Dermatology Flashcards

(51 cards)

1
Q

Topical Retinoids Examples

A
  1. Tretinoin/Retin-A - 1st gen

2. Adapalene/differin - 3rd gen

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2
Q

Oral Retinoids examples

A

isotretinoin/accutane - 1st gen

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3
Q

what are Retinoids?

A

vitamin A derivatives

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4
Q

special considerations with Accutane/Isotretinoin

A
  1. extremely teratogenic (category X) - causes craniofacial abnormalities, CNS structural malformations, cardiovascular abnormalities
  2. need to be part of iPledge program to prescribe and take - can only give 30 days at a time
  3. should avoid pregnancy for 3 years after acitretin is discontinued
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5
Q

general Retinoids MOA

A

increase growth factors –> causes epidermal hyperplasia and thickened skin –> subsequent desquamation and peeling of skin

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6
Q

Isotretinoin/Adapalene Indications

A
  1. acne

2. photoaged skin

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7
Q

Indications for retinoids in general

A
  1. acne
  2. photoaged skin
  3. severe psoriasis not responsive to other treatments
  4. cutaneous T cell lymphoma
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8
Q

Retinoids CI

A
  1. pregnancy - must have extensive conversation

2. tetracycline coadministration - risk of increased intracranial HTN

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9
Q

who are you most concerned about pseudotumor cerebri? how does it present?

A
  1. females, early adolescents to 20s - taking oral retinoids and tetracycline
  2. new onset headache and blurred vision
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10
Q

Retinoids MOA in acne

A
  1. decreases sebum secretion and sebaceous gland size
  2. reduces abnormal follicular epithelial differentiation and desquamation
  3. reduces comedogenesis (comedone is blackhead)
  4. reduces colonization of proprioibacterium
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11
Q

Retinoids MOA in photoaged skin

A

partial restoration of markedly reduced levels of collagen

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12
Q

instructions on how to take oral retinoids

A
  1. take with meals, fatty foods to increase absorption

2. take will full glass of water

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13
Q

Retinoids metabolism

A

liver

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14
Q

Retinoids SE

A
  1. mucocutaenous side effects
    - cheilitis
    - xeroderma
    - skin peeling
    - sicca (dry eyes)
    - epistaxis
  2. myalgias
  3. photosensitivity
  4. depression / changes in mood
  5. hyperostosis (excessive bone growth) after 5 years of treatment
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15
Q

Retinoids patient education

A
  1. side effect of dryness is common, would expect to see it
  2. combat w/ lip balm, vasaline, eye drops, sugarless candy, saline nasal spray
  3. may get worse before you get better
  4. don’t donate blood if taking oral isotretinoin
  5. pregnancy
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16
Q

Retinoids less common SE

A
  1. reversible increase in liver enzymes
  2. elevated cholesterol
  3. transient loss of color or night vision
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17
Q

Retinoids rare SE

A
  1. pseudotumor cerebri
  2. psychosis
  3. IBD
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18
Q

labs to do with isotretinoin

A

baseline LFTs and follow every 1-2 months

urine pregnancy test monthly

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19
Q

keratolytic examples

A
  1. alpha hydroxyl acids
  2. salicyclic acid
  3. benzoyl peroxide (mild) - Benzac
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20
Q

keratolytic MOA

A

break down keratin in skin

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21
Q

keratolytic indications

A
  1. acne (mild keratolytics)
  2. hyperkeratotic lesions - warts, psoriasis, eczema
  3. cosmetic - chemical peels
22
Q

keratolytic CI

23
Q

benzoyl peroxide MOA

A

oxidizes bacterial proteins and deceases anaerobic bacteria in follicles

24
Q

keratolytic formulations

A
  1. cream
  2. ointment
  3. plasters
25
what percentage does salicyclic acid start to become destructive to tissue
6%
26
how to apply plasters
1. apply for 4-5 days and then removed | 2. occlusive dressing is commonly applied over topical agent to prevent it from being washed away, increases absorption
27
keratolytic SE
1. local skin irritation - redness, itching, tenderness 2. salicyclic acid toxicity (esp children) 3. hyperpigmentation if high concentration
28
Topical steroid examples
1. Betamethasone | 2. Tramcinolone
29
Topical steroid indications
1. psoriasis 2. atopic dermatitis 3. seborrheic dermatitis 4. contact or irritant dermatitis
30
Topical steroid CI
active infection in skin (may cause impetigo)
31
Topical steroid MOA
anti-inflammatory effect, vasoconstrictive effect | - inhibits phospholipase A2 --> no arachidonic acid --> no prostaglandins or leukotrienes
32
areas on body with thinner skin
face, axilla, groin
33
Things that impact absorption of Topical steroid
1. occlusive skin covering - increase 2. inflammation - increase 3. exfoliative skin - decrease
34
Topical steroid potency
1. graded on scale from 1 to 7 with 1 being most potent | 2. most use low, medium, high, very high potency
35
Topical steroid formulations
ointments, creams, lotions, gels, foam
36
general info/pros/cons of Topical steroid ointments
general - water suspended in oil, apply 2-3x per day after skin has been moistened pros - greatest absorption, good for dry lesions b/c form water barrier (occlusive effects) cons - greasy and not useful on hairy areas
37
general info/pros/cons of Topical steroid creams
semisolid emulsions in 20-50% water pros - not greasy, easy to use if area is exposed or frequently touching cons - less potent than ointments
38
general info/pros/cons of Topical steroid lotions
general - powder in water formulations pros - useful in hairy areas and large areas, evaporate and provide cooling and drying effect so good for moist lesions cons - least potent
39
general info/pros/cons of Topical steroid gels
general - oil in water emulsion w/ alcohol in base, liquify on contact with skin pros - not greasy, useful for hair covered areas
40
general info/pros/cons of Topical steroid foams
general - pressurized collections of gaseous bubblies in liquid film pros - spread readily, easy to apply
41
Topical steroid SE
1. skin atrophy - w/in 2 weeks if high potency 2. telangiectasia 3. ecchymosis 4. striae 5. hypertrichosis (increased hair) 6. redness 7. pigmentation changes
42
Topical steroid systemic SE
1. adrenal suppression 2. Cushing's syndrome 3. Na retention 4. HTN 5. mood changes 6. glaucoma
43
sites to use low potency steroids
face, genitals, axilla, neck | children!
44
duration goal or steroid treatment
<3 weeks
45
imiquimod / Aldara indications
1. genital and perianal warts resistant to conventional therapy 2. actinic keratosis 3. basal cell carcinoma
46
imiquimod / Aldara MOA
1. enhances immune system and stimulates response against abnormal skin cells 2. increases release of interferon, TNF, interleukins 3. activates macrophages, Langerhans cells 4. induces proliferation and maturation of B lymphocytes 5. enhances NK cell activity
47
imiquimod / Aldara CI
none
48
imiquimod / Aldara SE
1. local skin reaction - burning, stinging, itching, redness, swelling 2. long term skin reactions - pigmentation changes 3. skin blistering, flaking, crusting, open sores 4. systemic reactions - fatigue, diarrhea, flu-like symptoms, HA
49
next step if actinic keratosis does not respond to treatment with imiquimod / Aldara
biopsy to ensure no carcinoma
50
first line treatment for warts
1. ablation ie. cryoablation using liquid nitrogen - apply for 10-20 seconds
51
5 characteristics that increase the probability that lesion is squamous cell carcinoma
1. hyperkeratosis - raised 2. full thickness 3. surrounding induration 4. surrounding erythema 5. tenderness