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Dermatology > Dermatologic Therapies > Flashcards

Dermatologic Therapies Flashcards

1
Q

How do you determine efficacy of any topical medication?

A

Active ingredient (strength)

Anatomic location

Vehicle (mode in which it is transported)

Concentration of medication

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2
Q

Ointments

A

Vaseline

Use: Smooth non-hairy skin; dry, thick, hyperkeratotic lesions

Avoid: Hairy and intertriginous (skin in contact with skin) areas e.g. armpits, groin, pannus

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3
Q

Creams

A

Vanish when rubbed in.

Less greasy, drying effects, not occlusive, can sting, more likely to cause irritation (preservatives/fragrances).

Use for acute exudative inflammation, intertriginous areas.

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4
Q

Lotion

A

Pourable liquid.

Less greasy, less occlusive, may contain alcohol (drying effect on oozing lesion); penetrate easily, little residue.

Use for hairy areas

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5
Q

Oils

A

Less stinging than lotions or solutions.

Use for scalp, esp for people with coarse or curly hair.

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6
Q

Gel

A

Jelly-like. May contain alcohol, greaseless, least occlusive, dry quickly.

Use for acne, exudative inflammation (acute contact dermatitis); on scalp/hairy areas without matting.

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7
Q

Foams

A

Cosmetically elegant; spread readily, easier to apply, more expensive.

Use for hairy areas; inflammation.

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8
Q

Sprays

A

Aerosols (rarely used), pump sprays

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9
Q

Medication costs

A

OTC are cheaper than prescriptions.

Not all topical meds are covered by insurance.

Generics are less expensive than brand name prescriptions.

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10
Q

Desonide cream 0.05% apply to affected area (face) BID PRN for scaling #15 grams RF3

A

Generic name: Desonide

Vehicle: Cream

Concentration: 0.05%

Sig (directions): Apply to affected area BID PRN for scaling

Amount: #15 grams

Refills: RF3

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11
Q

Topical corticosteroids

A

Produce anti-inflammatory response.

Effective for conditions characterized by hyperproliferation, inflammation, immunologic involvement.

Provide relief for burning/pruritic lesions.

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12
Q

Steroids in any class have the _______ potency.

A

The same potency

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13
Q

Strength of steroids depends on the _______ not the ________.

A

Depends on the molecule not the concentration.

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14
Q

Super high potency steroid

A

Class I

Clobetasol propionate 0.05%

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15
Q

High potency steroid class

A

Class II

Fluocinonide 0.05%

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16
Q

Medium potency steroid class

A

III-V
Triamcinolone acetonide ointment 0.1%
Triamcinolone acetonide cream 0.1%
Triamcinolone acetonide lotion 0.1%

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17
Q

Low potency steroid class

A

Fluocinolone acetonide 0.01%
Desonide 0.05%
Hydrocortisone 1%

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18
Q

What do you use super high potency steroids for?

A

Severe dermatoses over nonfacial and nonintertriginous areas: Scalp. palms, soles, thick plaques on extensor surfaces.

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19
Q

Medium to high potency steroids (classes II-V) used for?

A

Mild ot moderate nonfacial and nonintertriginous areas

**OK to use on flexural surfaces for limited periods

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20
Q

Low potency steroids (classes VI, VII) used for?

A

Large areas and on thinner skin: Face, eyelid, genital, and intertriginous areas.

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21
Q

Side effects of topical steroids?

A

Skin atrophy, telangiectasias, striae, acne, steroid rosacea, hypopigmentation.

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22
Q

Higher the potency, the more likely ________.

A

Side effects will occur.

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23
Q

Systemic effects of topical steroids?

A 
Glaucoma (when steroid applied to eyelid).
Hpyopthalamic pituitary axis suppression
Cushing's syndrome
Hypertension
Hyperglycemia
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24
Q

Super high potency: How long should treatment time be?

A

<3 weeks

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25
Q

High and medium potency: How long should treatment time be?

A

<6-8 weeks

26
Q

Low potency: How long should treatment time be?

A

1-2 week intervals to avoid skin atrophy, telangiectasia, and steroid-induced acne.

27
Q

To avoid rebound/flares, what should you do?

A

Taper with gradual reduction of both potency and dosing frequency every two weeks.

28
Q

1% BSA is…

A

1 palm (Use size of patient’s palm)

29
Q

Fingertip unit is…

A

Topical medication quantity: Dispensed from 5mm nozzle. Placed on pad of index finger from distal tip to DIP joint.

FTU=500mg=Treats 2% BSA

30
Q

Children have a high body surface area to volume ratio. This puts them at high risk for…?

A

Systemic absorption of topically applied medications.

31
Q

Benzoyl peroxide: What can it be used for?

A

Comedolytic (breaks up comedones) and antibacterial.

Available as prescription and OTC. In combinations with topical antibiotics.

Available as cream, lotion, gel, or wash.

32
Q

Benzoyl peroxide: Side effects

A

Bleaching hair, colored fabric, carpet.

May irritate skin.

33
Q

Topical antibiotics: Used for?

A

Reduce number of P. acnes and reduce inflammation in inflammatory acne.

Do not use as monotherapy (often used as benzoyl peroxide to prevent development of antibiotic resistance in treatment of mild-to-moderate acne and rosacea).

Erythromycin 2% (solution, gel)
Cindamycin 1% (lotion, solution, gel, foam)

34
Q

Metronidazole 0.75%, 1% (cream, gel) used in treatment of…?

A

Rosacea

35
Q

Topical retinoids (tretinoin, all trans retinoic acid): Used for?

A

Acne vulgaris, photodamaged skin, fine wrinkles, hyperpigmentation.

Topical retinoids are vitamin A derivatives.

Available as cream or gel.

Do not apply at same time as benzoyl peroxide because it oxidizes tretinoin.

36
Q

Topical retinoids (tretinoin, all trans retinoic acid): Side effects

A

Dryness, erythema, scaling

Photosensitivity

37
Q

Topical acne treatment takes how long to have effect?

A

2-3 months

38
Q

What are oral antibiotics that can be used to treat moderate to severe inflammatory acne?

A

Tetracycline, doxycycline, minocycline

Often combined with benzoyl peroxide to prevent antibiotic resistance.

39
Q

If patient has not responded after 3 months of therapy with oral antibiotic, what should you do?

A

Increase dose.
Change treatment.
Refer to dermatologist.

40
Q

Oral antibiotics: Side effects

A

Tetracycline: GI upset; photosensitivity
Doxycycline: GI upset, photosensitivity
Minocycline: GI upset, vertigo, hyperpigmentation

Contraindicated in pregnancy and children age <8 years.

May cause GI upset (epigastric burning, nausea, vomiting, diarrhea).
(TAKE WITH FOOD)
(TAKE WITH FULL GLASS WATER TO AVOID ESOPHAGEAL EROSIONS)

Can cause photosensitivity (patients may burn easier which can be managed with better sun protection).

41
Q

Do tetracyclines interfere with birth control?

A

NO.

42
Q

When is oral isotretinoin indicated?

A

Severe, nodulocystic acne failing other therapies.

43
Q

How long is course of isotretinoin?

A

5-6 months

44
Q

Isotretinoin: Side effects

A

Teratogenic; absolutely contraindicated in pregnancy.

Female patients must be enrolled in FDA mandated program to use medication.
Two forms of contraception must be used during isotretinoin therapy and for one month after treatment has ended.

45
Q

Common side effects of isotretinoin:

A 
Xerosis (dry skin)
Cheilitis (chapped lips)
Elevated liver enzymes
Hypertriglyceridemia
Mood changes/depression
Severe headache can be manifestation of uncommon side effect pseudotumor cerebri.
46
Q

Topical antifungals: MOA

A

Fungistatic (stop fungi from growing)

Fungicidal (kill fungi)

47
Q

Which conditions do not respond to topical antifungals?

A

Hair infections

Nail infections

48
Q

Examples of topical antifungals:

A 
Imidazoles (fungistatic)
Ketoconazole (Rx and OTC)
Econazole
Miconazole (OTC)
Useful to treat candida and dermatophytes

Allylamines and benzylamines (fungicidal): Naftifine, terbinafine, butenafine
Better for dermatophytes but not candida

Polyenes (fungistatic in low concentrations): Nystatin
Better for candida but not dermatophytes.

49
Q

Antihistamines are used for?

A

Pruritus and chronic urticaria

50
Q

First generation antihistamines antagonists: Features

A

Sedating
Anticholinergic side effects (dry mouth, blurred vision, memory impairment, confusion) are dose-limiting.

Use as sleep aid for patients with pruritus.

Use with caution in elderly due to increased fall risk, CNS, and anticholinergic effects.

51
Q

Second generation antihistamine antagonists: Features

A

Antagonists are minimally sedating and require less frequent dosing than first generation antihistamines.

52
Q

Examples of first gen antihistamines

A

Diphenhydramine (OTC)
Hydroxyzine (Rx, generic)
Chlorpheniramine (OTC)

53
Q

Examples of second gen antihistamines

A

Cetirizine (OTC)
Loratadine (OTC)
Fexofenadine (OTC)

54
Q

Most pruritic dermatoses that are not urticaria, first gen antihistamines work through their _______ effect rather than their _____ effect.

A

Sedative effect rather than anti-histamine effect.

55
Q

Some dermatoses are associated with higher rate of???

A

Epidermal turnover

Example: Epidermis of psoriasis replicates too quickly.

56
Q

Topical therapies that inhibit keratinocyte proliferation are…?

A

Vitamin D analogs
Coal tar
Tazarotene

57
Q

Calcipotriene (Calcipotriol): MOA

A

Inhibits keratinocyte proliferation. Topical Vitamin D analog.

Common side effect: Skin irritation

58
Q

Calcitriol: MOA

A

Inhibits keratinocyte proliferaton. Topical vitamin D analog.

Stimulates keratinocyte differentiation.

Inhibits T cell proliferation.

On more sensitive areas, less skin irritation than calcipotriol.

59
Q

Tar 2-5%: MOA

A

Psoriasis treatment
Antiproliferative effect

Disadvantages: Stain clothing/hair/skin; messy; increases photosensitivity. Can be combined with salicylic acid to penetrate thick plaques.

60
Q

Tazarotene 0.05% and 0.1%

A

Psoriasis treatment.
Topical retinoid used for acne, rosacea, psoriasis.

Disadvantages: Skin irritation; teratogenic; increases photosensitivity.

Can be combined with Class II corticosteroid to reduce irritation.

61
Q

It takes how many grams to cover average adult body for one application?

A

30 grams

62
Q

What is most common cause of treatment failure in acne patients?

A

Lack of adherence

Dermatology (3 decks)

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