Flashcards in Derm Deck (91)
Palm area rule
2 palm areas x2/day needs 30g for 1 month
Fingertip Units (FTU's)
2 FTU=1 g of Topical Steroid
How can we enhance absorption/efficacy with topical agents?
Occlusion-Apply plastic wrap
10x increase with topical steroid agents
What is the role of dressings?
1. Protect open lesions
2. Facilitate healing
3. Increase drug absorption
4. Protect patient's clothing
What is the MC Nonocclusive dressing?
Purpose of Nonocclusive dressing?
1. Maximally allow air to reach wound
2. Allow lesion to dry
Purpose of wet-to-dry dressings
Cleanse and Debride thickened/crusted lesions
How do you apply wet-to-dry dressings?
Applied Wet (saline solution)
Removed after solution has evaporated
What conditions increase penetration in topical steroids?
1. Inflamed skin-Atopic dermatitis
2. Exfoliative disease
Class I Potency and areas of application
Super High Potency steroid
Severe dermatoses over nonfacial and nonintertriginous:
4. Thick plaques on extensor surfaces
Class I length of treatment
Class II-V Potency and areas of application
Medium-to-High Potency Steroid
Mild-to-Moderate nonfacial and nonintertriginous
Class II-V length of treatment
Class VI-VII Potency and areas of application
Low Potency Steroid
Large Areas and thinner skin:
4. Intertriginous areas
Class VI-VII length of treatment
Low potency steroids SE's?
1. Skin atrophy
3. Steroid induced acne
Systemic SE's of Topical Glucocorticoids
1. HPA Axis suppression
3. Growth retardation
5. Sodium retention
6. Pseudotumor cerebri
Ocular SE's Topical Glucocorticoids
3. Retarded healing of corneal abrasion
4. Extension of herpetic infection
5. Increased susceptibility to bacterial and fungal infections
Cutaneous SE's of Topical Glucocorticoids
1. Skin atrophy
3. Telengiectasis, purpura, echymosis
4. Retardation of wound healing
5. Contact allergic dermatitis: Vehicle induced=common
What organisms does Bacitracin cover?
Compound ointment base:
Combo with Neomycin/polymyxin B OR
Most frequent SE of Bacitracin ?
Allergic contact dermatitis
Most likely from Neomycin
What organism does Mupirocin (Bactroban) cover?
1. Gram +
What is the preferred vehicle of Mupirocin? What is covered by insurance?
Cream=covered by insurance
List the Triple ABx Ointment
1. Polymyxin B
What organisms does Polymyxin B cover?
1. P. aeruginosa
ALL gram + are resistant
What organism does Neomycin cover?
1. Gram - (E.coli)
2. Gram + (S. aureus)
Sensitization (contact dermatoses)
What is the main benefit of Gentamcin?
More active against Pseudomonas than Neomycin
Mild inflammatory acne treatment
Topical Retinoid OR
Topical Benzoyl Peroxide AND/OR
Moderate acne treatment
Retinoid + Benzoyl Peroxide
+/- Topical Abx
What should you consider for moderate acne treatment in females?
Severe acne treatment t
Retinoid + Benzoyl Peroxide+ Oral Abx
+/- Topical Abx
What should you consider for severe acne treatment in females?
Topical Tretinoin (Retin A)
Cystic Acne treatment
List Topical Abx for use in mild-to-moderate cases of inflammatory acne
1. Clindamycin (water-based gel)
2. Erythromycin (water-based gel)
What can you combine both. Topical Clindaymycin and Erythromycin with?
Who is Retinoic Acid beneficial in?
1. Tx of Acne Vulgaris
2. Photodamaged skin
3. Thickened skin (psoriasis)
4. Atrophic areas
What is the best Retinoic Acids (acid form of Vitamin A)
Tretinoin (Retin A)
Retinoic Acid application
Every night at bedtime to dry skin only x4-6 weeks
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
Who is Retinoic acid NOT recommended in?
Benzoyl Peroxide PK/Mechanism
1. Converted to Benzoic acid within epidermis and dermis
2. Bacteriostatic against P.acnes
What is the OVERALL recommendation in Acne?
1. Topical Retinoid +Abx (when inflammatory lesions are present)
2. Benzoyl Peroxide +/- ABx
When should you discontinue Abx therapy in acne?
Inflammatory lesions resolve
1. Slate gray hyperpigmentation
2. Drug-Induced lupus
4. Dizzines (Minocycline)
Pro-kinetic= Increases GI motility=GI upset
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
What labs must you obtain monthly with the use of Isotretinoin (Accutane)
1. Serum Pregnancy test
2. Fasting lipids
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%
Who is Metronidazole NOT recommended in?
List the ORAL abx used in treatment of Rosacea
Stage III rosacea with rhinopehyma and rosacea flumicans treatment
What type of rosacea is Isotretinoin (accurate) NOT recommended in?
List Topical Imidazoles
Indications for Topical Imidazoles treatment
Dermatophyte and Candida infections of:
1. Stratum Corneum
What is Topical Imidazoles treatment NOT indicated in?
1. Nail infections
2. Hair infections
3. SubQ infections
Seborrheic dermatitis treatment
What is Nystatin NOT effective against?
Atopic Dermatitis Treatment
Tacrolimus, Pimecrolimus MOA
1. Calcineruin inhibitors
2. Inhibit T-lymphocyte activation: Prevents degranulation of mast cells by antigen-IgE complexes
Tacrolimus, Pimecrolimus Black Box warning
2. Avoid continuous use
3. Limit application to areas of involvement
3. Not indicated in kids under 2
What low pH cleanser would you recommend for general pruritus?
Topical Doxepin: What is it? Used for? CI in?
Potent H1/H2 receptor antagonist
CI: Urinary retention, narrow angle glaucoma
List the Ectoparasiticides in the treatment of head lice/scabies
Concentrated in fatty tissues, including brain: Neurotoxic-Seizures
List agents that reduce hyper pigmentation. MOA?
Hydroquinone + Mequinol
Interferes with biosynthesis of melanin
Repigmentation of depigmented macule in Vitiligo
Risks of psoralen photochemotherapy
2. Skin CA
Chemical compounds that absorb UV light
Contain opaque materials that reflect light
Doesn't need a chemical reaction to work= can go out immediately
Apply 20 minutes before going out
Replace every 2 hours
What do we use Salicylic Acid to treat?
Keratolytic agent to tx:
Who do you want to caution Salicylic Acid use in?
Effects of Urea?
Softening and moisturizing effect on stratum corneal
Humectant (urea agent) effects
Increases water content of stratum corneum
What do we use Podophyllum Resin and Podophyllotoxin to treat?
Actinic Keratoses treatment
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
What is a disadvantage of Minodixil (Rogaine)?
Effects are not Permanent: Stop tx, hair loss in 4-6 months
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
Finasteride (trcichogenic agent) ADE's
1. Decreased libido
2. Ejaculation disorder
3. Erectile dysfunction
What is initial treatment for Psoriasis?
High potency topical steroid + Phototherapy
What is Acitretin (soriatane) a metabolite of? Treatment for?
Treatment of Psoriasis
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
Who is Methotrexate NOT indicated in?
Pregnancy and breastfeeding=Category X