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Treatments > Dermatology - Acne, Rosacea, Psoriasis > Flashcards

Dermatology - Acne, Rosacea, Psoriasis Flashcards

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1
Q

What do you treat mild acne?

A

topicals

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2
Q

What do you treat moderate acne?

A

topical and or oral ABX

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3
Q

What do you treat severe acne with?

A

oral isotretinoin

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4
Q

What are acne topicals for oily to normal skin type?

A

gels, solutions, lotions

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5
Q

What are acne topicals for normal skin?

A

gels, solutions, lotions, creams

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6
Q

What are acne topicals for normal to dry skin?

A

lotions, creams

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7
Q

What are pt issues for topicals?

A

bleaching, odor, irritation

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8
Q

What is the most common trigger for acne in females?

A

Hormonal - androgens

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9
Q

What are environmental issues for acne?

A

diet, location, mechanical pressure, season, stress

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10
Q

What is salicyclic acid useful for?

A

self-treatment of small blackheads

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11
Q

Why do pt use salicyclic acid first when not first line treatment?

A

available OTC

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12
Q

What does salicylic acid do?

A

increases sloughing of skin, mildly irritating

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13
Q

What is benzoyl peroxide useful for?

A

superficial inflammatory acne

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14
Q

What does benzoyl peroxide do?

A

increases sloughing of epithelium and loosens follicular plug
NOT an antibiotic

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15
Q

What is the process of acne?

A

hyperproliferation of ductal epidermis, increased sebum, propionibacterium acne, inflammatory

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16
Q

What are the different forms of benzoyl peroxide?

A

soaps, washes, creams, gels, lotions

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17
Q

What products work against abnormal kertinization of follicle in acne?

A

salicylic acid, benzo peroxide, topical retinoidsm isotretinoin

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18
Q

What product works for abnormal sebum in acne?

A

antiandrogens, isotretinonsm, oral or topical ABX

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19
Q

What are the adverse effects of benzoyl peroxide?

A

dryness, redness, peeling

may bleach hair and clothing

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20
Q

What is the starting dose for benzoyl peroxide?

A

2.5 or 5% and every other day

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21
Q

What are retinoids?

A

vit A derivities

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22
Q

What do retinoids do?

A

epithelial differentiation dependent on vit A, increases cell turnover

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23
Q

What are the formations of retinoids?

A

gel or cream

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24
Q

What are the adverse effects of retinoids?

A

burning, stinging, scaling, photosensitivity

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25
What are the retinoid products?
tretinoin, adapalene, tazarotene
26
What does tretinoin do?
decrease layers of stratum corneum from 14 to 5, lessens wrinkles and scars
27
What is the first line retinoid?
adapalene
28
What is the most effective retinoid and what is bad about this?
tazarotene - preg cat X
29
What is azelaic acid?
antibacterial against P acnes and s epidermis, anti-inflammatory
30
What does azelac acid helpful for?
hyperpigmentation due to inflammation
31
What are the formulations of azelaic acid?
cream, gel, foam
32
What are the adverse effects of azelaic acid?
burning, itching, stinging
33
Why is oral abx not first line for acne?
issues with resistance as well as long-term exposure
34
What are the oral abx used for acne?
tetracycline, doxycycline, minocycline
35
What are the problems with ABX with acne?
cannot use under age 8 photosensitivity tetracycline must be taken on empty stomach minocycline - hyperpigmentation, toxic hep, drug induced lupus give with lots of fluids because cause esophageal irritation
36
What is isotretinoin?
vit A metabolite
37
What does isotretinoin cause?
decreased sebum production, inhibit growth of p acne, decrease inflammation
38
What is the preg cat for isotretinoin?
preg cat X, requires IPledge program
39
What are the side effects of isotretinoin?
``` Depression Drying of mouth, eyes, skin, nasal mucosa Inflammation of lips Hypertriglyceridemia Alopecia Muscle and joint pain Photosensitivity ```
40
What is the only isotretinoin that does require to be given with food?
Absorica
41
How long is isotretinoin given?
5 months
42
What is first line for comedonal, noninflammatory?
something that will induce exfolitation - retinoids - BPO - azelaic acid
43
What are first line tx for mild to moderate papulopustular inflammatory acne?
decrease p acnes in follicle - adapalene + BPO - oral abx + adapalene
44
What is the first line for severe papulopustular, nodular acne or conglobate?
oral isotretinoin
45
What are the types of rosacea?
erythematotelangiectatic papulopustular phymatous ocular
46
What is rosacea that has flushing and spider viens?
erythematotelangiectaticc
47
What are rosacea with thickening of skin and overgrowth of blood vessel?
phymatous
48
What is roseacea with redness with bumps and pimple-type lesions?
papulopustular
49
What is rosacea with redness of eye with dryness, tearing, burning and swelling?
ocular
50
What are the topical treatment options for rosacea?
``` Sulfacetamide/sulfur Metronidazole Azelaic acid Ivermectin Brimonidine ```
51
What are the oral treatments for rosacea?
ABX and isotretinoin
52
What is first line tx of papulopustular roacea?
``` metronidazole (MetroGel) applied once a day anti-inflammatory effects Azelaic acid (Azelex) bid, more expensive ```
53
What are the adverse effects of?
facial burning, stinging, itching
54
What is the efficacy of sulfacetamide or sulfur?
limited, cannot use with sulfa allergy
55
What is ivermectin (soolantra) used for only?
papulopustular rosacea
56
What is the features of ivermectin?
applied once a day, possibly more effective than other two, kills skin mites and anti-inflammatory, expensive
57
What is the alpha 2 receptor agonist for rosacea?
brimonidine (Mirvaso), only good for erythema, expensive
58
What are oral abx for papulopustular rosacea and erythema (but not spider veins) in erythematotelangiectatic rosacea?
Doxycycline, TMP/SMX, erythromycin, metronidazole, ampicillin, clindamycin, dapsone
59
How long do you give oral ABX for rosacea?
12 weeks then switch to topical, give low dose
60
What is the rate limiting step to topical absorption?
thickness of stratum corneum
61
What factors affect topical absorption?
hydration, formulation, applying more does not increase how quick absorbed
62
What is the formulations from most absorbative to lease?
gels> ointment > cream
63
Why do gels have alcohol in them?
increase penetration, dry quickly, drying or stinging, drug is well dispersed
64
What are most occlusive but also greasy?
ointments
65
What is fingertip unit?
one fingertip = 500 mg, enough to cover front and back of hand
66
How many fingertips are needed to cover trunk front and back?
15
67
Where are low dose steroids used?
thin stratum corneum and for limited time
68
What is mid and high potency used in adults?
average or thick stratum corneum
69
How long do you use steroid?
2-4 wks then taper to prevent flare
70
What are the adverse effects of steroids?
Skin: atrophy, telangiectasia, striae distensae, acne, folliculitis, and purpura Exacerbation of rosacea, fungal infections Rebound Systemic effects rare but possible
71
What are class 1 superpotent topical steroids?
betamethazone diproprionate 0.05% | Clobetasone propionate lotion/spray/cream/shampoo
72
What are class 2 potent topical steroids?
betamethasone diproplionate 0.05 Desoximetazone0.25% fluocinonide0.05%
73
What are class 3 upper mid strength topical steroids?
betamethasone valerate fluticasone propionate mometasone furoate triamcinolone acetonide
74
What are some vit D analogs?
Calcipotriene (Dovonex) | Calcipotriene/betamethasone dip (Enstilar, Taclonex)
75
What do vit D analogs do?
inhibit keratinocyte proliferation and improve differentiation
76
What are the adverse effects of vit D analogs?
Burning, stinging, redness, itching, peeling, drying – diminish over time Systemic absorption is a concern only in doses over 100 g per week Calcipotriene inactivated by UVA
77
What is the goeckerman regimen?
coal tar + UV light
78
What does coal tar do?
suppress DNA synthesis, decrease cell division
79
What are problems with coal tar?
otc varies quality staining odor irritation
80
What are calcineurin inhibitors and their characteristic?
Tacrolimus and pimecrolimus good for thinner skin, must be occluded to work on thick plaques stops activation of T cells black box warning of malignancy
81
What is anthralin?
tx for psoriasis not as good as steroids or vit D unknown patho causes stinging, skin staining
82
What is the mot effective when used along with topical steroids for psoriasis?
tazarotene
83
Can you use salicylic acid on kids?
NO
84
What is the best evidence treatment for psoriasis?
Monotherapy with topical corticosteroid, vitamin D analog, or tazarotene Combinations Topical corticosteroid + vitamin D analog Topical corticosteroid + tazarotene
85
What does steroids do?
itching, redness, inflammation reduction
86
What are some other strategies of psoriasis treatment?
Monotherapy with tacrolimus, pimecrolimus, coal tar Combinations Topical corticosteroid + salicylic acid Tacrolimus + salicylic acid
87
When is phototherapy contraindicated?
pt with lupus or xeroderma pigmentosum
88
What is the traditional systemic therapy for psoriasis?
methotrexate
89
What is the most effective systmeic therapy for psoriasis?
cyclosporine
90
What is the least effective systemic therapy and used with phototherapy?
acetretin
91
What are the risks of methotrexate use?
hepatotoxicity, bone marrow suppression
92
When is methotrexate contraindicated?
pregnancy, renal or hepatic impairment, presence of leukemia or thrombocytopenia
93
What are the cyclosporines used for psoriasis?
Gengraf, neoral, sandimmune
94
What do cyclosporines do?
inhibit production and rlease of IL 2, inhibit activation of resting T lymph
95
What are the risks of cyclosporine?
HTN, lymphoma, cutanoeous malignancies, structural kidney disease
96
What are the contraindications of cyclosporine?
uncontrolled HTN, renal dysfunction, concomitant tx with MTX, PUVA, UVB, coal tar, radiation or immunosuppressant
97
What are the contraindications for acetretin (soriatane)?
``` females who are pregnant who might become preg in 3 years severe liver or kidney disease uncontrolled dyslipidemia use of MTX or tetracycline ETOH use ```
98
What are the other biologics used for psoriasis?
``` Adalimumab (Humira) Certolizumab pegol (Cimzia) Etanercept (Enbrel) Golimumab (Simponi) Infliximab (Remicade) Ixekizumab (Taltz) Secukinumab (Cosentyx) Ustekinumab (Stelara) Apremilast (Otelza) ```

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