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1

Palm area rule

2 palm areas x2/day needs 30g for 1 month

2

Fingertip Units (FTU's)

2 FTU=1 g of Topical Steroid

3

How can we enhance absorption/efficacy with topical agents?

Occlusion-Apply plastic wrap
10x increase with topical steroid agents

4

What is the role of dressings?

1. Protect open lesions
2. Facilitate healing
3. Increase drug absorption
4. Protect patient's clothing

5

What is the MC Nonocclusive dressing?

Gauze dressings

6

Purpose of Nonocclusive dressing?

1. Maximally allow air to reach wound
2. Allow lesion to dry

7

Purpose of wet-to-dry dressings

Cleanse and Debride thickened/crusted lesions

8

How do you apply wet-to-dry dressings?

Applied Wet (saline solution)
Removed after solution has evaporated

9

What conditions increase penetration in topical steroids?

1. Inflamed skin-Atopic dermatitis
2. Exfoliative disease

10

Class I Potency and areas of application

Super High Potency steroid
Severe dermatoses over nonfacial and nonintertriginous:
1. Scalp
2. Palms
3. Soles
4. Thick plaques on extensor surfaces

11

Class I length of treatment

<3 weeks

12

Class II-V Potency and areas of application

Medium-to-High Potency Steroid
Mild-to-Moderate nonfacial and nonintertriginous

13

Class II-V length of treatment

<6-8 weeks

14

Class VI-VII Potency and areas of application

Low Potency Steroid
Large Areas and thinner skin:
1. Face
2. Eyelid
3. Genital
4. Intertriginous areas

15

Class VI-VII length of treatment

1-2 weeks

16

Low potency steroids SE's?

1. Skin atrophy
2. Telangiectasia
3. Steroid induced acne

17

Systemic SE's of Topical Glucocorticoids

1. HPA Axis suppression
2. Cushings
3. Growth retardation
4. Edema
5. Sodium retention
6. Pseudotumor cerebri

18

Ocular SE's Topical Glucocorticoids

1. Cataracts
2. Glaucoma
3. Retarded healing of corneal abrasion
4. Extension of herpetic infection
5. Increased susceptibility to bacterial and fungal infections

19

Cutaneous SE's of Topical Glucocorticoids

1. Skin atrophy
2. Striae
3. Telengiectasis, purpura, echymosis
4. Retardation of wound healing
5. Contact allergic dermatitis: Vehicle induced=common

20

What organisms does Bacitracin cover?

Gram +

21

Bacitracin Vehicle

Compound ointment base:
Alone OR
Combo with Neomycin/polymyxin B OR
Both

22

Most frequent SE of Bacitracin ?

Allergic contact dermatitis
Most likely from Neomycin

23

What organism does Mupirocin (Bactroban) cover?

1. Gram +
2. MRSA

24

What is the preferred vehicle of Mupirocin? What is covered by insurance?

Ointment=preferred
Cream=covered by insurance

25

Mupirocin ADE's

1. Stinging/Burning
2. Pruritis
3. HA

26

List the Triple ABx Ointment

1. Polymyxin B
2. Neomycin
3. Bacitracin

27

What organisms does Polymyxin B cover?

Gram -
1. P. aeruginosa
2. Enterobacter
3. E.coli
ALL gram + are resistant

28

What organism does Neomycin cover?

1. Gram - (E.coli)
2. Gram + (S. aureus)

29

Neomycin SE

Sensitization (contact dermatoses)
= 30%

30

What is the main benefit of Gentamcin?

More active against Pseudomonas than Neomycin

31

Mild inflammatory acne treatment

Topical Retinoid OR
Topical Benzoyl Peroxide AND/OR
Topical Abx

32

Moderate acne treatment

Retinoid + Benzoyl Peroxide
+/- Topical Abx

33

What should you consider for moderate acne treatment in females?

Oral Abx
Derm referral
Hormal therapy

34

Severe acne treatment t

Retinoid + Benzoyl Peroxide+ Oral Abx
+/- Topical Abx

35

What should you consider for severe acne treatment in females?

Oral Isotretinoin
Derma Referral
Normal therapy

36

Comedone treatment

Topical Tretinoin (Retin A)

37

Cystic Acne treatment

Intralesional Triamcinolone

38

List Topical Abx for use in mild-to-moderate cases of inflammatory acne

1. Clindamycin (water-based gel)
2. Erythromycin (water-based gel)

39

What can you combine both. Topical Clindaymycin and Erythromycin with?

Benzoyl Peroxide

40

Who is Retinoic Acid beneficial in?

1. Tx of Acne Vulgaris
2. Photodamaged skin
3. Thickened skin (psoriasis)
4. Atrophic areas

41

What is the best Retinoic Acids (acid form of Vitamin A)

Tretinoin (Retin A)

42

Retinoic Acid application

Every night at bedtime to dry skin only x4-6 weeks

43

What should you educate your patients about with the use of Retinoic acid?

1. Avoid contact with: corner of nose, eyes, mouth, mucous membranes
2. Can look worse initially
3. Avoid sun exposure and wear SPF

44

Who is Retinoic acid NOT recommended in?

Pregnant patients

45

Benzoyl Peroxide PK/Mechanism

1. Converted to Benzoic acid within epidermis and dermis
2. Bacteriostatic against P.acnes

46

What is the OVERALL recommendation in Acne?

COMBO THERAPY
1. Topical Retinoid +Abx (when inflammatory lesions are present)
2. Benzoyl Peroxide +/- ABx

47

When should you discontinue Abx therapy in acne?

Inflammatory lesions resolve

48

Tetracycline ADE's

1. Slate gray hyperpigmentation
2. Drug-Induced lupus
3. Tetragenic
4. Dizzines (Minocycline)

49

Erythromycin ADE

Pro-kinetic= Increases GI motility=GI upset

50

Management of Isotretinoin (Accutane) to prevent Teratogenic

1. 2 effective forms of contraception: 1 month before, throughout, and 1 menstrual cycle after Tx ends
2. Serum pregnancy test 2 weeks PRIOR to initiating tx

51

What labs must you obtain monthly with the use of Isotretinoin (Accutane)

1. Serum Pregnancy test
2. Fasting lipids

52

List the Topical abx used in treatment of Rosacea

1. Clindamycin 1% cream/lotion/gel
2 Erythromycin 2% solution
3. Metronidazole (Metrogel, Metro cream, Metrolotion)
4. Sodium Sulfacetamide 4%

53

Who is Metronidazole NOT recommended in?

Pregnancy
Nursing
Kids

54

List the ORAL abx used in treatment of Rosacea

Tetracyclines:
1. Doxycycline
2. Minocycline

55

Stage III rosacea with rhinopehyma and rosacea flumicans treatment

Isotretinoin (accurate)

56

What type of rosacea is Isotretinoin (accurate) NOT recommended in?

Ophthalmic rosacea

57

List Topical Imidazoles

1. Ketoconazole
2. Miconazole
3. Fluconazole

58

Indications for Topical Imidazoles treatment

Dermatophyte and Candida infections of:
1. Stratum Corneum
2. Mucosa
3. Cornea

59

What is Topical Imidazoles treatment NOT indicated in?

1. Nail infections
2. Hair infections
3. SubQ infections

60

Seborrheic dermatitis treatment

Ketoconazole

61

What is Nystatin NOT effective against?

Dermatophytes

62

Atopic Dermatitis Treatment

Immunomodulators:
1. Tacrolimus
2. Pimecrolimus

63

Tacrolimus, Pimecrolimus MOA

1. Calcineruin inhibitors
2. Inhibit T-lymphocyte activation: Prevents degranulation of mast cells by antigen-IgE complexes

64

Tacrolimus, Pimecrolimus Black Box warning

1. Malignancy
2. Avoid continuous use
3. Limit application to areas of involvement
3. Not indicated in kids under 2

65

What low pH cleanser would you recommend for general pruritus?

CeraVe

66

Topical Doxepin: What is it? Used for? CI in?

Potent H1/H2 receptor antagonist
Tx Pruritis
CI: Urinary retention, narrow angle glaucoma

67

List the Ectoparasiticides in the treatment of head lice/scabies

1. Permethrin
2. Lindane
3. Crotamition
4. Sulfar

68

Lindane ADE

Concentrated in fatty tissues, including brain: Neurotoxic-Seizures

69

List agents that reduce hyper pigmentation. MOA?

Hydroquinone + Mequinol
Interferes with biosynthesis of melanin

70

Vitiligo treatment

Psoralens:
1. Trioxsalen
2. Methoxypsoralen

71

Psoralens MOA

Repigmentation of depigmented macule in Vitiligo

72

Risks of psoralen photochemotherapy

1. Cataracts
2. Skin CA

73

Define Sunscreen

Chemical compounds that absorb UV light

74

Define Sunblock

Contain opaque materials that reflect light
Doesn't need a chemical reaction to work= can go out immediately

75

Sunscreen instructions

Apply 20 minutes before going out
Replace every 2 hours

76

What do we use Salicylic Acid to treat?

Keratolytic agent to tx:
1. Acne
2. Psoriasis
3. Warts

77

Who do you want to caution Salicylic Acid use in?

1. Diabetics
2. PAD

78

Effects of Urea?

Softening and moisturizing effect on stratum corneal

79

Humectant (urea agent) effects

Increases water content of stratum corneum

80

What do we use Podophyllum Resin and Podophyllotoxin to treat?

Condyloma acuminatum

81

Actinic Keratoses treatment

Fluorouracil

82

What do we use Imiquimod to treat?

1. Warts (FDA approved)
2. Actinic Keratosis
3. Basal cell carcinoma
4. Squamous cell carcinoma
5. Lentigo maligna melanoma

83

What is a disadvantage of Minodixil (Rogaine)?

Effects are not Permanent: Stop tx, hair loss in 4-6 months

84

What do we use Finasteride (trcichogenic agent) to treat? How long?

Promotes hair growth: Prevent further hair loss in men with Androgenic alopecia
Tx for 3-6 months

85

Finasteride (trcichogenic agent) ADE's

1. Decreased libido
2. Ejaculation disorder
3. Erectile dysfunction

86

What is initial treatment for Psoriasis?

High potency topical steroid + Phototherapy

87

What is Acitretin (soriatane) a metabolite of? Treatment for?

Retinoid Metabolite
Treatment of Psoriasis

88

What is the treatment regimen/management/limitatinos of Acitretin (soriatane)?

1. Must not be used in pregnancy/looking to become pregnant years after tx
2. NO alcohol during tx and 2 years after tx
3. CANT donate blood during tx AND for 3 years after tx

89

Methotrexate PK

Folate antagonist

90

Who is Methotrexate NOT indicated in?

Pregnancy and breastfeeding=Category X

91

What is a rare ADE with the use of biologic agents in the treatment of Psoriasis?

Lymphoma