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239B > dermatology > Flashcards

dermatology Flashcards

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1
Q

Ointments

A

consist mainly of water suspended in oil and exellent lube, most potent vehicles, occulsive effect, not hairy areas to to greasiness-
use: dry, lichenified lesions

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2
Q

creams

A

less potent than ointments but stronger than lotions, semisolid emulsion of oil in water, washed off with water, nonhairy areas such as palms and soles

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3
Q

lotions

A

powder in water preparation, less potent vehicle

use: moist areas, dermatoses, pruritius, hairy areas, lg areas, cooling effect on skin

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4
Q

solutions

A

water in combo with various meds/substances
coolness and aid in drying of exudative lesions
use: closed dsg, infected dermatoses or hairy areas

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5
Q

gel

A

oil in water, semisolid emulsion with alcohol in the base, transparent and colorless and liquefies on contact with the skin
use: hairy body areas and combine the advt of ointments with cosmetic adv of creams

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6
Q

corticosteroids GROUP 1 (most potent)

A 
Clobetasol propionate (Temovate; cream, ointment 0.05%)
 Betamethasone dipropionate (Diprolene; ointment 0.05%)
Halobetasol propionate (Ultravate; cream, ointment 0.05%)
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7
Q

corticosteroids GROUP 2

A 
Fluocinonide (Lidex; cream, ointment, gel, solution 0.05%)
Mometasone furoate (Elocon; ointment 0.1%)
Betamethasone dipropionate (Maxivate; ointment 0.05%)
Amcinonide (Cyclocort; ointment 0.1%)
Desoximetasone (Topicort; cream, ointment 0.25%; gel 0.5%)
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8
Q

corticosteroids GROUP 3

A 
Triamcinolone acetonide (Kenalog, Aristocort; ointment 0.1%) 
Amcinonide (Cyclocort; cream, lotion 0.1%)
Betamethasone dipropionate (Diprosone; cream 0.05%)
Betamethasone valerate (Valisone; ointment 0.1%)
Fluticasone propionate (Cutivate; ointment 0.005%)
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9
Q

corticosteroids GROUP 4

A 
Mometasone furoate (Elocon; cream, lotion 0.1%)
Triamcinolone acetonide (Kenalog, Aristocort; cream 0.1%)
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10
Q

corticosteroids GROUP 5

A 
Fluticasone propionate (Cutivate; cream 0.05%)
Fluticasone acetonide (Synalar; cream 0.025%)
Betamethasone valerate (Valisone; cream 0.1%)
Hydrocortisone valerate (Westcort; cream 0.2%)
Betamethasone dipropionate (lotion 0.05%)
Prednicarbate (Dermatop; cream 0.1%)
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11
Q

corticosteroids GROUP 6

A 
Fluocinolone acetonide (Synalar; solution 0.01%)
Betamethasone valerate (Diprolene lotion 0.05%)
Triamicinolone acetonide (Aristocort, Kenalong; cream 0.1%)
Desonide (DesOwen; cream, ointment, lotion 0.05%, Tridesion; ointment 0.05%)
Alclometasone dipropionate (Aclovate; cream, ointment 0.05%)
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12
Q

corticosteroids GROUP 7 (least potent)

A 
Hydrocortisone (Hytone; cream, ointment, lotion 2.5%, generic cream 0.1%, 2.5%
Pramoxine hydrochloride (HC Pramoxine; cream 0.1%, 2.5%)
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13
Q

group 1 and II used for

A

Groups 1-2 (severe): psoriasis, discoid lupus, severe eczema, resistant adult atopic dermatitis

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14
Q

group III- V used for

A

Groups 3-5 (intermediate): atopic derm, eczema, seborrheic derm, intertrigo, tinea, scabies (after scabicide), severe dermatitis of face

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15
Q

group VI- VII used for

A

Groups 6-7 (mild): derm of eyelids, diaper area, face, mild intertrigo.

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16
Q

group I-II use these to tx

A

Groups 1-2 (severe): psoriasis, discoid lupus, severe eczema, resistant adult atopic dermatitis

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17
Q

group 3-5 use these to tx

A

Groups 3-5 (intermediate): atopic derm, eczema, seborrheic derm, intertrigo, tinea, scabies (after scabicide), severe dermatitis of face

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18
Q

group 6-7 use these to tx

A

Groups 6-7 (mild): derm of eyelids, diaper area, face, mild intertrigo.

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19
Q

psoriasis s&s

A

Scaly plaques & papules
well demarcated, elevated, erythematous, silvery white plaques
pitting on nail beds
most psoriatic lesions are asymptomatic, but can be pruritic. Picking & scratching can worsen lesions (produce Koebner’s response?)
Skinfold lesions more likely to itch (axilla, groin, genitals = inverse proriasis)

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20
Q

differential dx of psoriasis

A 
gout
pseudogout
reactive arthritis
syphilis
squamous cell CA
nummular eczema
lichen simplex chronicus
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21
Q

management of psoriasis

A

meds = Oral retinoids i.e. methotrexate, Cyclosporine
phototherapy- uvb
topical- reduce epidermal proliferation and decrease inflammation wiht steroids (ointments pref), shampoo help, coal tar prep or vit D prep

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22
Q

methotrexate

A

oral retinoids for psoriasis
use with caution of childbearing age
effective in treating severe, recalcitrant psoriasis involving a large body area
CI: pregnancy, liver/kidney disease, anemia, colitis or debility

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23
Q

cyclosporine

A

oral retinoids for psoriasis
limited because of its potential nephrotoxicity
monitor BP, and serum creat.
Dermatologist should manage/co-manage

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24
Q

referral of psoriasis

A

medication management, pt with re-calcitrant or unresponsive psoriasis

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25
education to pt on psoriasis
understand chronic nature, adherence with meds/ointments, avoid injury sunburn/trauma, triggers BB ASA chloroquines
26
Acne Vulgaris patho
before puberty- androgenic stimulation which increases sebaceous gland production, abd adherent keratinization (plugged follicles)
27
acne vulgaris management
tx comedone (retinoids), topical keratolytics (retin A) salicylic acid, inflam/bacteria with benozyl peroxide & ABX for severe acne i.e. doxy/minocycline or estrogen/spironolactone suppress the androgenic stimualtion of sebum
28
acne vulgaris s&s
primary lesion (comedone) open- blackhead closed- whitehead inflam rx to sebum, fatty acids, and gm + propionibacerium acnes (cytokines causing papules and pustules)
29
acne vulgaris referral
``` cystic acne unresponsive to std therapy systemic isotretinoin (accutane) ```
30
contact dermatitis overview
eczematous dermatitis- irritant or allergic type | hands and ACD most common
31
ICD vs ACD
irritant CD- acute- well demarcated area of erythema, scaling or crusting at site of exposure cumulative ICD- weak irritants (cosemetics) occurs months after continual exposure (not as ACD) ACD_ typically acute with itch, inflam, vesicles
32
differential dx of CD
``` atopic derm dyshidrotic eczema bacterial or candida infection phytophotodermatitis herpes zoster ```
33
distribution dx - for CD
scalp/ears: shampoo, hair dyes, eyeglasses eyelid- nail polish, contact lens face- airborne allergens, cosmetics, sunscreen neck- necklace, airborne allergen, perfumes trunk- meds, sunscreen , plants, clothing axillae- deodorant, clothing arms- same as hands, watch hands- soap detergents, foods, plants, metal, gloves genitals- poison ivy, rubber condoms anal region- hemorrhoid prepartions, nystatin, lower legs- topical meds, socks feet - shoes
34
CD patient education
avoid offending agent- dont use personal product until healed, domeboros solition for soothing inflammed/crusted lesions, reduce handwashing, liberal use of emollinets, anithistamines to help sleep not ithc, urushiol resin( poison oak) remains on clothing/tools for months
35
CD referral
refractory cases, dx in ??, patch test to determine allergy
36
CD tx
topical medium to high potency corticosteroids( group 1-5) ointments pref (less preservative)- steroid allergy use topical calcineurin inhibitors oral prednisone- when periorbital/gential regions or >20% body SA involved
37
atopic dermatitis
chronic DO c/o exacerbation and remissions of dry, itchy, red skin can start in infancy (a/w asthma, allergic rhinitis, urticaria, acute reactions to foods) FH itch and rash develops rash followed by lichenification if untreated pruritic, erythematous, dry patches of skin, often w/ scale. linear excoriations. ill defined borders, crusting and oozing are common Infants: cheeks, scalp, forehead, extensor extremities Adults: generalized typically on face, neck, flexural folds, wrists, and dorsa of feet.
38
atopic dermatitis triggers
Aggravating factors dry skin, sweating, heat, dry environments, occlusion(athletic equipment, dressings, gloves) topical agents (soap, laundry detergents) and wool make it worse exacerbated by infections, stress, allergies
39
atopic dermatitis differential dx
``` seborrheic derm: psoriasis: Scabies: Molluscum contagiousum: tinea: ```
40
atopic dermatitis tx
moisturize for dryness antihistamines for itching and sleep aid. hydration w/ tepid water bath immediately followed by emollient like petrolatum Topical mild corticosteroid ointment for inflam discontinue once inflam has reduced but continue lubricants and emollients Nonsteroidal calcineurin inhibitors (tacrolimus and pimecrolimus) for chronic mod to severe AD Treat secondary bacterial, fungal, or viral infection Systemic corticosteroids reserved for extreme cases.
41
atopic dermatitis education
Must avoid rubbing and scratching Avoid known triggers; continuous use of lubricants and emollients to decrease need for topical corticosteroids. use mild soaps and laundry detergents
42
scabies s&S
itching, (esp at night) lesions at site of infestation & lesions secondary to hypersensitivity to mite intraepidermal burrows are linear or serpiginousNOT “typical” common sites: interdigital spaces (web spaces), wrist, arms, genitals, feet, buttucks, axillae
43
scabies differential dx
``` contact dermatitis asteatotic dermatitis insect bites animal scabies seborrheic dermatitis psoriasis ```
44
scabies tx
Apply Permethrin 5% head (neck) to toe (sparing face); leave on for 8-12 hrs; and then wash off May use antihistamines & corticosteroids after permethrin for itching Ivermectin off-label is PO med used as well
45
patient education on scabies
all household contacts must be identified and treated all clothing & bedding must be washed in hot water and dried on hot cycle stuffed sofas & chairs should be vacuumed materials that cannot be washed should be placed in a plastic bag for 1 week
46
seborrheic dermatitis s&S
dry, flaky scales greasy, erythematous, sharply marginated plaques FYI: (this is Cam’s two cents) often in adults nasolabial folds & eyebrows. Golden dry flaky hue & on scalp (aka dandruff & in infants = cradle cap) Unknown cause, over reaction to normal yeast on skin ?? (hence use anti-fungal cream to treat yeast, and then stop over reaction)
47
seborrheic dermatitis differential dx
``` dandruff scabies asteatotic eczema psoriasis ** in particular this is hard candidal infection intertrigo ```
48
seborrheic dermatits tx
topical 2% ketoconazole 10% sodium sulfacetamide wash daily if above doesn’t work, topical steroid shampoo = Nizoral 1% OTC
49
patient education on seborrheic dermatitis
this is chronic & recurrent | monitor for early flares (and Cam’s two cents: avoid triggers - sun, ETOH etc)
50
fungal infections
``` dermatophytes most common fungi tinea capitis tinea corporis tinea cruris tinea pedis tinea manus tinea unguium ```
51
tinea capitis
head/scalp - patchy, scaly, nonscarring areas of hair loss
52
tinea corporis
body-erythematous plaques and papules in annular or arciform pattern=elevated borders w/ central clearing
53
tinea cruris
jock itch- groin and upper thigh, gluteal folds: erythematous scaling patches w/ raised borders. often spares scrotum.
54
tinea pedis
athletes foot- interdigital scaling, maceration, and fissuring, also scaling eruption on sole and sides of foot
55
tinea manus
hand- dry, diffuse, scaly eruption of palms, w/ shrp marginated plaques on dorsum.
56
tinea unguium
nail aka onychomycosis | begins in distal nail bed and spreads to infect nail plate=thickened/yellowed nail
57
patient education on fungal infections
caution use of OTC steroid creams for long-term use (causes skin thinning and striae) absorbent powders help reduce moisture and prevent reinfection. Tinea capitis: clean combs, towels and bedding; don’t share refer if start ORAL ANTIFUNGALS
58
canidiadisis
appearance depends on location thrush (oral cavity): white or gray membranous plaques w/ base-macerated and brightly erythematous lesions can extend down esophagus, lips. skin: axillary, gluteal, interdigital, perianal/diaper region, panniculus foldes, shaved areas (folliculitis of beard), vagina, glans penus. Treatment: powders, vaginal douches, oral suspensions, creams and tablets
59
tinea versicolor
chronic, asymptomatic, superficial lesions white or light pink in hypopigmented version or tan and brown in hyperpigmented version; pigment returns w/ treatment. slightly scaly, round/oval coalescing papules and plaques. sternum, sides of chest, abdomen, or back, pubis, intertriginous areas. Treatment antifungal creams (imidazoles), shampoos w/ selenium sulfide or pyrithione zinc x 7-14 days consecutively
60
management of most tinea
Acute, exudative lesions - drying agent like aluminum 1)sulfate (Domeboro) soaks 2) topical antifungal solutions and creams 3) keratolytic agents remove thick scales on hands and feet allowing topical antifungal agent to penetrate. 4) Oral antifungals: for widespread tinea or infections involving scalp and nails. consult Onychomycosis: terbinafine 250mg daily x 6wks for fingernail and 12wks for toenail **monitor liver fx and CBC for SE of neutropenia
61
most fungal infections application of steroids
BID- tx for 2 weeks , tinea pedis, tinea unguium and tinea capitis require 6 weeks or more of tx

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