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Flashcards in Dermatology Deck (26):
1

Topical antibacterials

mupirocin (bactroban, centany) tid
retapamulin (altabax) bid
bacitracin (2-5 times a day)
double: bacitracin polymixin
triple: bacitracin neomycin polymixin (can dev sensitivity to neomycin)

2

Antibacterials

Systemic required for

moderate to severe impetigo
boils or abscesses
perianal strep
cellulitis (children- h. flu)
MRSA suspected

3

Impetigo
Treatment

topical

oral

perianal strep

Topical-
mupirocin or retapamulin
OTC bacitracin
bacitracin/polymyxin

If worsening (no imp. 2-3 days) or greater than 5 lesions- oral
Keflex
Augmentin
Dicloxacillin
If MRSA suspected
Clindamycin
Doxycycline, TMP/SMZ

Perianal strep- penicillin or erythromycin

4

Bacterial skin infections
Cellulitis

treat with

if suspected MRSA

systemic antibiotics
followed by oral

Broad spectrum i.e. bactrim (caution with renal)

TMP/SMZ, clindamycin or doxycycline

5

Deep tissue infections
Furuncle
First line

Cellulitis

Furuncle- keflex, bactrim, dicloxacillin

Cellulitis- think h. flu in children
Most skin GRAM +
Augmentin or broad spectrum cephalosporin

6

Nasal MRSA carrier
tx

nasal mupirocin

retapamulin- not intranasal

7

Fungal skin infections

Oral candidiasis

Tinea capitus

CANDIDIASIS topical nystatin (liquid) or clotrimazole (dissolve tab)
oral- fluconazole

-otc azoles, nystatin*, prescription azoles (start nystatin if not systemic) fluconazole systemic best option less interactions

TINEA CAPITUS Oral- griseofulvin*
Biweekly shampoo- selenium sulife or ketoconazole (typical)

griseofulvin or terbinafine, use sporicidal shampoo

8

Fungal skin infections continued
Tinea corporis (ringworm)

Tinea cruris (jock itch)

Tinea pedis (athletes foot)

Tinea versicolor (pitryiasis versicolor)

ringworm- topical antifungal cream
(topical azoles, naftifine, ciclopirox olamine)

jock itch- topical azoles

Tinea pedis- topical azoles topical antifungals

topical app selenium sulfide shampoo
topical antifungal (imidazoles ie miconazole, clotrimazole, econazole)
all similar effecicacy

9

Fungal skin infections continued
Oncychomycosis (fungal nail)

are topical but do oral
Systemic antifungal medications (griseofulvin, ketoconazole, itraconazole) or TERBINAFINE **
Topical- ciclopirox

New agent- jublia- topical takes 48 weeks to work

10

Antifungals topical
treat
-
-
-
-
-
-

superficial fungal infections
azoles- otc
allylamines (naftin)
benzylamine (butenafine)
ciclopirox olamine
tinactin (multiple dosage forms athletes foot)
Nystatin

OTC- tinactin butenafine naftin

pregnancy B, few contraindications

11

Antifungals systemic
-
- (three)
-

use caution with
griseofulvin caution

interactions

-griseofulvin (not as common)
-azoles (ketoconazole, itriconazole, fluconazole)
-terbinafine (lamisil)

liver*
cross-sensitivity with penicillin

multiple related to liver

12

Systemic antifungal considerations

Griseofulvin:
Ketoconazole:
Itraconazole:
Terbinafine:

Griseofulvin: LIVER, RENAL
Ketoconazole: LIVER
Itraconazole: LIVER, electrolytes
Terbinafine: LIVER, CBC

13

Viral skin infections
HSV

Famciclovir valacyclovir (vala less dosing, acyclovir for pregnant patient)
Topical- acyclovir, peniciclovir, OTC abreva

topical not recommended use oral

14

Acne
topical

retinoids- peeling, take time to work
topical abx- clindamycin erithromycin
oral abx- tetracycline doxy, mino, erythromycin (used interchangeably)

isotretinoin- X, liver enzyme and lipid panel

15

Acne rosacea

topical metronidazole tx for life

16

Topical antihistamines

benadry- minor skin disorders, consider oral as well
doxepin- mod to severe pruritis rx

17

Eczema
Acute treatment

second line treatment

topical corticosteroids
hydrocortisone- lower potency, avoid high or super high in children
pregnancy C

oral not usually recommended

second line- consult-
immunomodulators- pimecromilus and tacrolimus BB warning rare malignancy
(pregnancy C, do not use in children <2)

Antipruritics (oral antihistamines benadryl hydroxyzine) doxepin oraly or topical

emollients

abx

18

Dermatitis

Contact

Diaper

Seborrheic

contact- topical steroids, maybe oral
wet drressing or bath- aluminum acetate, baths containing colloidal oatmeal

diaper- barrier (white petrolatum zinc oxide balmex desitin) anti-inflammatory (low dose hydrocotrisone 2-3 days) antifungals (nystatin, miconazole, clotrimaxole) wet soaks

seborrheic topical shampoo- (selenium sulfide, ketoconazole, pyrithione zinc twice a week) topical corticosteroids (low potency if not responding to shampoo)

if initial doesnt work increase potency of corticosteroids, 2nd line tx after corticosteroids- immunomodulators (pimecromilus and tacromilus)

19

Psoriasis
Treatment

Intermediate to high dose corticosteroids (compared to eczema dermatitis low)
pulse therapy- hard with high dose potency then back off
taper

coal tar

Anthralin- irritating, stains, not widely used
Vitamin d3 derivatives ) calcipotriene calcitriol (remember these have weekly max)

20

LICE
Head

Body

Pubic

head- pyrethrins and permethrin, benzoyl alcohol
second line- lindane and malathion

body- topical lindane and permethrin

pubic- lindane, pyrethrin and permethrin

lindane- do not use in pregnancy or infants same with benzoyl alcohol

21

Scabies

permethrin or lindane and topical corticosteroids for itching

22

Burns partial thickness

Pregnancy?
SE?
caution with?

alternative

Silvadene
Pregnancy B but near term D
Leukopenia up to 20%

liver, renal, or hematological disorders

bacitracin

23

Cauterizing/destructive agents

examples

uses

Silver nitrate and chloroacetic acid

umbilical granuloma, alphthous ulcer, vesicular or bullous legion, poorly healing wounds or ulcers, warts

24

Keratolytics
used for
example

corns, calluses, and warts

salicylic acid OTC

25

Topical anesthetics

Lidocaine

sodium bicarb lessen sting

26

Alopecia Androgenetica


considerations for systemic meds

Minoxidil- mod to dense hair growth continue use 4 months (may cause dermatitis)
Finasteride- 3 months of tx ( low dose hair loss high dose bph) systemic- takes 6-12 months do not prescribe to hepatic dysfunction, elevated PSA PREGNANCY X (including semen) sexual dysfunction, prostate exam, PSA levels pregnancy prevention