Dermatology Flashcards
Characteristics to consider when choosing a particular vehicle?
Solubility of active drug
Ability to hydrate stratum corneum
Stability of drug in vehicle
Ability to retard evaporation from the skin (least with tinctures)
Baths Characteristics
Completely water soluble
Colloidal
Soothing
Lotions Characteristics
Mostly water
Evaporation gives cooling action
Vasoconstriction decreases inflammation
Gel Characteristics
Semi-solid colloidal solutions and suspensions
Contain alcohol
Enhance absorption through the skin
Powder Characteristics
Absorbent
Can cause crusting
Aspiration
Caution with corn starch (can cause yeast infection or worsen)
Sometimes can have anti-fungal qualities like Nystatin
What is a disadvantage for use of powder in babies and elderly?
Aspiration that can lead to pneumonitis
Paste Characteristics
Thick ointment containing powder
very adhesive
Don’t need to put on additional addressing (sometimes have to, to keep in place)
Not commonly used
Creams Oil in Water Characteristics
Mix with serous discharges (primarily aqueous)
Washable
Will not stain clothing
Creams Water in Oil Characteristics
Vehicle for fat-soluble substances
Do not mix with serous discharges
Ointment types and characteristics
Water-soluble:
Improve penetration of drugs
PEG (poly ethanol glycol)
Emulsifying:
Mix with water and exudate
Allows for more uniform penetration in the area being treated
Non-emulsifying:
Occlusive dressing, enhance hydration, can help with faster wound healing
Atopic Dermatitis Treatment Options
- Reduce contact with irritants (soap substitutes)
- Reduce exposure to allergens
- Emollients
- Topical Steroids
- Antihistamines
- Antibiotics (a last resort, when start seeing a secondary infection)
- Steroid sparing
- Other (herbals, soaps)
How to reduce contact with irritants
Avoid overheating: lukewarm baths, 100% cotton clothes, & keep bedding to minimum
Avoid direct skin contact with rough fibers, particularly wool, & limit/eliminate detergents
Avoid dusty conditions & low humidity
Avoid cosmetics (make-ups, perfumes) as all can irritate
Avoid soap- use soap substitute
Use gloves to handle chemicals and detergents
Soap Substitutes
Cetaphil- soap substitute- far less drying and irritating than soap
Cleansing & moisturizing formulations, all OTC
Lotion, bar, ‘soap’, cream, sunscreen
(Costs about $8-9 for 16 oz.)
Emollients
Soften the skin and reduce itching.
Moisture trapping effectiveness from best to least
Best: Oils (e.g. Petroleum Jelly)
Moderate: Creams
Least: Lotions
When do you apply emollients?
after bathing and times when the skin is unusually dry (e.g. winter months).
How to Use Emollients Oils
Consider using bath oil or mineral oil-based lotions in lukewarm bath water
Add to tub 15 minutes into bath
Corticosteroid Forms and Common Use
Topical steroids very effective
Ointments for dry or lichenified skin
Creams for weeping skin or body folds
Lotions or scalp applications for hair-areas.
How to use Cortcosteroids
Once under control, intermittent use of topical corticosteroid may prevent relapse
Systemic steroids may bring under rapid control, but may precipitate rebound
Once daily probably most cost effective
When is antibiotics use acceptable for eczema
When secondarily colonized with bacteria.
Use oral antibiotics in recalcitrant or widespread cases.
Usually only need a weeks worth
Antihistamine use
Oral antihistamines can reduce urticaria & itch
Non-sedating antihistamines less side effects but more expensive
Alternative medications some patients may use for eczema
Licorice Calendula Echinacea Golden Seal Nettle Oats
What type of soap is recommended for derm?
mild or hypoallergenic
Which brand of soap is the worse?
Pure Ivory is very drying and irritating
Diaper Dermatitis: usual pathogen and risks?
Irritant dermatitis usually caused by Cutaneous Candidiasis infection (C. Albicans )
Risks: areas where warmth and moisture lead to maceration of skin or mucous membranes
Diaper Dermatitis Clinical Presentation
Pruritus, pain
Erythematous papules/vesicles, edema
Satellite lesions to peri-genital, peri-anal, inner thigh, buttocks
Diaper Dermatitis Management
Topical antifungal agents such as nystatin, miconazole, or clotrimatzole (“no good reason to use a systemic antifungal”)
Topical corticosteroids (can possibly increase severity)
Educate care givers
Pimercrolimus (Elidel) and Tacrolimus (Protopic) MOA and Indication
Inhibit inflammatory cytokine release
Minimal systemic immunosuppression
Indicated for atopic dermatitis and contact dermatitis
Alternative to corticosteroids
Imiquimod (Aldara) MOA and Indication
Immunomodulator
Treatment of external genital and perianal warts and actinic keratitis
Stimulates peripheral mononuclear cells to release interferon alpha
Stimulate macrophages to produce interleukins and TNF alpha
*can be used for Molluscum
Topical Antivirals Names and Indication
Acyclovir (Zovirax)
Pencyclovir (Denavir)
Treatment of Herpes
What do you have to be careful with when using topical antivirals for herpes?
If the vesicles burst after application of the med, then you are helping spread of the herpetic infection
What are the species of Pediculosis?
Infestation by human lice
Pediculosis capitis-head
Pediculosis corporis-body
Pediculosis pubis- pubic or crab
Pediculosis symptoms
Pruritis and Excoriation
Pediculosis is a vector for what other diseases
Typhus
Recurrent Fever
Pediculosis Capitis Treatment
Pediculicides Hand pick or comb nits out Launder bed linens & vacuum Seal items in plastic bags for 14 days Repeat above in 10-14 days
Pediculosis Capitis Etiology and Signs
More common in women
Sides and back of scalp
Assess for
Visible white flecks (nits)
Matting and crusting of scalp
Foul odor
Pediculosis Corporis Etiology and Signs
Lice live and lay eggs in clothing
Itching
Assess for excoriation on:
Trunks
Abdomen
Extremities
Pediculosis Pubis Characteristics
Intense pruritis Vulvar region Peri-rectal More compact Crab-like appearance
Pediculosis Pubis Etiology and other areas that may be effected
Contracted from:
Infested bed linens
Sexual intercourse
May also infest:
Axilla
Eyelashes
Chest
Pediculosis Pubis Treatment
Chemical killing Clean linens with hot water and soap Dry-clean Fine-tooth comb Treat social contacts
Pediculosides Drugs
Lindane (not in California)
Hepatotoxic and neurotoxic
Permethrin (Nix)
Scabies Etiology
Contagious skin disease Mite infestation Transmitted by close-prolonged contact with Infested companion Infested bedding
Scabies is characterized by
Epidermal curved or linear ridges
Follicular papules
Pruritus Palms
More intense and unbearable at night
White visible epidermal ridges by mite burrowing into outer layers of skin
Scabies Clinical Findings
Hypersensitivity reaction
Excoriated erythematous papules
Pustules, crusted lesions: Elbows Axillary folds Lower abdomen Buttocks, thighs Between fingers Genitalia
Scabies Treatment
Topical sulfur preparations Crotamiton (Eurax) Permethrin 5% (Elimite) Launder personal items No disinfectant
Acne Types
Comedones (keratin plugs in sebaceous duct opening)
Papules
Pustules - MC
Nodules
Cysts
Scars
(last 3 are more common in adults and more severe)
Acne Pathogens
Propionibacterium acnes
Staphylococcus spp.
Androgenic stimulation of sebaceous gland
Acne Treatment
Keratolytics:
Benzoyl peroxide
Selenium sulfide
Acne Cyst Treaments
Retinoic acid derivatives (a keratolytic):
Tretinoin (Retin-A) - topical
Isotretinoin (Accutane) –oral
What must be done for someone to be able to use
Isotretinoin (Accutane)
Restricted distribution system (iPLEDGE program)
Numerous side effects
Acne Antibacterial Topical Treatments
erythromycin
clindamycin (Cleocin)
Azelaic acid (Azelex, Finacea)
Acne Antibacterial Oral Treatments
tetracyclines
erythromycin
Rosacea Treatment
Azelaic acid
Metronidazole
Psoriasis Topical Treatment
Keratolytics (those that are more potent than benzoperoxide):
Coal tar
Salicylic acid
Corticosteroids (potent) - penetrate through stratum cornea and go to dermal infiltrate
Psoriasis Systemic Treatment
Corticosteroids
Methotrexate
Hydroxyurea (Hydrea)- was a chemotherapeutic agent
Cyclosporine (decreases infiltration of inflammatory cells)
Infliximab (Remicade)
Mild Psoriasis Treatment
Topical (keratolytics, corticosteroids)
Phototherapy
Mild psoriatic arthritis Treatment
NSAIDs
Intra-articular injections of corticosteroids
Moderate to severe psoriasis and psoriatic arthritis Treatment
DMARDs: Methotrexate Cyclosporine Gold Antimalarials
Systemic corticosteroids - in more sever cases, MC is prednisone
Biologics
Criteria for Using Biologics
18 years or older
Moderate to severe psoriatic arthritis AND:
At least one comorbidity
Inadequate control with DMARD alone
Failed other therapies
No active infection
Normal liver function
Psoriasis T-Cell Inhibitor Biologics
Alefacept (Amevive)
Efalizumab (Raptiva)
Psoriasis TNF Inhibitor Biologics
Etanercept (Enbrel)- Injection
Adalimumab (Humira)- Injection
Infliximab (Remicade) -IV
What is a precaution for use of TNF inhibitors?
TNF inhibitors have been associated with the development of blood cancers, so advise pt about this possible problem.
Always check lymph nodes during exam.
What glucocorticoid steroid potency can you apply on the face?
Want to make sure only mild corticosteroid is used on the face, no more than .5%
Sunscreens strength
Filter UVA and UVB
Mild (<10)
Moderate (10-15)
Strong (>15)
List the potency of the following glucocorticoids: Hydrocortisone Triamcinolone Desonide Mometasone
Hydrocortisone - mild
Triamcinolone- intermediate
Desonide- potent
Mometasone- ultra potent
Hair Loss Drug Options
Minoxidil (Rogaine):
Vasodilatation
Effect not predictable or permanent
Finasteride (Propecia)
What potency of glucocorticoid is used for psoriasis?
Potent and Ultra Potent
Fungal Skin Infection Topical Treatment Options
Clotrimazole (Mycelex)
Miconazole (Monistat)
Terbinafine (Lamisil) - also good for onychomycosis
Ketoconazole (Nizoral) - also available as shampoo
Tolnaftate (Tinactin)
Nystatin (Mycostatin)
Fungal Skin Infections Systemic Treatment
Ketoconazole (Nizoral)
Itraconazole (Sporanox)
Terbinafine (Lamisil)- also good for onychomycosis
Griseofulvin (Grisactin)
What is an ADE of both Terbinafine and Griseofulvin
Hepatotoxicity
