with topical steroids first and use the following if steroids failed, topical calcineurin inhibitors (Tacrolimus, Pimecrolimus), topical PDE-4 inhibitor (Eucrisa), monoclonal antibody (Dupixent)
100
What are safety/counseling points for all topical products treating eczema?
- Wash hands after application
- Apply a thin layer only to the affected skin twice a day
- Use the smallest amount needed to control symptoms
101
What are safety/counseling points of 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 shirt-term, intermittent
- Avoid exposure to natural or artificial sunlight
- Side effects cna include headache, skin burning, itching, cough and flu-like symptoms
102
What are some safety/counseling points of Dupilumab?
- Avoid use of live vaccines
| - Injection site reactions are the most common side effect
103
What is hyperhidrosis and how is it diagnosed?
Hyperhydrosis is excessive sweating. Diagnosis is based on physical exam and thorough medical history
104
What are some treatment options of hyperhidrosis?
- OTC: antiperspirants
| - RX: glycopyrronium topical (Qbrexa)
105
What is a note about Qbrexza?
Qbrexza is a topical anticholinergic
106
What is a safety point about Qbrexza?
Do not use Qbrexza in medical conditions that can be exacerbated by anticholinergics
107
What is a counseling point of Qbrexza?
Wipe dry skin in the underarm area with a single-use, premoistened cloth. Wash hands with soap and water afterward
108
What are some examples of skin fungal infections?
Tinea pedis, cruris, corporis and topical Candida infections
109
What is tinea pedis?
A fungal infection of the foot caused by various fungi (commonly trichophyton rubrum)
*This is a common infection, particularly among those using public pools, showers and locker rooms
110
What are symptoms of tinea pedis?
Symptoms include feet itching, peeling, redness, mild burning and sometimes sores
111
How is tinea pedis diagnosed?
Diagnosis is usually by symptoms but if unclear, the skin can be scraped off and viewed under a microscope
112
How is tinea pedis treated?
Treated topically with antifungal, except in severe cases
113
What does tinea cruris affect?
Affects the genitals, inner thighs and buttocks
114
Describe the symptoms of tinea cruris.
The rash is red, itchy and can be ring-shaped
115
Is jock itch (tinea cruris) contagious?
Jock itch is not very contagious, but can be spread person-to-person with close contact
116
What are some counseling points about treating tinea cruris?
- Keep the skin dry (use a clean towel after showering) and treat with topical antifungal. Creams work best
- Change underwear at least daily
117
What is tinea corporis?
Tinea corporis is ringworm. It is not a worm, but a fungal skin infection
118
What are the symptoms of ringworm?
Ringworm can appear anywhere on the body and typically looks like circular, red, flat sore (one or more, may overlap) usually with dry, scaly skin. 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
119
How can tinea corporis be spread?
Most cases are treated topically
120
What is tinea capitis?
Tinea capitis is ringworm on the scalp
121
What are the common symptoms of topical candida infections and where are they most commonly located?
Topical candida infections cause red, itchy rashes, most commonly in the groin, armpit or anywhere the skin folds
122
Who is most likely to experience skin candida infections?
More likely in obese persons because they will have more skin with folds; the infection can be in unusual places, such as under the breasts, if the skin is moist. Diabetes is another risk factor
123
What is done if a candida infection appears in the corner of nails?
If this is a suspected bacterial infection, OTC antibiotic topicals or mupirocin can be used
124
What are examples of fungal treatments for the skin?
- OTC: Terbinafine, Butenafine, Clotrimazole, Miconazole, Tolnaftate, Undecylenic acid
- RX: betamethasone/clotrimazole, Ketoconazole, Luliconazole
125
What are some safety/counseling points of fungal treatments for the skin?
- If infection is on the foot, do not walk barefoot (to avoid spreading it); wear sandals in public showers
- 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
- Creams work best and use used in most cases
- Solutions can be easier to apply in hairy areas
- Powders do not work well for treatment but may be used for prevention
126
What is onychomycosis?
Onychomycosis is a fungal infection of the nail often caused by tinea unguium. It can cause pain, discomfort and disfigurement and lead to physical limitations
127
Can topical drugs be used for onychomycosis?
Topical drugs are limited to mild cases and patients who cannot tolerate systemic therapies, in combination with systemic treatment or as prophylaxis. They are not potent enough to cure most infections
128
What medications are approved for the treatment of onychomycosis?
Itraconazole and terbinafine are approved for this use and most commonly used; fluconazole and posaconazole are used off-label. Griseofulvin is rarely used
129
What are some alternative treatment options of onychomycosis?
- Pulse therapy (intermittent) can be used to reduce costs and possibly toxicity, but may not be as effective
- A 20% potassium hydroxide (KOH) smear is essential for diagnosis as other conditions can produce a similar presentation
130
What are examples of RX treatment options of onychomycosis?
Terbinafine, Itraconazole, Ciclopirox, Tavaborole, Efinaconazole
131
What are some notes about ciclopirox?
Used in combination with orals; poor efficacy when used alone
132
What is a note about Tavaborole?
Applied topically for 48 weeks
133
What is a note about Efinaconazole?
Applied topically x 48 weeks
134
What are some safety/counseling points about the treatment options of onychomycosis?
- Systemic drugs used for nail fungal infections are hepatotoxic (monitor LFTs), QT-prolonging (avoid in QT risk) and CYP3A4 substrates and inhibitors
- Nausea and diarrhea are common
- Recurrence is common. Practice proper foot care and keep the nails dry. Keep blood glucose controlled. Do not smoke
135
What is a safety point of Itraconazole?
Boxed warning to avoid use in heart failure. Requires gastric acid for absorption; cannot use with strong acid-suppressing drugs
136
What is a safety point about Terbinafine?
Oral: primarily headache, rash, nausea, risk of hepatotoxicity
137
What typically causes vaginal infections?
Hormones impact the pH of the vagina, making menstruating women more susceptible
138
When are vaginal fungal infections more common?
Vaginal fungal infections are more common during pregnancy. Pregnant patients should consult their physician. Longer (7-10 day) treatment is required
139
What are some symptoms of vaginal fungal infections?
Symptoms are primarily itching with possible soreness and pain (burning) during urination or sex. Some women have a cottage-cheese like discharge (white, thick, clumpy)
140
How can vaginal fungal infections be diagnosed?
Diagnosis can be confirmed with vaginal culture to check for fungal growth, while a pH test can be used to help rule out other conditions. A pH > 4.5 is consistent with bacterial vaginosis or trichomoniasis infection
141
When is testing for vaginal fungal infections not necessary?
Testing is not necessary if the woman has been seen by a physician for the initial infection and is able to recognize the symptoms. Self-treatment with OTC products is appropriate
142
What should be done if there are more than four vaginal infections in a year or if symptoms recur within two months?
Refer to the physician to rule out an underlying condition that could be causative
143
Who is at an elevated risk to develop vaginal fungal infections?
Women taking high-dose estrogen, hormone replacement therapy or antibiotics are at elevated risk. Antibiotic use can kill the normal flora and lead to fungal overgrowth
144
What is thought to reduce vaginal fungal infection occurrence?
Lactobacillus or yogurt with active cultures is thought to reduce infection occurrence; however this is rated as "possibly ineffective" by the Natural Medicines Database
145
What should be counseling if someone is self-treating a vaginal fungal infection?
If self-treating, counsel that condoms and diaphragms do not provide adequate pregnancy protection; the oil in OTC antifungals weakens the latex
146
What are some non-pharmacological counseling points to prevent future vaginal fungal infections?
To avoid future infections, keep the vaginal area clean, wipe from front to back after using the restroom, use cotton underwear, avoid tight-fitting clothing, change pads/tampons often, change out wet swimsuits or clothing quickly and recommend against use of vaginal douches, sprays and deodorant tampons (these can alter the vaginal pH and contribute to infection)
147
What are some examples of treatment options for vaginal fungal infections?
- OTC, topical: Clotrimazole, Miconazole
- RX, topical: Butoconazole, Terconazole
- RX, oral: Fluconazole
148
What are some counseling points for OTC antifungals?
- Prior to using the product, wash the external genital area with mild soap and water and pat dry with a towel
- Insert applicator, suppository or vaginal tab at night before bed. Lying down immediately after insertion helps retain the medicine inside the vagina
- The creams and suppositories are oil-based medications that can weaken latex condoms and diaphragms; avoid sexual intercourse
- If you get your menstrual cycle during treatment, you may continue the treatment
- Do not use tampons during treamtnet
- Complete entire course of treatment
- Medical care is warranted if symptoms persist/return within 2 months after using an OTC product, or if > 4/year
149
Why does diaper rash occur?
The skin is sensitive, and when exposed to urine, stools and friction from diaper moving back and forth, a rash appears. Once the skin is damaged, it is susceptible to bacteria and yeast overgrowth
150
What are some prevention tactics for diaper rash?
- Change diapers often; do not cover diapers with plastic
- Wipe well with unscented wipes or plain water
- Leave the diaper off, when possible, to let the skin air-dry
- Use a skin protectant: Petrolatum ointment or petrolatum with zinc oxide
151
What are some treatment options for diaper rash?
- Clotrimazole, miconazole, nystatin: for stubborn rashes, if yeast is thought to be involved
- Hydrocortisone 0.5-1% cream can be applied twice a day, but not for more than several days at a time. Hydrocortisone can be used in combination with topical antifungals
152
What are safety/counseling points of diaper rash?
- Infants should be referred to the physician (especially if under 6 months); refer older babies if condition appears serious or worsens
- Diaper rashes can have more than one contributing organism. Topical antibiotics can be needed if bacterial involvement is suspected. Topical antifungals can be needed if fungal involvement is suspected
- Low-potency topical steroids may be used short-term
153
What is hemorrhoids?
Hemorrhoids are swollen blood vessels in the lower rectum
154
What causes hemorrhoids?
They are often the result of constipation and straining to have a bowel movement. Rectal tissue is sensitive with a rich blood vessel supply making it susceptible to engorgement
155
What are common symptoms of hemorrhoids?
Common symptoms are pruritus, burning and rectal bleeding. The blood is usually bright red
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What options can treat the cause of hemorrhoids?
If dietary fiber intake is not optimal, increasing fiber intake can held reduce straining. Products such as psyllium will mix with the stool to make it easier to push out. A stool softener will reduce straining
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What are some treatment options for the symptoms of hemorrhoids?
- Phenylephrine (Preparation H) is a vasoconstrictor that shrinks the hemorrhoid and reduces burning and itching
- Hydrocortisone comes in anal suppositories and various topicals that reduce itching and inflammation
- Witch hazel is a mild astringent that can relieve mild itching
- Barriers to reduce irritation from stool/urine are helpful in some cases
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What are the counseling points of ointments to treat hemorrhoids?
Clean the skin first with mild soap and warm water. Gently pat dry. Apply ointment externally up to 5 times daily
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What are counseling points of suppositories to treat hemorrhoids?
Hold wrapped suppository container with rounded end up, separate the foil tabs and slowly peel apart, remove from the wrapper, insert into the rectum up to 4 times daily, especially at night and after bowel movements
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How does pinworm infection typically present?
Pinworm infection most commonly occurs in children and presents as anal itching
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What is typically active against Enterobius vermicularis?
Anthelmintics, such as mebendazole, pyrantel pamoate and albendazole, are active against Enterobium vernicularis
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What is the tape test?
The tape test is used to identify eggs
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How do you do the tape test?
Stick a piece of tape around the anus in the morning prior to voiding/defecating. The tape is removed and brought to a healthcare provider, who examines it under a microscope to look for eggs. It can take up to three morning tape tests to identify the eggs
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What is a safety/counseling point of Pyrantel?
Pyrantel causes headaches and dizziness. It is given as a single dose and repeated in 2 weeks to eliminate reinfection
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What is a safety point about Mebendazole and albendazole?
Mebendazole and albendazole cause headache, nausea and are hepatotoxic
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What are safety/counseling points of treatments for systemic worm infections?
Treatments for systemic worm infections are toxic. In some cases, such as treating CNS infections, steroids and AEDs will be given with the anthelmintic. When treating systemic infections, albendazole must be taken with a high fat meal (to increase absorption)
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How are scabies and lice typically spread?
Scabies (mites) and lice are spread mainly through close body contact and treated wtih some of the same medications
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What is the OTC drugs of choice to treat lice and scabies?
Topical pyrethrins and permethrin are the OTC drugs of choice, though the efficacy of pyrethrins has decreased due to resistance. These products can be used in infants as young as 2 months. Avoid with chrysanthemums or ragweed allergy
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What are some alternative options to treat lice and scabies?
- Malathion lotion 0.5% is an organophosphate only for use one persons 6 years of age and older (can irritate the skin and is flammable so do not smoke or use electrical heat sources
- Benzyl alcohol 5% lotion kills live lice but not nits (can irritate the skin and eyes)
- Lindane shampoo 1% is no longer recommended due to neurotoxicity and is reserved for refractory cases (never used in pregnancy, on irritated skin, in infants, children or the elderly)
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What are some non-pharmacological treatments for lice and scabies?
- Wash clothes and bedding in hot water, followed by a hot dryer
- If something cannot be washed, seal it in an air proof bag for two weeks or dry clean. Vacuum the carpet well. Soak combs and brushes in hot water for 10 minutes
- Do not use condition before using lice medicine. Do not re-wash the hair for 1-2 days after treatment
- After each treatment, check the hair and use a nit comb to remove nits and lice every 2-3 days. Continue to check for 2-3 weeks to be sure all lice and nits are gone
- Re-treatment is needed for most products on days 7-10 to kill any surviving hatched lice before they produce new eggs
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What are basic types of minor wounds?
Basic types of minor wounds are cuts, abrasions, bites and burns
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What vaccine should be given if a wound is dirty?
Make sure tetanus vaccine is current (booster every 10 years). If the wound is dirty, a repeat tetanus vaccine may be required if it is > 5 years since vaccination
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What do some chronic wounds require?
Debridement of chronic wounds is often needed to remove the head, devitalized or contaminated tissue that prevents healing
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What is the most common method of debridement?
The most common method of debridement is enzymatic debridement, which is done with the application of collagenase ointment (Santyl)
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What are some other debridement methods?
Other debridement methods, including surgical debridement, are considered for more complicated wounds
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What is the definition of a laceration?
Lacerations are defined as irregular wounds with ragged edges, with the potential for deeper skin damage and bruising under the skin
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How is a cut different from a laceration?
A cut is different than a laceration because the edges will be more uniform or regular
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After cleaning a cut or laceration, if the bleeding does not stop, what should be done?
Seek medical attention because it may require stitching to get the wound too close. If not, regular bandaging should close the wound over time
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What products can be used for wound care?
- Antibiotic ointment can be applied prior to bandaging
- Tissue adhesives create a polymer layer, which binds to the skin, keeping the wound clean and keeping moisture out. Some contain topical analgesics
- Wound seal is a topical powder that can be used over a bleeding wound to quickly form a scab and reduce the risk of infection
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What are abrasions?
Abrasions are minor injuries to the top layer of skin and are primarily treated with simple first aid
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How should abrasions be treated?
Abrasions, such as a skinned knee should be cleaned thoroughly; apply antibiotic ointment and bandage if desired
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Why should bites (except minor insect bites) never be treated with only first aid?
Because of the high risk of infection especially with animal or human bites
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How can spider bites be avoided?
Spider bites can usually be avoided by inspecting and shaking out clothing or equipment prior to use and wearing and protective clothing. If bitten, stay calm, identify the type of spider if possible, wash with soap and cold water, apply a cold compress with ice, elevate the extremity and get emergency medical care
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How can minor, harmless insect bites be treated?
Minor, harmless insect bites can be treated with a topical steroid or oral antihistamine to reduce itching
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How can burns be characterized?
Burns are characterized as first degree (red/painful, minor swelling), second degree (thicker, very painful, produce blisters), or third degree (damage to all layers of skin, appears white or charred)
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Why type of burns require emergency medical care?
Burns from chemical exposure or in immunosuppressed
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When is OTC treatment appropriate for burns?
If the burn is first or second degree, OTC treatment is acceptable if the area is less than two inches in diameter and not located on the face, over a major joint or on the feet or genitals
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How should minor burns be treated?
Minor burns should be treated first by running the burn under cool water or soaking in cool water for 5-20 minutes. Do not apply ice as it can further damage injured skin
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What should be used for skin protection over a minor burn?
Ointments (80% oil/20% water, such as Aquaphor) should be used for skin protection over a minor burn to hod in moisture and reduce scarring risk
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What can silver sulfadiazine be used for?
Silver sulfadiazine can be used topically to reduce infection risk and promote healing. If the skin is broken, systemic toxicity could occur. Do not use with sulfa allergy or G6PD deficiency (due to hemolysis risk)
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What are some examples of topical antibiotics?
- OTC: Polymyxin/bacitracin/neomycin
| - RX: Mupirocin, Bacitracin/neomycin/polymyxin B/hydrocortisone
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What are some safety/counseling points about application of topical antibiotics?
- Clean the affected area and apply a small amount of medication (an amount equal to the surface area of the tip of a finger) to the affected area 1 to 3 times daily
- If the area can get dirty (such as a hand) or be irritated by clothing, cover with an adhesive trip or with sterile gauze and adhesive tape +/= antibiotic ontment
- Change dressing/s daily
- Burns require a moist (but not wet) environment for healing. Apply either an ointment or a bandage designed for burns
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What is poison ivy, oak or sumac poisoning?
Poison ivy, oak or sumac poisoning is an allergic reaction that results from touching the sap of these plants, which contain the toxin urushiol
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What are OTC products that can be used to treat poison ivy, oak or sumac poisoning?
Aluminum acetate solution, colloidal oatmeal, calamine lotion/pramoxine, Zanfel
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What are some counseling points about treating poison ivy, oak or sumac?
- Aluminum acetate is an astringent
- Wash the urushiol off with soap and water carefully, including under fingernails and on clothing
- Topical or oral steroids will help (oral needed in severe rash)
- Cold compresses can help
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What is the primary treatment for skin irritation?
The primary treatment for skin irritation is topical steroids
*Two strengths of hydrocortisone are available OTC, 0.5% and 1%
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What does steroid vehicle influence?
Steroid vehicle influences the strength of the medication. Usual potency, from highest to lowest: ointment > creams > lotions > solutions > gels > sprays
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Where should low potency steroids be used?
Thin skin on the face, eyelids and genitals is highly susceptible to topical steroid side effects so low potency steroids should be used on these areas where the absorption is higher
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What are some local (skin) steroid side effects if used long-term?
Skin thinning, pigment changes, telangiectasia, rosacea, perioral dermatitis and acne, increased risk of skin infections, delayed wound healing, irritation/burning/peeling and possibly contact dermatitis
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What is preferred for the treatment of urticaria?
For urticaria, second generation antihistamines are preferred over first-generation antihistamines due to better tolerability. Higher doses are used. Histamine-2 receptor antagonists are helpful in some patients with urticaria
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What are some notes about the use of topical steroids?
- Use ointments for thick or dry skin
- Use lotions, gels and foams for hairy skin
- No evidence for use of topical diphenhydramine, can use systemic but caution due to side effects
- Skin should be lubricated (hydrated) with moisturizers for most conditions
- Camphor, menthol, local anesthetics can help relieve itching
- Severe rash will likely require oral steroids for 1-2 weeks
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What is a counseling point of topical steroids?
The "fingertip" unit is used to estimate amount: from the fingertip to the 1st joint provides enough medication to cover one adult hand. Encourage patient not to use more than directed as overuse has risks. Do not apply for longer than 2 weeks
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What are some safety points of Hydroxyzine?
Anticholinergic side effects, primarily sedation and dry mouth
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What are some topical steroids that have very high potency?
Clobetasol, Fluocinonide 0.1% cream
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What are some topical steroids that have high potency?
Betamethasone dipropionate 0.05% cream, Fluocinonide 0.05% ointment, mometasone furoate 0.1% ointment
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What is a high-medium potency topical steroid?
Fluocinonide 0.05% cream
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What are some examples of medium potency topical steroid?
Mometasone furoate 0.1% cream, triamcinolone acetonide 0.1%
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What is the topical steroid with the lowest potency?
Hydrocortisone
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Why is applying sunscreen important?
Due to the risk of sun damage and skin cancer
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What are some non-pharmacological methods to avoid sun damage?
It is advisable to stay out of the sun when it is strongest. The damaging UV rays penetrate clouds. Another way to avoid the sun is to wear protective clothing
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What does UVA and UVB do?
UVA causes damage below the skin surface causing aging. UVB causes burning
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What does SPF stand for?
SPF stands for sun protection factor, which is a measure of how well the sunscreen deflects UVB rays
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What are some counseling points in applying sunscreen?
The key is to apply liberally and at least every two hours and reapply after swimming or sweating. The AAP recommends keeping babies less than 6 months old out of the sun
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How do you calculate TTB?
SPF x TTB (without sunscreen)
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What is sunscreen no longer able to be labeled as?
Waterprrof or sweatproof
*A sunscreen can claim to be "water-resistant" but only for 40-80 minutes. Always reapply after swimming or sweating
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What chemical sunscreens does the AAD recommend?
Oxybenzone, Avobenzone, octisalata, octocrylene, homosalata or octinoxate
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What physical sunscreens are recommended by the AAD?
Zinc oxide and titanium dioxide
