Flashcards in Exam 3 dermatological therapeutics Deck (71):
What is drug delivery dependent on?
Skin type, skin condition, lipid vs. water-based vehicle, charge, concentration gradient
What is the rate limiting step of topical therapy absorption?
The stratum corneum
What increases absorption of topical treatments through the skin?
Hydration of the skin
What are the actions of corticosteroids?
Anti-inflammatory, immunosuppressive, anti-proliferative, vasoconstrictive
What can corticosteroids be used for?
eczema, contact dermatitis, psoriasis, itch, lichen planus
What are adverse side effects of corticosteroids
Skin atrophy (thinning), striae, acne, suppression of the HPA (hypothalamus, pituitary, adrenal) axis
Explain the levels of corticosteroid strength
1 is for very thick skin, 7 is for very thin skin and babies
What are retinoids in terms of their background?
vitamin A analoges
How do retinoids work?
working through nuclear receptors on DNA causing alteration of gene transcription
What is the action of retinoids?
regulate cell growth, inhibit carcinogenesis, alter enzymes involved with cellular differentiation
What can retinoids be used for?
acne, psoriasis, cosmetic skin improvement (reduction of fine wrinkles and pigmentation)
What are the side effects of retinoids?
dryness, irritation, sun sensitivity
What is calcipotriene
Vitamin D analog that acts through DNA receptors to alter skin differentiation
What are the uses for calcipotriene
psoriasis (localized), eczema
What are side effects of calcipotriene?
irritation, increased serum calcium
What are topical antimicrobials used for?
wounds, acne, fungal infections, rosacea
What do non-steroidal anti-inflammatories (topical calcinuerin inhibitors) work through?
calcineurin to alter T-cell activation
What are the uses for non-steroidal anti-inflammatories (topical calcinuerin inhibitors)
Eczema around the eyes, dermatitis
What sun rays are the best to block for sunscreen?
UVA and UVB
What new sunscreens help to block UVA rays?
avobenzone/helioplex or mexoryl
What is so special about titanium and zinc oxide for blocking sun rays?
they stay on the skin and do not get absorbed so they block longer
How does Imiquimod/aldara cream work?
increase local immune activity through toll receptors
What is imiquimod used for?
condyloma, actinic keratosis, BCC, common warts, molluscum, in situ cancer
what can topical 5-fluorouracil be used for?
actinic damaged skin cells; actinic keratosis,
How does 5-flourouracil work?
inhibits thymidylate synthase resulting is reduced DNA synthesis
How do systemic retinoids work?
by repairing disordered keratinization
What can systemic retinoids be used for?
acne, psoriasis, ichthyosis, Darier's disease, chemoprophylaxis of skin cancer
What are two systemic retinoids?
What are side effects of systemic retinoids?
teratogenicity (don't use during pregnancy), depression, arthralgia, hair loss
What labs should be ordered with retinoids?
Lipids, LFT, HCG
What kind category is dapsone in?
What can dapsone be used for
Leprosy therapy, dermatitis herpetiformis, linear IgA disease, bullous lupus, Sweet's syndrome, spider bites
How does dapsone work?
inhibits myeloperoxidase in PMNs (affects CD11a/CD18)
What are the side effects of dapsone?
Hemolysis in people with G6PD deficiency
What labs should be done before Rx dapsone?
What is the action of methotrexate?
Dihydrofolate reductase inhibitor that disrupts DNA synthesis to block cell division
What can methotrexate be used for?
extensive psoriasis, CTCL, lupus
Side effects of methotrexate
hepatotoxicity, myelosuppression, pneumonitis
Labs to order before Rx methotrexate
CBC, LFT, Liver biopsy
What can biological therapies be used for?
psoriasis, psoriatic arthritis and rheumatoid arthritis
What proteins do Biological therapies target?
TNF and IL12 and IL23
What can oral antibiotics be used for?
acne, folliculitis, cellulitis, rosacea, wound infection
What can anti-vitals be used for?
HSV infection, cold sores, zoster
What can antifungals be used for
Ring worm, athletes foot, infected foot
What are some miscellaneous therapies that can be used for different derm disorders?
UV light (psoriasis, eczema, inflammatory), Minoxidil, finasteride, Liquid nitrogen (some keratoses)
what can UV light therapy be used for?
psoriasis, pruritis, eczema, CTCL
What is minoxidil used for?
What is the action of minoxidil?
vasodilation and direct stimulation of hair shaft growth
What is finasteride used for?
What is the action of finasteride?
Blocks 5-alpha reductase enzyme in follicles to inhibit the conversion of testosterone to dihydrotestosterone
What can liquid nitrogen be used for?
Warts, actinic keratoses, skin cancer
What are the three cycles of hair cycle?
Anagen, catagen, telogen
What typically causes scarring alopecia?
What causes androgenetic alopecia
Genetically determined miniaturization of follicles triggered by androgens
What are treatments of androgenetic alopecia?
minoxidil, finasteride, hair transplants
What causes telogen effluvium
Major stressors disrupting growth cycle of hairs causing premature shift to telogen
What causes alopecia areata
Autoimmune disease where T-cells attack hair bulb
What is treatment of alopecia areata?
What does alopecia areata look like?
Circular patches on scalp or beard. Totalis= all scalp hair lost. Universalis= all body hair lost. Looks like that basketball player who KG called a cancer patient.
What causes secondary alopecia?
Chemotherapy, meds, thyroid disease, iron deficiency, nutritional disorders, renal or hepatic failure
What usually causes tinea capitis?
What is the treatment for tinea capitis?
Oral Grisofulvin, possibly terbinifine or itraconazole
What form of lupus causes hair loss?
Discoid lupus of the scalp can destroy hair units
Treatment of discoid lupus?
What is pediculosis?
Head lice and pubic lice
What is the treatment for pediculosis?
Permethrin, vaseline for eyelids, cetaphil cleansear, Remove nits, wash bedding and clothes
What is paranychia?
inflammation of the nail folds
What causes causes acute paranychia?
trauma, bacteria, contact dermatitis, acute eczema flair
What causes chronic paranychia?
contact dermatitis, eczema, psoriasis, candida
What organisms cause onychomycosis (tinea unguium)
T. rubrum, T. mentagrophytes