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Flashcards in Derm Deck (29):
1

Lotions MOA

Mostly water

Evaporation gives cooling action

Vasoconstriction decreases inflammation

2

Gels

semi-solid colloidal solutions and suspensions

contain alcohol

enhance absorption thru skin

3

Creams

oil in water: mix with serous discharge, washable

water in oil: vehicle for fat-soluble substances

do not mix with serous dischages

4

ointments

water-soluble: improve penetration of drugs, PEG

emulsifying: mix with water and exudate

non-emulsifying: occlusive dressing, enhance hydration

5

atopic dermatitis tx

reduce contact and exposure

emollients 

topical steroids (try not to use)

systemic antihistamines

antibiotics

 

6

soap substitues

cetaphile--less drying an dirritating

cleansing and moisturizing formulas--OTC

expensive

7

emollients

soften skin and reduce itching; trap moisture

best: oils--petroleum jelly

moderate: creams

use after bathing and dry times

agents: vanicream, eucerin, lubriderm, moisturel, curel, neutrogena, vegetable shortening, vaseline, urea creams, oils

8

emollients: alpha-hydroxy acid

 creams are excellent for relieving dryness, but can sting and sometimes aggravate eczema

useful for maintenance when no longer inflamed

forces epidermal cells to produce keratin that is softer, more flexible and less likely to crack

preps: glycolic acid, lactic acid, urea

use 1x/d

9

Emollients: Oils

Bath oil or mineral oil lotions in lukewarm water

Add to tub 15 minutes into bath

Bath oil preps: alpha-keri, aveeno bath, jeri-bath

Colloidal oatmeal (Aveeno) reduces itching 

10

Corticosteroids

Topical steroids very effective

Ointments for dry or lichenified skin

Creams for weeping skin or body foldsOnce under control, intermittent use may prevent relapse

Systemic may bring rapid control but may precipitate rebound

11

Antibiotics

atopic eczema frequently secondarily colonized with a bacteria (up to 30%)

Use oral antibiotics in recalcitrant or widespread cases

12

Antihistamines

Oral can reduce urticaria and itch

13

Alt medications for eczema

Licorice, calendula, echinacea, golden seal, nettle, oats

14

Diaper dermatitis

Irritant dermatits

Cutaneous candidiasis infection (c. albicans)

risks: areas where warmth and moisture lead to maceration of skin or mucous membranes 

tx: topical antifungal agens: nystatin, miconazole or clotrimatzole; topical corticosteroids

15

Pimecrolimus (Elidel) and Tacrolimus (Protopic)

Inhibit inflammatory cytokine release

Minimal systemic immunosuppression

indicated for atopic dermatitis and contact dermatitis

alt to corticosteroids 

16

Imiquimod (Aldara)

Immunomodulator

Tx of external genital and perianal warts and actinic keratitis

stimulates peripheral mononuclear cells to release interferon alpha and stimulate macrophages to produce interleukins and TNF-alpha

17

Parasitic skin infections

Pediculosis: Lice. 2-4mm. Female lay 100s of nits. Vectors of other diseases: typhus, recurrent fever. tx: chemical killing, clean linens/clothes, comb out, tx social contacts

pediculocides: lindance (not in cali): hepatotoxic and neurotoxic. Permethrin (Nix)

scabies: mite infestation transmitted by close-prolonged contact. epidermal curved or linear ridges, follicular papules, pruritus palms. excoriated erythematous papules, pustules, crusted lesions. tx: topical sulfur preps, crotamiton, permethrin, launder. no disinfectant. 

18

acne

comedones (keratin plugs in sebaceious duct opening), papules, pustules, nodules, cysts, scars

propionibacterium acnes, staphylococcus spp., angrogenic stimulation of sebaceious gland

tx: kertaolytics: benzoyl peroxide, slenium sulfide, retic A, accutane oral (isotretinoin); antibacterial: topical erythromycin, clindamycin or azelaic acid. oral tetracycline or erythromycin 

19

rosacea

azelaic acid

metronidazole

20

psoriasis

hyperproliferative disorder

thickened skin plaques

inflammatory infiltrate in the dermis

comorbidities: autoiummune, CV, metabolic sx, malignancies, mood disorders, smoking, alcohol

tx: topical: keratolytics: coal tar, salicylic acid. corticosteroids (potent)

systemic: corticosteroids (prednisone), methotrexate (neutropenia), hydroxyurea, cyclosporine (decreases infiltration of inflammatory cells), infliximab (remicade)

21

tx of psoriasis

mild: topical (kertolytic, corticosteroids); phototherapy

mild psoriatic arthritis: NSAIDs, intra-articular injections of corticosteroids

Moderate to severe psoriasis and PsA: DMARDs: methotrexate, cyclosporine, gold (can cause renal dysfunction), antimalarials; systemic corticosteroids, biologics (NOT during an active infection)

 

22

criteria for using biologics

18yo or older

moderate to severe PsA AND:at least one comorbiditiy, inadequate control with DMARDs alone, failed other therapies

NO active infection

Normal liver function

23

Biologics

T-cell inhibitors: alefacept, efalizumab

TNF inhibitors: etanercept, adalimumab, infliximab

24

Glucocorticoids

mild, moderate (triamcinolone), potent (desonide), very potent (mometasone). 

only use mild on face (1% hydrocortisone, no higher)

 

25

sunscreens

filter UVA and UVB

Mild: <10

Moderate: 10-15

Strong: >15 sunscreens 

26

hair loss

minoxidil (rogaine): vasodilation, effect not predictable or permanent

finasteride (propecia): increases levels of testosterone and decreases the rate of death of follicles. side effects are high and its not shown to be very effective 

27

fungal skin infections: topical tx

Clotrimazole

Miconazole

Terbinafine

Ketoconazole

Tolnaftate

Nystatin

28

fungal skin infections systemic tx

Ketoconazole

Iatraconazole

Terbinafine

Griseofulvin

Look at LFTs prior to initition of drug and once a month

 

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