Dermatology

Question 1

How can impetigo be treated?

Answer 1

Usually topically if mild, consider oral if outbreak or severe/ at risk for secondary infection

Question 2

What is first-line treatment for mild impetigo?

Answer 2

Muciprocin 2% cream applied to affected area TID x7 days or fusidic acid 2% cream applied sparingly TID/QID (or if occlusive dressing, BID)

Question 3

What is the tx for impetigo if severe in adults?

Answer 3

Cephalexin 250-500 mg QID x10 days or cloxacillin 250-500 mg QID x 10days

Question 4

What is oral tx for impetigo in children?

Answer 4

Cephalexin 50-100 mg/kg/d QID x10 days

Question 5

What are treatment options for furuncles (boils)?

Answer 5

Hot compresses and antiseptic cleaner if small and drainage if large, should culture if recurrent
If severe, can use muciprocin 2% cream sparingly TID

Question 6

When to consider oral ABX in carbuncles?

Answer 6

When large (>5 mm), have multiple, have surrounding cellulitis or systematic symptoms

Question 7

What oral ABX therapy should be used for severe carbuncles?

Answer 7

Cephalexin 500 mg QID or clindamycin 300 mg QID (second-line)

Question 8

What are considered complicated cutaneous infections?

Answer 8

Decubitus ulcers, perirectal abscesses

Question 9

What is the recommended tx for complicated cutaneous infections?

Answer 9

Usually polymicrobial, can use amox-clav 500 mg TID alone or ciprofloxacin 750 mg BID +/- metronidazole 500 mg BID

Question 10

What is first line tx for mild cellulitis?

Answer 10

Cephalexin 500 mg QID x5 days, children: 50-100 mg/kg/d QID x5 days
Until know culture result, then can tailor

Question 11

When to consider IV medications for cellulitis?

Answer 11

If severe, if facial, if diabetic (may not heal quick/absorb)

Question 12

What is first-line oral therapy for diabetic foot cellulitis?

Answer 12

TMP/SMX 1-2 DS tabs BID x 14 days +/- metronidazole 500 mg

Question 13

What is second-line oral therapy for diabetic foot cellulitis?

Answer 13

Amox-clav 500 mg TID x14 days

Question 14

What oral therapy is usually used for MRSA?

Answer 14

TMP/SMX 1 DS tab BID, children: 8-12 mg/kg/d q12h

Question 15

What is the usual first-line therapy for bites?

Answer 15

Amox-clav 500 mg TID x14 days in adults, 40 mg/kg/d q8h in children

Question 16

Second-line therapy for bites?

Answer 16

Doxycycline 100 mg BID for one day, then 100 mg daily x13 days or in CHILDREN >8: 2-4 mg/kg/d q12h x1, then half dose daily

Question 17

What is non-pharmacological therapy for bites?

Answer 17

GOOD CLEANING! Irrigation, cleansing, debriding

Question 18

What to consider with human bites?

Answer 18

Likely polymicrobial, presence of anaerobes, metronidazole can be good

Question 19

What are first-line therapies for HSV gingivostomatitis?

Answer 19

Famiclovir 250 mg TID or valacyclovir 1 g BID x10 days

Question 20

First line therapy for recurrent, severe cold sores (>3 per year)

Answer 20

Famiclovir 500 mg BID x7days or valacyclovir 2g BID x1 day

Question 20

When should antivirals be initiated in shingle exposure?

Answer 20

Within 72 hours, within 1 week for those at risk of severe complications

Question 21

What is the tx for shingles exposure?

Answer 21

Famiclovir 500 mg TID x7d or valacyclovir 1 g TID x 7d
Second line: acyclovir 800 mg five times a day x 7d

Question 22

What is tx for postherpetic neuralgia secondary to shingles?

Answer 22

Gabapentin, anti-seizure medications

Question 23

When should antivirals be initiated in the case of chickenpox exposure?

Answer 23

Within 24 hours of rash onset

Question 24

What prevention options are there for chickenpox expsosure?

Answer 24

Chickenpox vaccine within 72 hours

Question 25

Antiviral tx for post-exposure to chickenpox?

Answer 25

Famiclovir 500 mg TID x7 day or valacyclovir 1g TID x7 days

Question 26

What other option in recommended for those who are pregnant, non-immune to varicella and have had exposure?

Answer 26

VariZIG IM 125 U/10kg (max 625 U)

Question 27

What are options for tx for those who have been exposed to chickenpox and are pregnant?

Answer 27

Acyclovir 20 mg/kg/dose QID (max 800 mg/dose)

Question 28

Do warts spontaneously resolve?

Answer 28

Yes!

Question 29

Non-pharm tx options for warts?

Answer 29

Soak and debride, helps topical therapy penetration

Question 30

What are the four different topical tx options for warts?

Answer 30

Salicyclic acid (ex: Dr. Scholls), cryotherapy, blistering agents, and cantharidin

Question 31

What are the pros to salicylic acid for wart tx?

Answer 31

Cheap, OTC, limited AE and effective

Question 32

What are the cons to salicylic acid for warts?

Answer 32

Strict adherence schedule and long-treatment duration (12 weeks)

Question 33

What are the considerations with blistering agents for warts?

Answer 33

Better for plantar warts, effective, cannot be self-administered

Question 34

What are some considerations for cantharidin tx/ blistering for warts?

Answer 34

Can be painful (extreme if misapplied), irritation, hypo/hyperpigmentation, TOXIC if ingested

Question 35

What is the tx for anogenital warts?

Answer 35

Prevention/Gardisil, podophyllotoxin to lesion BID x3 days, off for 4 days (use for 4 weeks)

Question 36

What are some oral antifungal options?

Answer 36

Terbinafine (for onchomycosis, tinea capitis), fluconazole (candida species thrush), nystatin (thrush, less effective), itracanozole (broader spectrum than fluconazole)

Question 37

What is the dosing for terbinafine for onchomycosis?

Answer 37

250 mg daily x6 weeks (fingernails) or x16 weeks (toenail)

Question 38

What is the terbinafine dosing for tinea capitis?

Answer 38

250 mg daily x 8 weeks (adults), 125 mg daily (20-40kg), or 62.5 mg (<20 kg)

Question 39

What are some adverse effects of terbinafine?

Answer 39

Headaches, GI disturbances, taste disturbances, rash, liver toxicity **need to monitor LFTS (baseline, then at 4 and 6 weeks)

Question 40

What is dosing for oral fluconazole for onchomycosis?

Answer 40

125 mg PO weekly x3 months (fingernails) or x12 months (toenails)

Question 41

What are some adverse effects of fluconazole?

Answer 41

Well tolerated, can have headache/GI upset/ rash/alopecia or liver toxicity **monitor renal and liver function, avoid in pregnant

Question 42

What are some topical antifungals?

Answer 42

Ciclopirox olamine 1% cream for tinea pedis/cruris/corporis; clotrimazole 1% cream BID x4 weeks; terbinafine 1% cream daily x 4 weeks

Question 43

What are the four first line therapies for lice?

Answer 43

Permethrin (Nix), pyrethrins (R&C), isopropyl myristate (Resultz) and dimethicone (NYDA)

Question 44

What is critical in lice tx?

Answer 44

Adherence, nit picking, diligence

Question 45

What two treatments can be used in those <2?

Answer 45

Permethrin and pyrethrins

Question 46

What is the first-line treatment for scabies?

Answer 46

Permethrin 5% cream--massage into skin, leave on for 8 hours, wash off and repeat 7-10 d after

Question 47

What are the tx options for acne vulgaris?

Answer 47

Topical BPO, retinoid (or combo), topical ABX, CHC, spironolactone, oral ABX, oral retinoid

Question 48

What is first-line therapy for mild acne?

Answer 48

Benzoyl peroxide as monotherapy

Question 49

Things to consider with BPO?

Answer 49

Use QHS or BID, may bleach/stain, may cause irritation, may inactivate retinoids or ABX d/t oxidizing effects (use at diff times or use combo)

Question 50

What is first-line therapy for mild-moderate acne?

Answer 50

Retinoids, start at low potency and use 2-3 nights a week, titrate as needed

Question 51

What are some low potency retinoids?

Answer 51

Adapalene 0.1% and 0.3% apply pea-sized amount QHS

Question 52

What is a mid-potency retinoid?

Answer 52

Tretinoin 0.01%, 0.025%, 0.04%, 0.05% apply pea-sized amount QHS

Question 53

What is a high potency retinoid?

Answer 53

Tazarotene 0.025%

Question 54

What should be considered with retinoids?

Answer 54

Photosensivity and irritation common. Need sunscreen, avoid astringents/drying products, not recommended in those <12 years

Question 55

When to consider topical ABX for acne?

Answer 55

With moderate to severe acne and when inflammatory ++

Question 56

Topical ABX for acne?

Answer 56

Clindamycin (Dalacin) apply BID, can combine with BPO

Question 57

First-line oral ABX for acne?

Answer 57

Tetracycline on empty stomach: 500 mg BID initially then 500 mg daily, doxycycline 100 mg daily, or minocycline 100 mg daily initially, then 50 mg daily

Question 58

What are some adverse effects of tetracyclines for acne?

Answer 58

GI upset, vaginal candidiases, photosensivity, intracranial hypertension (rare)

Question 59

What is the dosing for isotretinoin for acne?

Answer 59

Initially, 0.5mg/kg/d x4 weeks, then maintenance of 1 mg/kg/d x 3-7 months

Question 60

What is imperative when starting somebody on isotretinoin?

Answer 60

Test for pregnancy TWICE before, initially and then 11 days within initiating, then upon D/C

Question 61

What are some adverse effects of isotretinoin?

Answer 61

Usually dose related--> include dry skin and mucus membranes, hair loss, red face, aches, increased lipids, photosensitivity

Question 62

What to monitor on isotretinoin?

Answer 62

Pregnancy tests, lipids, CBC, LFTs

Question 63

Who is spironolactone contraindicated in for acne?

Answer 63

Those with eGFR <30, hyperkalemia

Question 64

What are the first-line tx for rosacea?

Answer 64

Topical brimodine gel (for facial redness), topical metronidazole, topical azelaic acid and topical ivermectin

Question 65

What are some non-pharmacological options for atopic and contact dermatitis?

Answer 65

Education, avoidance of triggers, environmental factors, swimming, avoid scratching, change diet, use wet dressings/wraps, barrier repair products, cleansers, bath products,

Question 65

What are first-line tx options for atopic dermatitis?

Answer 65

Moisturizers and topical corticosteroids