Dermatology Flashcards
(26 cards)
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)
Antibacterials
Systemic required for
moderate to severe impetigo boils or abscesses perianal strep cellulitis (children- h. flu) MRSA suspected
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
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
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
Nasal MRSA carrier
tx
nasal mupirocin
retapamulin- not intranasal
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
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
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
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
- ## (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
Systemic antifungal considerations
Griseofulvin:
Ketoconazole:
Itraconazole:
Terbinafine:
Griseofulvin: LIVER, RENAL
Ketoconazole: LIVER
Itraconazole: LIVER, electrolytes
Terbinafine: LIVER, CBC
Viral skin infections
HSV
Famciclovir valacyclovir (vala less dosing, acyclovir for pregnant patient) Topical- acyclovir, peniciclovir, OTC abreva
topical not recommended use oral
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
Acne rosacea
topical metronidazole tx for life
Topical antihistamines
benadry- minor skin disorders, consider oral as well
doxepin- mod to severe pruritis rx
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
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)
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)
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
Scabies
permethrin or lindane and topical corticosteroids for itching
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
Cauterizing/destructive agents
examples
uses
Silver nitrate and chloroacetic acid
umbilical granuloma, alphthous ulcer, vesicular or bullous legion, poorly healing wounds or ulcers, warts
Keratolytics
used for
example
corns, calluses, and warts
salicylic acid OTC
