Derm Therapeutics Flashcards
(100 cards)
1
Q
What acne treatments target follicular hyperkeritiniazation?
A
topical retinoids and isotretinoin
azeliac acid
salicylic acid
2
Q
What do you need to warn patients abour when using benzol peroxide?
A
bleaching of clothes
3
Q
What is the strongest retinoid?
A
tazorac
4
Q
What acne treatments target increased sebum production?
A
isotertinoin
hormonal therapies-ocp, aldactone
5
Q
What acne treatments target P. acnes?
A
BPO
topical antimicrobials
oral abx-doxy or minocycline
azelaic acid
6
Q
What acne treatments target inflammation?
A
isotretinoin
oral abx
topical retinoids
azelaic acid
7
Q
What are SE of actuate?
A
dry skin and lips and photosensitivity
8
Q
How do you treat hyperpigmented skin?
A
hydroquinone
9
Q
How do you treat atrophic scars?
A
laser resurfacing
10
Q
How do you treat keloids or hypertrophic skin?
A
corticosteroid injection
11
Q
What topical vasoconstrictor meds can you use for redness of rosacea?
A
brimonidine and oxymetazoline
12
Q
What are possible treatments of rosacea?
A
Metronidazole Azelaic acid Sulfacetamide Acne meds Retinoids Topical/oral abx Ivermectin
13
Q
Acne treatments
A
Isotretinoin (accutane)
Topical retinoids (tretinoin, adapalene, tazorac-strongest)
Oral abx limit for 3 mo (doxycycline, minocycline)
topical antimicrobials (clindamycin, benzol peroxide-bleaches clothes, sulfacetamide, dapsone)
Azeliac acid
Hormonal therapy (OCP, spironolactone)
14
Q
Hidradenitis Suppurativa tx
A
Prevention-loose clothes, don’t pick, avoid dairy
Treat new lesions
Mild-clindamycin, punch surgery, kenalog inj, short course abx (doxy or minocycline)
Mod- above plus spironolactone
Severe-prednisone, Humiera (TNF α inhibitor), accutane, surgery
NO cure
15
Q
Alopecia Areata tx
A
Intralesional corticosteroid inj (kenalog 2.5-5 mg/mL)
Topical steroids
Topical immunotherapy
16
Q
Telogen Effluvium tx
A
Treat underlying cause
Minoxidil (rogaine)
Self-limited (6-12 mo)
17
Q
Androgenic Alopecia in Men tx
A
Minoxidil (rogaine) ↑ anagen phase and enlarges miniaturized follicles takes 6-12 mo
Finasteride (propecia) ↓ scalp DHT-better results from younger age and longer time on drug
Surgery
18
Q
Androgenic Alopecia in Women tx
A
“Minoxidil (rogaine)
Spironolactone
Surgery”
19
Q
Trichotillomania
A
Psych referral
Psychotherapy
20
Q
Pityriasis (tinea) Versicolor tx
A
Topicals Selenium sulfide Zinc pyrithione Azole antifungals Terbinafine Ciclopirox
Orals
Itraconazole and fluconazole
21
Q
Tinea Capitis tx
A
Oral antifungals
Griseofulvin, terbinafine, fluconazole, itraconazole
Do not share hats, helmets or hair products
22
Q
Tinea Corporis
ringworm tx
A
Topicals
azoles, allyamines, butenafine, ciclopirox, tolnsftate
Oral
terbinafine, itraconazole, fluconazole, griseofulvin
23
Q
Tinea Cruris
jock itch tx
A
Topicals
azoles, allyamines, butenafine, ciclopirox, tolnsftate
Oral
terbinafine, itraconazole, fluconazole, griseofulvin
OTC zeasorb powder and avoid tight clothing
24
Q
Tinea Pedis
athletes foot tx
A
Topicals
azoles, allyamines, butenafine, ciclopirox, tolnsftate
Oral
terbinafine, itraconazole, fluconazole, griseofulvin
25
Onychomycosis tx
Topical-can take a year
efinazonazole, amorolfine, tavaborle, ciclopirox
Oral-can take 3 mo
terbinafine
26
Candidiasis tx
Topical clotrimazole, miconazole, nystatin
Oral fluconazole
27
MRSA oral therapy
Trimethoprim- Sulfamethoxazole (Bactrim DS)
Doxycycline
Clindamycin
Linezolid
28
MRSA IV therapy
Clindamycin
Linezolid
Vancomycin
Daptomycin
29
Treatment for recurrent erythema multiforme
oral acyclovir or valtrex MC
Other: dapsone, antimalarials, azathioprine, cyclosporine, thalidomide
30
Describe ointments
consist primarily of water suspended in oil
strongest moisturizer
best for dry, non-hairy skin
31
Describe creams
mix of water in oil
less potent than ointments
easy to wash off
contain preservatives which can cause SE
32
Describe Gels
oil in water with alcohol
drying effect
transparent
33
Describe lotions
powder in water-must shake first, may also contain alcohol
good for large surface area and hairy area
cooling effect
34
What class is hydrocortisone in?
Class 7-least potent
35
What class is betametasone dipropinate G, O, L, clobetasol and diflorasone diacetate in?
Class 1-super potent
36
What steroid class is safest for LT use?
Class 6 and 7 for 1-2 wk intervals
37
What steroid class is most appropriate for non-facial and intertriginous areas with mild to mod disease?
Class 2-5 for <6-8 wks
38
What steroid class is best for thick skinned areas and hyperkeratotic lesions?
class 1 for < 3 wks
39
What is the most common side effect of steroids?
skin atrophy
40
What are adverse effects of kenalog injections?
local txn, systemic absorption, atrophy, hypopigmentation, telangiectasias
41
Tx for Seborrheic Dermatitis
corticosteroids, selenium sulfide 2.5% shampoo
42
Folliculitis tx
Mupirocin Ointment TID (covers MRSA*) Altabax BID
Clindamycin Gel or lotion BID
Keflex q6h Dicloxacillin 250-500mg q6h Augmentin 500-875mg q12h
Bactrim DS* q12h
Doxycycline* 100mg q12h
Clindamycin* 300-450mg q6h
Gram neg: Cipro 250-750 BID Bactrim DS * BID
43
Tx for Impetigo
Mupirocin (bactroban) ointment TID x 10 d
Keflex 250-500 q6h Dicloxacillin 250-500 q6h
Augmentin 500-875 q12h
44
Erysipelas tx
Oral
Penicillin 500 q6h Amoxicillin 500 q8h Keflex 250-500 q6h
IV
Cefazolin (Ancef) Ceftriazone (Rocephin)
45
Cellulitis tx
Keflex 250-500mg q6h
Amoxicillin-Clavulanate (Augmentin) 500-875mg q12h *bites
Clindamycin 300-450mg q6h *MRSA coverage
Cipro 500-750mg q12h *puncture wounds
IV: Cefazolin, cetriazone, nafcillin, clindamycin
Elevate head or affected extremity, warm compress, tylenol or ibuprofen for fever and pain
46
Head Lice tx
Permethrin 1% (Nix)
Pyrethrin/piperonyl butoxide (Rid) Malathion 0.5% (Ovide) -flammable Benzyl Alcohol 5%-used in pregnancy Topical/oral Ivermectin
47
Crab Lice tx
Permethrin 1% (Nix)
Pyrethrin/piperonyl butoxide (Rid) Malathion 0.5% (Ovide) -flammable Benzyl Alcohol 5%-used in pregnancy Topical/oral Ivermectin
48
Body Lice tx
Wash entire body
Topical/oral ivermectin
Wash clothing and bedding or dispose in plastic
sealed bags
49
Scabies tx
Permethrin 5% Cream (Elimite)
Bath before and 24 hr after last application
Could take weeks for ithching to subside
50
Bed Bugs tx
Bites resolve in 1-2 wks Topical/oral steroids Antihistamines Eradication
51
Brown Recluse Spider Bite tx
Rest, ice and elevation Tetanus shot Analgesics Wound cleaning and care Abx to ↓ 2° infections
Necrotic wounds heal slowly-may need excision
52
Pityriasis Rosea tx
```
Symptomatic management
Antihistamines
Calamine lotion
Steroids-oral prednisone
UVB phototherapy-caution with post-inflammatory hyperpigmentation
Rash lasts 4-10 wks
```
53
Lichen Planus tx
Topical corticosteroids
Clobetaols (Temovate) Betamethasone Diproprionate (Diprolene) Kenalog injections
Oral prednisone 30-60 mg QD 4-6 wk Narrow band UVB
Phototherapy Retinoids- Acitertin (Soriatane) Cyclosporine 5mg/kg/day
54
Lichen Planus Oral Lesions tx
Kenalog paste (in orabase)
55
Erythema Multiforme tx
```
Resolves spontaneouslt in 3-5 wks
Remove possible drug related cause
Oral antihistamines
Topical steroids
Oral prednisone if severe
Oral acyclovir if recurrnet EM (even if not due to HSV)
```
56
Erythema Multiforme tx if due to mycoplasma
Macrolide
57
Herpes Simplex tx
Primary tx 7-10 d
Acyclovir 400 mg TID Famcyclovie 250 mg TID Valtrex 1gm BID
Supressive (6+ episodes/yr)
Acyclovir 400 mg BID Famcyclovir250 mg BID Valtrex 500 mg QD or 1 gm QD
Recurrent
Acyclovir 400 mg tid or 800 mg bid X5 d Acycloviror 800 mg tid X2 days Famciclovir 125 mg bid X 5 d Famciclovir 1000 mg bid X 1 d Valtrex 500 mg bid X 3d Valacyclovir 1g qd X 5d
58
Herpes Zoster tx
Prevention with vaccine
Urgent opthalmic referral and antiviral within72 hrs
Acyclovir 800 mg po five times a day for 7-10 d Valacyclovir 1 g po tid x 7 d Famcyclovir 500 mg po tid x 7 d
Pain management
59
Molluscum Contagiosum tx
```
Self limited (~2 mo for single lesion) Cryotherapy
NO steroids
```
60
Verruca Vulgaris (HPV)
Physical or chemical cautery
Cryotherapy
Phenol nitrate
61
Condylomata Acuminata (anogenital warts) tx
No tx is curative & relapses are common
Cryotherapy
Laser ablation
Podophyllin (smaller lesions use chemical to burn) Inter-lesional interferon
Imiquimod cream
5-flourouracil
QUIT smoking
Prevention: vaccine (guardasil)
62
Acne rosacea tx
Metronidazole Azelaic acid Sulfacetamide Acne meds Retinoids Topical/oral abx Ivermectin
Redness relief: brimonidine and oxymetazoline moisturize, clense, sunscreen, laser, avoid triggers
63
Hidradenitis Suppurativa tx
Prevention-loose clothes, don't pick, avoid dairy Treat new lesions
Mild-clindamycin, punch surgery, kenalog inj, short course abx (doxy or minocycline)
Mod- above plus spironolactone Severe-prednisone, Humiera (TNF α inhibitor),
accutane, surgery NO cure
64
Atopic Dermatiti tx
Emollients
Creams- Cetaphil or Eucerin Ointments- Aquaphor, petroleum jelly
Topical Steroids
High potency (grade 1-III)-chronic eczema Moderate potency (Grade III-V) - flare ups on face
Mild potency (Grade V-VII)-persistent lesions on face, neck, axilla, groin, flexor surfaces
Topical Calcineurin Inhibitors- for severe cases not responding to steeroids (BBW of lymphomas and skin malignancies)
Abx if 2° infection Antihistamines-NOT recommended Phototherapy if refractory to topicals
Bleach baths if need to kill staph
65
Alopecia Areata tx
Intralesional corticosteroid inj (kenalog 2.5-5 mg/mL)
| Topical steroids Topical immunotherapy
66
Telogen Effluvium tx
Treat underlying cause Minoxidil (rogaine)
| Treat underlying cause Minoxidil (rogaine)
67
Androgenic Alopecia in Men tx
Minoxidil (rogaine) ↑ anagen phase and enlarges miniaturized follicles takes 6-12 mo
Finasterida (propecia) ↓ scalp DHT-better results from younger age and longer time on drug
Surgery
68
Androgenic Alopecia in Women tx
Minoxidil (rogaine) Spironolactone Surgery
69
Trichotillomania tx
Psych referral
| Psychotherapy
70
Pityriasis (tinea) Versicolor tx
Selenium sulfide
Zinc pyrithione
Azole antifungals
Terbinafine Ciclopirox
PO Itraconazole and fluconazole
71
Tinea Capitis tx
PO Griseofulvin, terbinafine, fluconazole, itraconazole
Do not share hats, helmets or hair products
72
Tinea Corporis
| ringworm tx
azoles, allyamines, butenafine, ciclopirox, tolnsftate
PO terbinafine, itraconazole, fluconazole, griseofulvin
73
Tinea Cruris
| jock itch tx
azoles, allyamines, butenafine, ciclopirox, tolnsftate
PO terbinafine, itraconazole, fluconazole, griseofulvin
OTC zeasorb powder & avoid tight clothing
74
Tinea Pedis
| athletes foot tx
azoles, allyamines, butenafine, ciclopirox, tolnsftate
PO terbinafine, itraconazole, fluconazole, griseofulvin
75
Onychomycosis (Tinea Unguium) tx
topical tx can take a year-efinazonazole, amorolfine, tavaborle, ciclopirox
Oral-can take 3 mo terbinafine
76
Candidiasis tx
Topical clotrimazole, miconazole, nystatin
| Oral fluconazole
77
Exanthematous tx
Resolves in a few days to a week after medication stopped
Stop offending agent
±Topical Steroids,
Oral antihistamines and reassurance
Cold to help itch
78
Fixed Drug Eruption tx
Lesions resolve days to weeks after drug discontinues
Non-eroded- treated with potent topical glucocorticoid ointment
Eroded- treat with antimircobial ointment and dressing until sire reepithelialized
Address pain
Refer to derm
79
DIHS
| or DRESS tx
Sx may persist for weeks ater cessation fo drug 10% fatality
STOP suspected medications & d/c non-essential meds
Topical/oral steroids
Systemic antihistamines
80
SJS and TENs tx
Consult derm, optho, burn, gyno
D/c non-life sustaining meds ASAP
Pain management
Consider AMT for corneal damage
Monitor fluids & electrolytes
2° infection
NO steroids
Do NOT use CHG-impregnated patched (can cause chemical burns
81
Staphlycoccal Scalded Skin Syndrome (SSSS) tx
Penicillinase resistant PCN (Naficillin, oxacilin)
Vancomycin for MRSA
Mupirocin ointment with xeroform
Monitor fluids and hemodynamic status
82
Pemphigus Vulgaris/Bullous Pemphigoid tx
Corticosteroids
Immunosupressive drugs (Retuximab, sulfasalazine, methotrexate)
Ig IgG
Caution: skin infections, mouth hygiene, ocular involvement, psych surrport
83
Necrotizing Fasciitis tx
Send to burn/trauma SICU
Broad spectrum abx: carbapenem, clindamycin (anaerobic coverage)
Vancomycin or linezolid for MRSA coverage
IV fluids
NPO
OR prep
Complications: sepsis, amputation, death Mortality: 20-35%
84
Fournier Gangrene tx
Complications: pan w/ erection, genital scarring, impotence, psych problems, extensive reconstruction
NSQIP mortality 10%
85
Purpura Fulminans tx
```
Fluid management
Broad spectrum antibiotics
DIC management
Heparin vs FFP vs Protein C concentrate
Prompt removal of dead tissues +/- amputations
```
86
Vitiligo tx
```
Sun protection-SPF 50
Steroids
Betamethasone Fluocinonide
Phototherapy
Depigmentation- monobenzone 20% (benoquin) cream BID x 18 mo
Surgical grafting
Laser therapy
```
87
Albinism tx
Unable to manufacture melanin Prevent sun damage (SPF 50+) Frequent skin checks regular optho visits
Psych/social support
88
Solar Lentigos (liver spots) tx
```
Chemical peel
Cryotherapy
Laser therapy Hydroquinone
Retinoids
Prevention: sunscreen and ↓ sun exposure
```
89
Melasma tx
Hydroquinone glycolic or Azelaiz acid peel Retinoids
| D/c OCP, sunscreen
90
Ephelides (freckles) tx
Can treat like lentigo if desired-caution for hyperpigmentation
91
Acanthosis Nigricans tx
Treat underlying condition
92
Post-Inflammatory Hyperpigmentation tx
Hydroquinone 3%
| Azelaiz (finacea) acid peel 20%
93
Keloids tx
Topical steroids-gels, lotions, creams and ointments
| Kenalog or 5-FU injections Surgical excision Cordran tape Recurrence is common
94
Epidermal Cyst tx
Kenalog Injection I & D Surgical excision
95
Lipoma tx
Surgical excision for cosmetic reasons
96
Dermatofibroma tx
Surgery for cosmetic
97
Acrochordons (skin tags)
```
Cosmetic removal (may also be irritating)
Electrodessication or surgical excision
```
98
Hemangioma tx
None necessary
| If bleeds-arterial embolization, surgery, laser, interferon
99
Actinic Keratosis tx
Cryotherapy Curettage Electrosurgery Topical chemotherapy Fluoroplex-5FU Effudex-5FU Zyclara-imiquimoid
100
Skin cancer tx
Mohs
Electrodessication & currettage (ED&C)
Cryotherapy
Erividge
