Dermatology Flashcards
(258 cards)
1
Q
What are the 3 layers of the skin?
A
Epidermis
Dermis
Subcutis
2
Q
What layer do most dermatological conditions present in?
A
Epidermis and Dermis
3
Q
What are the terms for a flat, nonpalpable change in skin color?
A
Macule (small)
Patch (big)
4
Q
What are the 3 types of elevation from fluid in a cavity?
A
Vesicle (small)
Bulla (big)
Pustule (pus-filled)
5
Q
What layer of skin has the blood supply?
A
Subcutis
6
Q
How is cellulitis treated?
A
With antibiotics–topicals can’t penetrate deeply enough
7
Q
What are the terms for elevated palpable solid masses?
A
Papule (smaller)
Plaque (larger)
Wheal (even bigger)
8
Q
What is the difference between a nodule and a tumor?
A
Nodule doesn’t penetrate the skin
Tumor penetrates the skin
9
Q
What are the two types of secondary lesions?
A
Material on skin surface
Erosion of skin surface
10
Q
What is erosion?
A
Top layer eroded away
11
Q
What is an ulcer?
A
Deeper penetration into skin than ulcer
12
Q
What is excoriation?
A
Line that looks like dried erosion
13
Q
What is a fissure?
A
Large tracks, deeper lesions
14
Q
What are the 3 secondary lesions found on the skin surface?
A
Scale
Crust
Keloid
15
Q
What are the 4 vascular lesions?
A
Cherry angioma
Telangiectasia
Petechiae
Ecchymosis
16
Q
What is a cherry angioma?
A
Benign red area
17
Q
What is telangiectasis?
A
Center w/spiderweb presentation from ruptured microvessels
18
Q
What arre petechia?
A
Subcutaneous hemorrhages
19
Q
What is ecchymiosis?
A
Larger area of subcutaneous hemorrhages
20
Q
What dosage form is the most hydrating?
A
Ointment
21
Q
What dosage form has the best bioavailability of the active ingredient?
A
Ointment
22
Q
What are the 4 main properties of ointments?
A
Occlusive (water retention from hydrophobic barrier)
Humectant (water retention from hygroscopic properties)
Emollient (softens and soothes skin)
Protective
23
Q
What is the biggest disadvantage of ointments?
A
Greasy–poor patient acceptance
24
Q
Where is an ointment used?
A
Smooth skins w/short or sparse hair
25
How are creams and ointments applied?
Based on fingertip units--0.5 gram of cream or ointment on the end of the finger
26
Do ointments or lotions/solutions require less for effectiveness?
Ointments
27
Are creams/lotions water-removable?
Yes
28
Do ointments or creams need to be administered more frequently?
Creams
29
What are the formulations of creams/lotions?
Oil-in-water emulsions OR aqueous microcrystalline dispersions of long fatty acids or alcohols
30
Lotion is essentially watered-down ___?
Cream
31
Gel is a ____ system consisting of either suspensions made up of _____ particles or _____ interpenetrated by a liquid
semi-solid; small inorganic; large organic molecules
32
Where are gel, lotions, solution, and foam used?
Hair bearing skin (scalp, very hairy men)
33
What's the biggest disadvantage of gel?
Drying---NOT for use if skin needs hydration
34
What are disadvantages of lotions, solutions, and sprays?
They are drying and have lower bioavailability
35
Can lotions, solutions, and spray be used on the face?
yes
36
What are the properties of an oleaginous base?
Absorbs no water
| Not water washable
37
What are 3 examples of oleaginous bases?
White Petrolatum*
Vaseline
Plastibase
38
What are the properties of absorption bases?
Can absorb lots of water
| Not water washable
39
What are 3 absorption bases?
Aquaphor
Aquabase
Polysorb
40
What are water-in-oil emulsion base properties?
Absorb less water than absorption
| Not water washable
41
What are 3 examples of water-in-oil emulsion bases?
Nivea, Eucerin, Hydrocerin
42
What are oil-in-water emulsion base properties?
Water washable
| Add water = lotion
43
What are examples of oil-in-water bases?
```
Hydrophilic ointment
Dermabase
Hydrocerin
Unibase
Cetaphil Lotion
Vanicream
```
44
What are the properties of water soluble bases?
Water washable
Minimal therapeutic effect
Primarily used for drug delivery
45
What is the water soluble base?
Polyethylene Glycol
46
What are the 3 types of hypersensitivity/allergic dermatologic reactions?
Rash
Hives
Scarlet Fever
47
What are characteristics of a rash from drugs?
Macular or popular
Diffuse
Bilateral
Itching
48
What differentiates hives from a rash?
Hives may be slightly raised and affect larger areas than rash
49
What is scarlet fever?
A systemic infection that causes dermatologic lesions
50
How do you treat allergic/hypersensitivity drug reactions?
1. stop the drug
2. Systemic antihistamine
3. Systemic/topical corticosteroids
4. Soothing baths/soaks
51
How do you prevent photosensitivity reactions?
SPF >30 sunscreen
| Protective clothing
52
How do you treat photosensitivity reactions?
```
Systemic analgesics
Systemic antihistamine
Prevent infections--no scratching
Moisturizers
Cooling creams and gels (Aloe)
```
53
What are the two toxic dermatologic reactions to medications?
Stevens-Johnson Syndrome
| Toxic Epidermal Necrolysis
54
What causes SJS and TEN?
Drug protein complex reaction activates T cells, which migrates to the dermis and releases cytokines
55
What are the characteristics of TEN and SJS?
Epidermal detachment
| Erosive mucosal lesions
56
What drugs cause SJS/TEN?
```
Sulfonamides
Cephalosporins
Penicllins
Flouroquinolones
Anticonvulsants
Allopurinal
NSAIDs
```
57
What class of drugs is most closely associated with SJS/TEN?
Anticonvulsants
58
How do you treat SJS/TEN?
```
STOP DRUG
IV fluids/nutrition
Pain control
Eye care, nasal saline--keep mucous membranes moist
Oral hygiene and anesthetic
Topic antiseptics
Wound care
```
59
How quickly will SJS/TEN occur within starting treatment?
In first 4 weeks
60
What are the systemic symptoms of SJS/TEN?
Flu-like (prodromal NVD, myalgias, sore throat, arthralgia) + Rash
61
What does full thickness epidermal detachment increase the risk of?
infection
62
Cellulitis: Treat or Refer?
Refer
63
Cellulitis treatment?
Oral antibiotics (IV if severe)
64
Impetigo: Treat or Refer?
Refer
65
What is impetigo?
Staph skin infection
66
Impetigo treatment?
topical or oral antibiotics (depending on diffuse or localized)
67
Does impetigo spread?
Yep
68
What does impetigo look like?
Circular areas, often on face, that scab over
69
Candida: Treat or refer
Refer
70
Candida treatment?
Topical antifungals
| Dry affected areas
71
What population is candida infection common in?
Moist areas, humid conditions
| Obese
72
Tinea pedis: Treat or Refer?
Treat
73
How do you treat tinea pedis?
Topical antifungals
74
What is tinea pedis?
Athlete's foot
75
Tinea corporis: common name?
Body ring worm
76
Tinea corporis: Treat or refer?
Treat
77
How do you treat tinea corporis?
Topical antifungals
78
What does tinea corporis look like?
Small, circular, red scaly areas (always round)
79
Head lice: treat or refer?
Refer
80
What age group gets head lice most often?
3-12 year olds
81
How do you treat head lice?
Permethrin 1%
Malathion
Oral/topical Ivermectin
Spinosad
82
What can be done to prevent recurring head lice?
Washing everything in the house--bed linens, clothes, etc
83
What is scabies?
Mite infestation
84
How does scabies present?
Mites burrow under skin and create red bumps--often in a line
85
Scabies: Treat or refer?
Refer
86
What is a major symptom of scabies?
Extreme pruritus
87
How do you treat scabies?
Permethrin 5%
Crotamiton
Oral Ivermectin (widespread)
88
When is herpes zoster contagious?
When blisters are present
89
What is the major symptom of shingles?
Major pain along dermatome (nerve)
90
What is the normal progression of shingles?
Tender red papules to scabs
91
Shingles: Treat or Refer?
Refer
92
What is treatment for shingles?
Oral valacyclovir or famciclovir
Manage acute pain and postherpetic neuralgia (oral opioids, gabapentin for PHN, lidoderm patches once lesions have healed)
93
Difference between BCC and SCC in appearance?
BCC is not eroded, SCC is eroded
94
Which skin cancer is the deadliest?
melanoma
95
What is xerosis?
Dry skin
96
Who is at risk for xerosis?
Elderly and frequent bathers (esp in warm, dry environments)
97
Treatment options for xerosis?
Emollients--for itching, restores barrier and skin function
Agents for itching
Alter bathing habits
98
Best bathing habits to prevent xerosis?
No more than 3 times a week for 3-5 minutes at a time at a temperature 3 degrees above body temperature
99
What should someone do after bathing?
Pat dry
Apply emollient within 3 minutes
Apply emollient 3 times throughout the day
100
What are some common emollients?
```
Vaseline
kivea
Keri
lubriderm
AmLactin
Eucerin
```
101
What are the 4 topical agents to reduce itching?
Menthol and camphor
Pramoxine
Aluminum Acetate
Hydrocortisone
102
Menthol and camphor do what?
Create sensation of cooling
103
What does pramoxine do?
Local anesthetic
104
What does aluminum acetate do?
Alter C-fiber nerve transmission
105
What does hydrocortisone do?
Anti-inflammatory
106
What are the characteristics of acute dermatitis?
Red patches/plaques
Pebbly surface or blisters
Itching
107
What are the characteristics of subacute dermatitis?
Dry
less red
Crusting, oozing
Mild thickening
108
What are the characteristics of chronic dermatitis?
```
Epidermal thickening
Exaggerated skin markings
Lichenificatin
Scaling
Less itching
```
109
What is the main symptom of acute contact dermatitis?
Itching
110
What are the two types of acute contact dermatitis?
Allergic and irritant
111
What is the itch-scratch cycle?
Irritation causes inflammation which causes itching which leads to scratching which causes more inflammation
112
Is irritant contact dermatitis immunologic?
No
113
How long does dermatitis occur after exposure to poison ivy?
24 to 48 hours
114
How long does dermatitis occur after exposure to an irritant?
Within a few hours
115
When can you use topical therapy to treat poison ivy?
If <10% BSA involved
116
When does poison ivy need to be referred?
If over a large area
117
What are some poison ivy treatment options?
Soaks
Calamine lotion
Topical/oral antihistamines
Topical/oral corticosteroids
118
What type of lesions are soaks best used for?
Oozing, weeping, crusting lesions
119
What goes in a soak?
Domeboro
Acetic acid
Saline
Water
120
What do corticosteroids do?
Anti-inflammation
Anti-pruritic
Suppress immune response
121
How often should topical corticosteroids be applied?
2 to 4 times a day for 3-14 days
122
How are corticosteroids classified?
Anti-inflammatory activity (Grade 1 = high, Grade 7 = low)
123
What can be done to increase penetration of corticosteroids?
Occlusion--plastic wrap and T-shirt, increase penetration x10
124
What are side effects of topical corticosteroids?
```
Thinning of skin
Dilated blood vessels
Bruising
Skin color changes
Risk of HPA suppression (long-term, high potency agents)
Tolerance
```
125
What are low potency corticosteroids?
Hydrocortisone
| Desonide
126
What are mid-potency corticosteroids?
Betamethasone
Triamcinolone
Mometasone
127
Where can mid-potency corticosteroids be used?
Most skin surfaces for exacerbations (short term)
| Avoid face
128
Where can high/very high potency corticosteroids be used?
NOT on face
129
How long can high potency topical corticosteroids be used?
2 weeks max
130
How many grams per week of topical corticosteroids can be applied?
50 grams
131
When are high potency corticosteroids used?
Psoriasis
132
What are high potency topical corticosteroids?
Fluocinolide
Halobetasol
Clobetasol
133
What potency of corticosteroids are calcineurin inhibitors equivalent to?
mid-potency
134
How do calcineurin inhibitors work?
Block pro-inflammatory cytokine genes
135
What is the side effect assoiated with topical calcineurin inhibitors?
Burning
136
Where can topical calcineurin inhibitors be used?
Anywhere
137
What is the black box warning for calcineurin inhibitors?
increased risk of infection <2 yo
| Risk of malignancies
138
Can calcineurin inhibitors be used chronically?
No
139
What is crisaborole ointment?
Phosphodiesterase Inhibitor
140
What is crisaborole ointment used for?
Mild or Moderate Acute dermatitis
141
How is crisaborole dosed??
twice a day for 28 days
142
What systemic therapy can be used for acute dermatitis?
Corticosteroids
Non-sedating antihistamines
Sedating anthistamines
143
What dosing for corticosteroids?
Prednisone 40-60 mg per day, taper every 3 days x 10-14 day minimum
144
What are the non-sedating antihistamines?
loratidine
Desloratidine
Fexofenadine
145
What are the sedating antihistamines?
Diphenhydramine
Cetirizine
hydroxyzine
Doxepine (Rx)
146
What is the most common form of eczema?
Atopic dermatitis
147
When does atopic dermatitis usually present?
Infancy
148
What is the atopic triad?
Atopic dermatitis
Allergic rhinitis
Asthma
149
What are the characteristics of atopic dermatitis?
```
Pruritis
Red papules/plaques
Scaling excoriations
Dry skin
Redness/inflammation
```
150
Where is atopic dermatitis located in infants?
Face
151
Where is atopic dermatitis located in chidlren?
Face, neck, arms, legs
152
Where is atopic dermatitis located in adults?
Hands, neck, flexor surfaces of arms and legs
153
What age group has the highest risk of skin infection from atopic dermatitis?
Children
154
What are common triggers of atopic dermatitis?
```
Allergens
Chemicals
Bathing
Detergents*
Smoke
Dust
Infections*
```
155
What are the steps in managing AD?
1. Non-pharmacological
2. Topical
3. Systemic
156
What are the non-pharmacological ways to manage AD?
Lukewarm baths, emolients
Eliminate irritants
Bleach baths
157
What topical therapy is used for AD?
Topical corticosteroids
| Calcineurin inhibitor therapy
158
What systemic therapy is used for AD?
Phototherapy
Oral immunosuppressant
Injectable biologic agents
159
What is Dupilumab?
Biologic used for moderate-severe AD
160
How is dupilumab administered?
300 mg SC q2weks
161
How do bleach baths help with AD?
They kill staph to prevent secondary staph infections
162
What causes stasis dermatitis?
Poor circulation
163
What are symptoms of stasis dermatitis?
Red, scaly, crusted plaques
Swelling/edema
Secondary infection/ulcers
Hyperpigmentation (retention of iron in skin)
164
How is stasis dermatitis treated?
Topical corticosteroids (itching)
Emollient
Oral antihistamines
Oral antibiotics for local infections
165
How is edema relieved?
Elevate feet/legs
Support stockings
Compressive bandages
166
How is chronic dermatitis treated?
Emollients
Avoid long-term corticosteroids
UV light
167
What is the cheapest option for treating dermatitis?
Oral corticosteroids
| Antihistamines
168
How long does treatment of fungal infections take?
4 weeks or longer
169
When should you refer for a fungal infection?
Systemic symptoms
| Patient is immunocompromised
170
What OTC products treat fungal infections?
Miconazole
Clotrimazole
Terbinafine
171
What Rx products treat fungal infections?
Nystatin
Ciclopirox
Ketoconazole
172
What does a fungal diaper rash look like?
It has satellite lesions
173
How can you treat diaper rashes?
```
Remove irritant (freq diaper changes)
Air dry
Keep clean
Antifungal/corticosteroids if it's a fungal diaper rash
Protectants!
```
174
What is seborrhic dermatitis?
Erythema (redness) with greasy yellow scaling--itchy
175
Where does seborrhic dermatitis occur?
Hairline, scalp, nose, neck, ears, back
176
What is the term for seborrhic dermatitis on infants?
Cradle cap
177
How do you treat cradle cap?
Baby oil + baby shampoo
178
How do you treat seborrhic dermatitis?
Medicated shampoo 2-3 times per week (OTC first, then Rx (higher strengths) if needed)
Topical corticosteroid--low strength
179
What should be used for seborrhic dermatitis on the ears and face?
Low strength topical corticosteroid
180
What are some seborrhic dermatitis medicated shampoos?
Pyrithione zinc, selenium, ketoconazole
181
What drugs exacerbate acne?
```
Androgenic steroids
Corticosteroids
Lithium
Anti-epileptics
Tuberculostatic drugs
OCs
```
182
What is a comedone?
Hair follicle plugged with sebum, eratin, and dead skin
183
What causes acne?
Keratinous obstruction of sebaceous follicle outlet
184
What bacteria grows in clogged sebaceous glands?
Propionibacterium
185
What causes the local inflammation in acne?
Bacteria convert TG to FFA
186
What are the non-inflammatory acnes?
Whiteheads
| Blackheads
187
What are the Inflammatory acnes?
Papules
Pustules
Ruptured contents
188
What causes blackheads to be black?
Melanin accumulates
189
What are the secondary lesions in acne?
Excoriations
Erythematous macules
Hyperpigmented macules
Scars
190
What are options for treating acne scarring?
Dermabrasion
Chemical peels
Laser resurfacing
191
What are the goals of acne therapy?
Long-term control
| Prevent scars
192
What are the four possible mechanisms of acne therapy?
Antimicrobial
Anti-inflammatory
Decreased sebum production
keratolytic/comedolytic
193
Which drug has strong activity in all four MOAs?
Isotretinoin
194
How does adapalene work?
It is keratolytic/comeodolytic, antimicrobial, and anti-inflammatory
195
What doe skeratolytic/comeolytic mean?
Inhibits development of additional lesions
196
How should ALL patients clean their face?
Twice a day with mild face soap, minimize products with irritation, tepid water (NOT HOT)
197
What is the first-choice therapy for comedonal, noninflammatory acne?
Topical retinoids (adapalene)
198
What is the first-choice therapy for mild-moderate, papulopustular inflammatory acne?
Adapalene + Benzoyl peroxide
| Clindamycin + BP
199
What is the first-choice therapy for severe papulopustular or moderate nodular acne?
Isotretinoin
200
What is the first-choice therapy for nodular or conglobate acne?
Isotretinoin
201
What is first-choice maintenance therapy?
Adapalene
202
What MOA is adapalene?
Retinoid
203
What MOA is tazorotene?
Retinoid
| Category X!
204
What MOA is tretinoin?
Retinoid
205
What MOA is Azelaic acid?
Antibacterial
Keratolytic
(Adjunct only!)
206
what MOA is clindamycin/erythromycin
Topical antibiotic
207
What MOA is benzoyl peroxide?
Antiseptic
Comedolytic/keratolytic
Anti-inflammatory
(bleaches)
208
What is the least expensive acne treatment?
Topical retinoid
209
What is the most expensive acne treatment?
Isotretinoin, anti-androgens, tazarotene
210
Which acne treatment has the most adverse effects?
Tretinoin
211
Why is adapalene ideal treatment?
It has minimal adverse effects
212
What are the potential adverse effects associated with acne treatments?
```
Erythema
Scaling
Burning
Flare
Resistance
```
213
Which class of drugs can cause resistance?
Antibiotics
214
What are the 2 combo products?
Clindamycin + BP
| Adapalene + BP
215
When is an oral antibiotic most effective?
When inflammation is present
216
What do oral antibiotics do for acne?
Decrease bacteria and inflammation
217
What is done to limit resistance of oral antibiotics?
Limit treatment to 6 weeks
| Rotate antibiotics
218
What oral antibiotics are used to treat acne?
```
Minocycline
Doxycycline
Erythromycin
Azithromycin
TMP/SMZ
```
219
What are side effects of oral tetracyclines?
Photosensitivity
Interact with OCs
Don't take with dairy/antacids
220
When should oral tetracyclines NOT be used?
In pregnancy--cause discoloration of teeth
221
Who is hormone treatment used for?
Females who's acne flares during menstrual cycle--decrases androgen production
222
What low-dose OCs are used for acne?
Ortho-Tri-Cyclen
| Estrostep
223
How do OCs prevent acne?
Non-androgenic progestins
224
What is spironolactone?
Hormone treatment--decreases androgen production in males (50-200 mg/day)
225
What are oral corticosteroids used for in acne?
Short course for highly inflammatory acne
226
What is isotretinoin derived from?
Vitamin A
227
How does isotretinoin work?
Reduces sebum production and shrinks sebaceous glands
228
How is isotretinoin dosed?
0.5-2mg/kg/day in 2 doses for 15-20 weeks
229
When can a second course of isotretinoin be used?
After 2 months off treatment if acne flares
230
What is an important counseling point with patients new to isotretinoin?
Acne will get worse before it gets better
231
What are side effects of isotretinoin?
```
Dry skin, eyes, everything
Photosensitivity
Aches and pains
Elevated AST/ALT
Elevated TGs and cholesterol
CATEGORY X (birth defects)
Mood changes
HA
```
232
What supplement should be avoided with isotretinoin?
Vit A
233
What is the iPLEDGE Program?
Program used to ensure female patients are not pregnant when taking isotretinoin--need 30 day supply only with a pregnancy test in between each refill
234
What causes rosacea?
Vascular instability
235
What characterizes rosacea?
Flushing, facial erythema, papules, pustules, telangiectasia
236
Do men or women get rosacea more?
Women
237
What is the most common subtype of rosacea?
Telangiectatic
238
What is telangiectatic rosacea?
Visibly dilated blood vessels
| Very red skin
239
What is papulopustular rosacea?
Resembles acne
240
What is phytmatous?
Enlarges sebaceous glands
Seen on nose
Males
241
What is ocular rosacea?
Watery, bloodshot eyes
242
What classes of drugs trigger rosacea?
```
Vasodilators*
Topical corticosteroids
Nicotinic acid
ACE inhibitors
Calcium channel blockers
Statins
```
243
What is treatment for mild rosacea?
Avoid triggers
Topical antibiotics
Topical retinoids
244
What is treatment for moderate rosacea?
Oral antibiotics
| Topical retinoids
245
What is treatment for severe rosacea?
Oral isotretinoin
| Laser treatments
246
What is the preferred topical antibiotic for rosacea?
Metronidazole (some burning/stinging, BID)
247
What are the topical antibiotics for rosacea?
Metronidazole
Clindamycin
Sulfacetamide and Sulfur
248
What does azelaic acid do?
Antibacterial
Comedolytic
anti-inflammatory
Better absorbed as Gel for Rosacea than acne formulation
249
What does brimonidine do?
Alpha-2 adrenergic agonist (vasoconstriction) for facial erythema
Cosmetic only!
250
What dosage forms does brimonidine come in?
Gel and ophthalmic drops (for ocular rosacea)
251
When is isotretinoin used for rosacea?
Rarely--only VERY severe cases
252
What is the lowest cost rosacea treatment?
Oral antibiotics
253
What causes psoriasis?
T-lymphocytes cause keratinocyte proliferation--7x more rapid skin growth than normal
254
Symptoms of psoriasis?
Thickened, red patches covered by silvery-white scales
255
What does the early stage of psoriasis look like?
not scabby/scaly--more like rash
256
What is plantar psoriasis?
On the bottom of the foot
257
What is psoriatic arthritis?
Rash on joints, follow by arthritic pain
258
What is guttate psoriasis?
Usually in children/young-adults
| Small, pink/red spots on trunk, upper arms, thighs, scalp
