Derm Preparations Flashcards
(161 cards)
1
Q
What causes diaper rash?
A
- Urine + feces in diaper
- Superinfx from systemic abx
2
Q
MCC of diaper rash?
A
- Candida albicans species
- Bacterial - S. aureus, group A S. pyogenes
3
Q
How can we prevent diaper rash?
A
- Keep area clean + dry
- Powder/cornstarch
- Freq diaper changes
- Loose fitting, ventilated diaper
- Change to cloth if needed
- Remove diaper + leave off as time permits
- Wash w/ water + mild cleanser (Cetaphil)
- Use cool air to dry buttocks
4
Q
What oints can be used as a protective barrier to prevent/tx diaper rash?
A
A+D oint
Petrolatum (Vaseline) ***not aquaphor
Zinc oxide
Desitin (zinc oxide + emollient)
Some have protectant + drying agent + anti-microbial + vitamins
5
Q
What can be used for the sx tx for diaper rash?
A
Topical steroids
*do little to treat rash, but beneficial for anti-inflamm effect
**caution: can cause adrenal suppression if too much absorbed (use low potency)
6
Q
Tx for a diaper rash caused by yeast - “red satellite lesions”?
A
- Topical antifungal
- Nystatin - powder/cream/oint
- Nystatin + Triamcinolone - cream/oint
- Clotrimazole - cream
- Clotrimazole + Betamethasone - cream
- Combo product - zinc oxide, petrolatum + 0.25% miconazole
7
Q
Tx for a diaper rash caused by bacteria (usually staph/strep) - “yellowish, fluid-filled pustules, honey-colored, crusty”?
A
Mild -> topical tx (bacitracin, mupirocin)
More severe -> systemic PO abx (beta-lactams)
Combo therapy -> topical + PO **most effective
8
Q
What is “butt paste” and what is it used for?
A
Zinc oxide + Aquaphor/A+D oint/petrolatum + Cholestyramine (binds uric acid, keeps pH at normal levels)
*NOT for prevention, for tx of diaper rash only
9
Q
What is true about the 3 main diff types of poisons (ivy, sumac, oak)?
A
If you are sensitive to one type -> sensitive to all
Tx for all is similar (self-limiting, resolve on own but take a long time)
10
Q
Why do most pts w/ poison contact end up spreading the poison all over themselves?
A
Rhus dermatitis - delayed hypersensitivity rxn occurs 12-72 hrs after exposure *most pts don’t know they have it on them
11
Q
What is urushiol?
A
Chemical secreted by bruised plants (poison ivy, oak + sumac)
12
Q
How can pts come in contact w/ urushiol?
A
Primary exposure - direct contact to bruised portion of plant that exudes urushiol
Secondary exposure - contact w/ exposed pets, contaminated clothing, smoke from burning plants
**NOT transmitted via fluid vesicles/blisters
13
Q
What are the sx for poison dermatitis?
A
Severe itching, burning sensation
*condition is self-limiting + resolves in 14-20 d
Secondary infx can occur b/c of scratching
14
Q
Tx goals for poisons - Ivy, Oak, Sumac?
A
Wash area immediately w/ soap + alcohol
Barrier products to protect/prevent plant oils penetrating skin + causing rash - Bentoquatam
Zanfel (OTC wash, not recommended)
Reduce pain/itch to prevent 2’ infx
15
Q
Tx of mild/moderate cases of poison ivy, oak + sumac - soaks, baths, mild dressings?
A
Colloidal oatmeal - bath, transient relief
Aluminum acetate - moist/wet dressings, reduce itch, mild astringent
For facial lesions use moist/wet dressings (NOT lotions - difficult + painful to remove once dry)
16
Q
Tx of mild/moderate cases of poison ivy, oak + sumac - topical preps for lesions?
A
Calamine (he says hydrocortisone is better)
Local anesthetics (Caladryl = calamine + pramoxine)
Antihistamines (Diphenhydramine cream - may sensitize skin, generally NOT effective, does not penetrate skin + may irritate further)
Camphor + menthol (“cooling effect”), phenol + EtOH (antibacterial) - promotes drying of vesicles
Aluminum Acetate solns
Steroids
17
Q
What type of tx should you not use for poisons while vesicles are present and/or weeping?
A
Ointments - can form a barrier + seal moisture in (vesicles need to dry)
18
Q
Tx of severe cases (widespread or eye involvement) of poison ivy, oak + sumac?
A
Antihistamines PO
Glucocorticosteroids PO
Abx PO *if 2’ infx
19
Q
Antihistamine for severe cases of poison ivy, oak + sumac?
A
Diphenhydramine - 25-50 mg PO QID PRN
ADRs: sedation, dry mouth
20
Q
Glucocorticosteroid for severe cases of poison ivy, oak + sumac?
A
Prednisone PO 7-21 d, taper off
Anti-inflamm, may be used in moderate cases too
*problem is that steroids mask infx
21
Q
Abx for severe cases of poison ivy, oak + sumac?
A
Tx for staph: cephalosporins + penicillins
22
Q
What is acne stimulated by?
A
Testosterone + dihydrotestosterone (its metabolite)
Multifactorial pathogenesis = bacterial (P. acnes) + irritants
23
Q
General tx guidelines for acne?
A
Cleanse skin BID w/ mild cleanser (Cetaphil) + pat dry
Use coarse cloth/sponge to exfoliate
Astringent
Medication prn
24
Q
Pharmacological tx of acne?
A
Topical Benzoyl Peroxide
Topical Salicylic Acid
Topical Retinoids
Misc topicals
Topical abx
PO abx
PO isotretinoin (Accutane)
OCP
25
MOA of Benzoyl Peroxide 2-5-10% for acne?
Causes **desquamation** - increases turnover of epithelial cells, promotes healing, may be bacteriostatic/bacteriocidal
26
Precautions/ADRs for Benzoyl Peroxide?
Do not use around mouth/eyes/lips
Some pts are hypersensitive
ADRs: drying, peeling, stinging; may bleach clothing/linens
27
MOA for salicyclic acid?
**Keratolytics** - helps remove upper layer of dead cells
0.5-2% -\> acne
10-15% -\> wart removal
28
ADRs for salicylic acid?
Drying, peeling
29
What is the 1st line tx of acne after OTCs?
Topical Retinoids - Vit A derivatives
Exs: **Tretinoin** gel + cream, **Tazarotene** gel + cream
30
MOA for topical retinoids?
Increases epithelial cell proliferation, reduces comedo formation
31
Precautions/ADRs for topical retinoids?
AVOID sun (SPF 30-45), don't use around eyes/mouth/lips
ADRs: erythema, dryness, peeling, scaling, itching, crusting, photosensitivity, pigmentation changes (bleaching)
32
Misc topicals for acne?
**Adapalene**
**Azelaic acid**
33
MOA of Adapelene used in tx of acne?
Retinoid-like compound, binds to different retinoid type receptors
34
ADRs of Adapelene?
Similar to other retinoids- local skin irritation, not shown to be teratogenic in rodents (no human studies)
35
MOA of Azelaic Acid used in tx of acne?
Not fully determined, but may have antimicrobial activity against P. acnes + blocks conversion of testosterone to dihydrotestosterone
36
ADRs of Azelic Acid?
Erythema, dryness
37
MOA for topical abx used in tx of acne?
Antimicrobial activity against causative organisms
38
Exs of topical abx used in tx of acne?
erythromycin
erythromycin + benzoyl peroxide
sodium sulfacetamide
clindamycin
combo w/ benzoyl peroxide
39
ADRs for topical abx used in tx of acne?
Burning, stinging, drying, peeling, erythema
Dosed 2-6xd; resistance rare due to minimal systemic absorption
40
MOA for oral abx used in tx of acne?
Antimicrobial activity against causative organisms
41
Exs of oral abx used for tx of acne?
**Tetracyclines** (doxycycline, minocycline)
**Macrolides** (erythromycin)
42
Precaution/ADRs for oral abx used in acne tx?
May increase risk of resistance due to chronic usage
ADRs: N/V/D, vertigo (w/ minocycline), OCP failure
43
What oral retinoid is used only for severe acne tx?
**Isotretinoin** (Accutane)
0.5-1 mg/kg/day divided BID x 15-20 wks (may repeat x 1 after 2 months off)
44
MOA of isotretinoin for acne tx?
Reduce sebaceous gland size, regulates cell proliferation + differentiation
## Footnote
**Best tx for severe acne**
45
ADRs for isotretinoin used for acne tx?
Dryness, itching of skin + mucous membrane
HA, depression, increase suicide risk
Hyperlipidemia, increase LFTs
Alopecia
Myalgia
Hematologic ADRs
Ocular ADRs, photosensitivity
**\*\*\*must sign informed pt consent + cannot be pregnant or get pregnant (cat X)**
46
Which tx of acne can only be used in females?
OCP (for \>18 yo)
47
MOA of OCPs that helps tx acne?
Increased estrogen helps counterbalance the high testosterone levels which cause acne
Estrogen alone or Estrogen/Progesterone combo (want high estrogenic activity + low androgenic activity - **tricycline** brands are good)
48
ADRs for OCPs used in acne tx?
PMS-like sx, bloating, weight gain
49
What drugs cause acne?
Hormones (gonadotropins, anabolic steroids, corticosteroids)
Anti-epileptic drugs
TB drugs (INH, Rifampin)
Misc (Lithium, Cyclopsorine, Iodine)
50
Tx of psoriasis can be defined as?
Acute or chronic
**NO CURE**
Tx aimed to reduce severity + be palliative
51
What factors influence tx selection?
Age of pt
Type of psoriasis
Site/extent of involvement
Previous tx
Coexisting disease
52
Tx of acute psoriasis?
Non-medicated topicals to soothe irritation to severely erythematous lesions: **Aquaphor, cold cream, Lac-hydrin, Eucerin**
May also use topical steroids
53
Tx of chronic psoriasis?
**Topical corticosteroids**: anti-inflamm, anti-pruritic, vasoconstrictor, immunosuppressive
**Coal Tar**
**Psoralens**
**Retinoids**
**Monoclonal ABs**
**Phosphodiesterase 4 (PDE4) Inhibitors**
**Misc. agents**: antimetabolites, immunosuppressants, topical immune modulators
54
How should topical steroids be used in tx of chronic psoriasis?
Start w/ **super high potency** (class 1-2) BID x 2-3 wks -\> **pulse tx** (2 days on, 5 days off) **OR** change to **lower potency**
55
Which topical steroids can be used on face, perineum or mucous membranes in tx of chronic psoriasis?
**Non-fluorinated** steroids
\*Halogenated or fluroinated steroids CANNOT, but increase absorption
56
ADRs of topical corticosteroids used in tx of chronic psoriasis?
Thinning + tearing
Bruising of skin
Acne
Hypopigmentation - blanching due to vasoconstriction
Infx (immune sx suppressed)
Contact dermatitis
57
Precautions for tx w/ topical corticosteroids?
**Do not use super potent on children or elderly** due to increased systemic absorption (children -\> skin not keratinized, elderly -\> thin skin)
**Avoid use of super potent in flexural areas** (groin, axilla, popliteal + antecubital fossa) -\> areas tend to be warm/moist -\> added absorption
**Super potent may also inhibit HPA axis**
58
What is Coal Tar used for?
Tx of chronic psoriasis - oint/lotion/soap/shampoo
Use alone or w/ low potency steroids
Applied HS + washed off in AM
May be used w/ UVB light therapy
59
Problem w/ coal tar in tx of chronic psoriasis?
Non-compliance
Cosmetically non-appealing (staining of clothes, bedding, hair)
60
ADRs of tx w/ coal tar?
Folliculitis
Photosensitivity
Irritation
Scaling
Itching
Inflamm
61
What is Psoralens?
Tx of chronic psoriasis
**Methoxsalen** - PO, lotion
Follow w/ UVA light tx 2 hrs post
Combo referred to as **PUVA**
62
ADRs of tx w/ Psoralens?
Pruritis, dry skin, loss of pigmentation
Nausea
Blistering
Painful erythema
Drug-food interx: **avoid furocoumarin-containing foods** (figs, celery, carrots)
63
What retinoids are used in tx of chronic psoriasis?
**Etretinate** (PO) - when used in combo w/ PUVA -\> "RE-PUVA"
**Acitretin** (PO)
**Tazarotene** (topical)
64
MOA of Etretinate (retinoid) in tx of chronic psoriasis?
Normalizes expression of keratin
Suppresses chemotaxis
Decreases stratum corneum cohesiveness
65
ADRs of Etretinate/Acitretin (retinoids) - tx of chronic psoriasis?
LFT abnormalities
Alopecia
Exfoliation
Hyperlipidemia
Myalgia
Arthralgia
66
What should be used if tx w/ retinoids for chronic psoriasis?
**Birth control** - 1 month pre + during therapy (must use for 3 yrs post; all **Cat X**)
67
What is the half-life of retinoids?
Etretinate = **100 days** (can be found in plasma 2-3 yrs after d/c)
Acitretin = **49 hrs**
68
What monoclonal ABs can be used for tx of chronic psoriasis?
Secukinumab - SQ
Izekizumab - SQ
Brodalumab
Guselkumab
69
MOA of Sueckinumab for tx of chronic psoriasis?
Human IL-17A antagonist: inhibits release of proinflamm cytokines + chemokines
70
Precautions/ADRs for Secukinumab in tx of chronic psoriasis?
Serious infx, check for TB, Crohn's exacerbations, anaphylaxis
Nasopharyngitis, diarrhea + URTIs
71
MOA for Ixekizumab in tx of chronic psoriasis?
Human IL-17A antagonist - tinea infx
72
MOA for Brodalumab in tx of chronic psoriasis?
Human IL-17RA antagonist - Chron's dis, TB
73
MOA for Guselkumab in tx of chronic psoriasis?
IL-23 blocker - plaque psoriasis who are candidates for systemic therapy or phototherapy
74
Which phosphodiesterase 4 (PDE4) inhibitor can be used for tx of chronic psoriasis?
**Apremilast** - PO
75
MOA of Apremilast - tx of chronic psoriasis?
Increase cAMP levels (phosphodiesterase 4 inhibitor); exact mech unknown
76
Indications for tx of chronic psoriasis w/ Apremilast?
Adult pts w/ active psoriatic arthritis
Pts w/ mod-severe plaque psoriases who are candidates for phototherapy or systemic therapy
77
Precautions/ADRs for Apremilast - tx of chronic psoriasis?
Worsening of depression, suicidal thoughts or other mood changes, severe weight decrease, do not use w/ strong CYP450 inducers
Diarrhea, nausea, URTIs + HA
78
What is methotrexate (PO) used for?
Antimetabolite: chemo drug, misc. agent used for tx of **chronic psoriasis**
79
What is cyclosporine A used for?
Immunosuppressant for tx of **chronic psoriasis**
80
What are Tacrolimus + Pimecrolimus (topicals) used for?
Topical immune modulators - tx of **chronic psoriasis**
81
What is Calciprotriene (topical) used for?
Misc. agent in tx of **chronic psoriasis**
Effects = class 2-3 steroids
Combo w/ betamethasone
82
SEs of Calciprotriene?
Vit D analong, therefore no steroid SE
SEs: local irritation + skin rxns
\*DO NOT use on face, eyelids, perineum or skin folds
83
What is Anthralin (topical) used for?
Misc. agent used for **short-term** tx of chronic psoriasis
Apply for 1 hr or \<, then wash off
84
SEs of Anthralin - tx of chronic psoriasis?
Staining (permanent brown color), irritation of un-involved skin
85
What are keratolytics used for?
Misc. agent for tx of **chronic psoriasis**
Soften keratin layer of skin -\> enhance absorption of other agents
**Phenol, Salicylic acid** used + mixed w/ aquaphor, cold cream, emollients, coal tar
86
What is phototherapy/photochemotherapy used for?
Misc. agents - tx of **chronic psoriasis**
Phototherapy -\> sunlight, UVB light therapy
Photochemotherapy -\> PUVA = psoralens + UVA ligh
87
What are the non-FDA approved agents for tx of chronic psoriasis?
IV Immune Modulators - **Etanercept** (usually used for RA + JRA)
Immunosuppressants - **Siroliums** (PO, usually for organ transplant)
88
What topical creams/lotions/oints/gels can be used for tx of rosacea?
Abx
Azelaic acid
Sulfur lotions
Ivermectin 1% cream (QD to inflamm lesions)
Benzoyl peroxide (limited data on effectiveness)
89
What topical abx can be used for tx of rosacea?
**Metronidazole = TOC for rosacea**, also an antiprotozoal agent
Sulfur products
Clindamycin + Erythromycin (not as effective as other topical abx or azelaic acid)
90
MOA for Azelaic Acid - tx of Rosacea?
Antibacterial, comedolytic, anti-inflamm
\*one small study: as effective as Metrogel
Products: **Finacea Gel 15%** (for rosacea) + **Azelex/Finevin Cream 20%** (for acne)
91
ADRs for Azelaic Acid - tx of rosacea?
Local skin irritation
92
What oral abx can be used for tx of rosacea?
**Tetracyclines (m/c used)**
Erythromycin
Clarithromycin (Biaxin)
Sulfamethoxazole/Trimethoprim
Metronidazole
93
Other misc. tx for rosacea?
**Glycolic acid** - peels (q2-4 wks), washes/creams
**Topical tretinoin** (Retin-A)
**Isotretinoin** (Accutane) - severe cases, off label use
94
Tx for rosacea eye problems?
Doxycycline (PO)
Minocycline (PO)
Tetracycline (PO)
95
Tx for redness/flushing of rosacea?
Anti-inflamm meds - steroid creams
Oxymetazoline - alpha1A adrenoceptor agonist (vasoconstrictor)
Electrosurgery
Intense light therapy
Vascular lasers
96
Tx for rhinophyma - rosacea?
Dermabrasion
Electrosurgery
Laser surgery
97
Overall goal of tx of rosacea?
**Minimize flare ups**:
Avoid rubbing, scrubbing, massaging face
Use mild cleansers/moisturizers/sun screen
Avoid triggers (hot drinks, spicy foods, EtOH)
SPF 15+, protective clothing
Protect skin from extreme heat/cold
Avoid cosmetics/soaps/moisturizers w/ EtOH + fragrances
98
What is eczema and when does it usually appear?
Dry, red, extremely itchy patches on skin (on any part of body)
During infancy
99
How can eczema be prevented?
Moisturize
Avoid rapid temp changes
Reduce stress
Avoid scratchy materials
Avoid harsh soaps, detergents
Avoid triggers - allergens
Be aware for foods that cause outbreak
100
Tx of eczema?
Prevent scratching
**Creams/lotions** to moisturize
**Cold compress** (relieves itch)
**Topical corticosteroids** (anti-inflamm)
**Topical + PO abx** (only if infx)
**PO antihistamines** (reduce itch)
**Coal tar**
**Phototherapy**
**Cyclosporine A** (PO)
**Topical Immune Modulators**
101
Indication for cyclosporine A?
Resistant eczema
\*it is an immune modulator (immunosuppressant)
102
Which topical immune modulators can be used for tx of eczema?
Tacrolimus
Pimecrolimus
103
Prevention/tx of eczema in kids?
Moisturize
Avoid temp changes
Keep bedroom + play area dust free
Mild soaps
Breathable clothing
**Topical hydrocortisone** (low pot)
**Topical immune modulators**
**PO steroids**
**PO antihistamines**
**PO or topical abx**
104
What is actinic keratoses?
Cutaneous dysplasia of epidermis (early beginning of skin CA)
**\*MCC = long sun exposure**
\*Increased risk in fair skin individuals, avg 40-50 yo, teens-20s in Cali/FL
105
What is m/c tx of AK?
Cryosurgery
106
What other tx is there for AKs?
Surgical excision + biopsy (suspect SCC)
Retinoids - topical + PO
Topical chemotherapy (5-Fluoruracil: 1, 2, 5%)- cat X
Chemical peels
Dermabrasion
Laser skin resurfacing
Electrosurgical skin resurfacing
107
What is Ingenol Mebutate gel used for?
Tx of AK; induces cell death, MOA unknown
108
Admin of Ingenol Mebutate - tx of AK?
**Topical use only!**
AK on face/scalp: 0.015% gel to area QD x 3 d
AK on trunk/extremities: 0.05% gel to area QD x 2 d
109
ADR of Ingenol Mebutate?
Local skin rxns: severe rxns, application site pain, application site pruritus, application site irritation, application site infx, periorbital edema, nasopharyngitis + HA
110
What is Aminolevulinic acid hydrochloride 10% gel indicated for?
Tx of AKs: mild-\>moderate on face + scalp
Combo w/ photodynamic therapy using BF-RhodoLED lamp (protective eyewear)
111
MOA of aminolevulinic acid hydrochloride 10% gel?
Porphyrin precursor- **metabolized to protoporphyrin IX**
Activated by BF-RhodoLED -\> excited state of porphyrin molecules
ROS formed -\> damage to cellular components -\> destroys cells
112
ADRs of aminolevulinic acid?
Erythema, pain/burning, irritation, edema, pruritus, exfoliation, scab, induration + vesicles
113
What is a potentially lethal skin CA?
Melanoma - skin CA in melanocytes
114
Tx of melanoma?
Localized -\> surgical excision
Higher stages -\> interferon injection, interleukin injection, combo chemotherapy
115
What are ectoparasites?
Parasite that lives outside the body - lice (head/body/pubic) + mites (scabies)
116
TOC for lice?
**Permethrin**
Eradicate the causative organism + provide sx relief
117
Tx of lice?
**Permethrin 1%**
**Malathion 0.5%**
**Lindane + Ivermectin lotion**
**Ocular lubricant (Lacri-lube)** - infx of eyelids
Calamine/menthol lotion - pruritus
118
Tx of scabies?
**Permethrin 5%**
**Crotamiton 10%**
**Ivermectin PO**
**Lindane**
**Topical steroids + PO antihistamines** - pruritus
119
MOA of permethrin?
Pediculicide, scabicide
Derived from flowers of *Chrysanthermum cinerariifolium*
Also used as pesticide
120
Precaution/ADR for Permethrin?
Precaution - pts w/ ragweed or *Chrysanthemum* allergy
ADRs - local itching, burning, stinging, tingling
121
Directions for Permethrin use for lice?
Wash hair w/ shampoo, towel dry -\> saturate scalp/hair w/ lotion + **leave on x 10 mins** -\> rinse -\> remove remaining nits (may repeat in 9 days x 2 more times, total = 3 doses)
Cure rate 90-97%
122
Directions for Permethrin use for scabies?
Wash + scrub body -\> Apply cream from head to toe -\> leave on x 8-14 hrs -\> wash w/ water
Cure rate 90%
123
What is a 2nd line agent for tx of lice?
**Malathion**
124
MOA of Malathion - tx of lice?
Organophosphate cholinesterase inhibitor
Must be **activated** in body by conversion to oxygen analogs **(occurs rapidly in insects/vertebrates)** -\> rapidly metabolized to **inactive** products in birds/mammals **(but NOT insects)**
125
Directions for use of malathion to tx lice?
Apply to **dry hair** + **leave on x 8-12 hrs** -\> shampoo hair -\> repeat in 7-9 days if necessary
126
What is 2nd or 3rd line tx for lice/scabies?
**Lindane**
127
Precaution for use of Lindane in tx of lice/scabies?
CNS + hematological toxicity; do NOT use in premature infants or in pts w/ known seizure d/o
128
MOA of Lindane?
Pediculicide, scabicide
\*can be absorbed + concentrate in fatty tissues, especially the brain
129
Directions for use of Lindane for tx of lice?
**Apply to clean, dry hair** -\> massage into hair x **4 mins** -\> rinse hair then remove nits w/ comb
Use 30-60 mL
130
Directions for use of Lindane for tx of scabies?
Apply thin layer on body, bathe + remove after **8-12 hrs**
131
What is another 2nd or 3rd line agent for tx of scabies?
**Crotamiton** - MOA unknown, maybe also antipruritic
132
Directions for use of Crotamiton for tx of scabies?
Apply to body in **2 applications (24 hrs apart)** -\> take cleansing bath **48 hrs after** last app
133
What would be used for a severe case of scabies/lice if tx w/ Permethrin/Malathion/Lindane failed?
**Ivermectin** - 2nd or 3rd line agent
200 mcg/kg x 1 dose (PO, Sklice - lotion)
134
MOA for Ivermectin?
Antihelminthic agent: binds **selectively\*** w/ high affinity to glutamate-gated Cl- channels (which occur in invertebrate nerve + muscle cells) -\> increase in permeability of cell membrane to Cl- w/ **hyperpolarization** of nerve/muscle cell -\> **paralysis + death of parasite**
\*some mammals do not have glutamate-gated Cl- channels (does not readily cross the human BBB)
135
Precautions/ADR for Ivermectin?
PO -\> Mazzoti rxn in pts w/ onchocerciasis (allergic/inflamm response due to death of microfilariae)
Lotion -\> conjunctivitis, ocular hyperemia, eye irritation, dandruff, dry skin + skin burning sensation
136
Admin of Ivermectin?
For topical use only!
Apply SKLICE lotion to dry hair in an amount sufficient to thoroughly coat hair + scalp -\> **rinse off w/ water after 10 mins**
For single use, discard any unused
137
Uses for topical antibacterial preparations?
Preventing infx in clean wounds
Early tx of infx'd dermatoses + wounds
Reducing colonization of staph in nares
138
Efficacy of topical antibacterial preps?
Varies amongst agent
139
Spectrum for topical antibacterial preps?
Varies amongst agents: combo products w/ broader spectrum to cover for mixed infx or infx due to undetermined pathogen
140
What does bacitracin cover?
Mostly **gram +**
Alone or combo w/ neomycin + polymyxin
141
What does gramicidin cover?
Mostly **gram +**
Combo w/ neomycin, polymyxin, bacitracin + nystatin
142
What does mupirocin (Bactroban) cover?
MRSA
Preferred agent for **impetigo** + to eliminate **nasal carriage of *S. aureus***
143
What does polymyxin B cover?
Mostly **gram -**
Available as combo
144
What does neomycin/gentamcin cover?
Topical aminoglycosides w/ **gram -** coverage, incl. pseudomonoas
Combo or alone
145
What does ozenoxacin cover?
Quinolone antimicrobial -\> impetigo due to **Staph aureus or Step pyogenes**
146
What is Doxepin hydrochloride used for?
Topical antipruritic - atopic dermatitis or lichen simplex chronicus
147
MOA of Doxepin hydrochloride?
Blocks H1 + H2 receptors
148
ADRs of Doxepin hydrochloride?
Local burning/stinging, sedation, anticholinergic SEs
149
What is Pramoxine used for?
Topical anesthetic: temporary relief from pruritus a/w mild **eczematous dermatoses + hemorrhoids** (external use only)
150
ADRs for Pramoxine?
Local burning + stinging
151
What is Dupilumab used for?
IL-4R alpha-antagonist for tx of adult pts w/ mod-\>severe atopic dermatitis
Can be used w/ topical steroids (SQ injection)
152
MOA of Dupilumab?
Monoclonal IgG4 AB that inhibits IL-4 + IL-13 signaling
153
Cautions/ADRs for Dupilumab?
Cautions - hypersensitivity, conjunctivitis, comorbid asthma
ADRs - injection site rxns, conjunctivitis, blepharitis, oral herpes, keratitis, eye pruritus, other herpes simplex virus infx, and dry eye
154
What is Crisaborole used for?
Phosphodiesterase 4 inhibitor - topical tx of mild-\> mod atopic dermatitis in pts 2yo+
Ointment 2%
\*MOA not well defined
155
ADRs for Crisaborole?
Hypersensitivity
Application site pain
156
What is Polidocanol Injectable Foam used for?
Varicose veins
IV use under US guidance only
157
CI/ADRs for Polidocanol Injectable foam?
CI - Acute thromboembolic dis
ADRs - be prepared to tx anaphylaxism, tissue ischemia+necrosis (do not inject intra-arterially, venous thrombosis), pain/discomfort in extremity, infusion site thrombosis, injection site hematoma/pain, thrombophlebitis superficial + extravasation
158
What is Deoxycholic acid (SQ) used for?
Improvement in appearance of mod-\>severe convexity or fullness a/w submental fat in adults
159
MOA for Deoxycholic acid?
Cytolytic drug - physically destroys the cell membrane -\> lysis
160
Precautions/ADRs for Deoxycholic acid?
Marginal mandibular nerve (MMN) injury, Dysphagia, Submental hematoma/bruising
Injct site edema/swelling, hematoma, pain, numbness, erythema + induration
161
What drugs are a/w photosensitivity?
Benzocaine
Coal Tar
Hexachlorophene
Isotretinoin
Methoxsalen
Tacrolimus
Tazarotene
Retinoin
Sunscreen agents: PABA, cinnamates, benzyphenones
