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Dermatology 2 > Pharm - Hair and Nails > Flashcards

Pharm - Hair and Nails Flashcards

1
Q

clinical presentation of alopecia areata

A
  • chronic, relapsing immune-mediated inflammatory disorder
  • affects hair follicles resulting in nonscarring hair loss
  • from small patching to complete loss
  • MC in < 20 but can happen at any age
  • M=F
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2
Q

fist line tx for alopecia areata

A

corticosteroids

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3
Q

what is the preferred route of administration for corticosteroids in the tx of alopecia areata?

A

intralesional

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4
Q

preferred pretreatment before intralesional corticosteroid injections

A

topical anesthetics

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5
Q

max dose of triamcinolone (injectable steroid) per tx session for alopecia areata

A

40 mg per tx session

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6
Q

ADRs of injectable and topical steroids

A
  • local skin atrophy
  • telangiectasia
  • hypopigmentation
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7
Q

expected clinical response to injectable steroids

A
  • new growth visible w/i 6-8 weeks

- if no response after 6 mos, dc tx and use alternative

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8
Q

role of potent topical steroids in the tx of alopecia

A

-for children and adults who cannot tolerate intralesional injections

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9
Q

place in therapy for topical immunity

A

for pts w/ extensive or recurrent scalp involvement

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10
Q

general mechanism of topical immunity

A
  • potent contact allergy applied weekly to scalp precipitates allergic contact dermatitis
  • the mild inflammatory rxn is associated w/ hair regrowth
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11
Q

what are the topical immunity products used for alopecia

A
  • diphenylcyclopropenone (DPCP)
  • squaric acid dibutyl ester (SADBE)
  • dinitrochlorobenzene (DNCB)
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12
Q

admin process of topical immunity for alopecia

A
  • application of solution to a small area to sensitize pt
  • 1-2 weeks later, tx is initiated w/ application of very dilute concentration of the allergen to affected areas
  • wash off after 24-48 hrs
  • protect from sun exposure
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13
Q

ADRs of topical immunity

A
  • severe dermatitis
  • lymphadenopathy
  • urticaria
  • vitiligo
  • dyschromia
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14
Q

2nd line therapy for alopecia

A
  • minoxidil

- anthralin

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15
Q

ADRs of topical minoxidil

A
  • unwanted growth of facial hair
  • occasional dermatitis, pruritis, scalp irritation/redness
  • chest pain, rapid HR, faintness, dizziness (d/t vasodilator properties)
  • weight gain, swelling of hands/feet
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16
Q

ADRs of anthralin

A
  • mild irritation

- will stain hair, skin, and clothing brown

17
Q

what is the primary dermatophyte that causes onychomycosis?

A

trichophytaon rubrum

18
Q

distal subungual onychomycosis (DSO)

A
  • MC
  • nail plate and bed affected
  • matrix affected in severe dz
19
Q

white superficial onychomycosis (WSO)

A
  • caused by t. mentagrophytes

- infection localized to surface of nail plate

20
Q

proximal subungual onychomycosis (PSO)

A
  • MC cause: t. rubrum

- fungi invade nail through proximal nail fold and spread to nail plate/matrix

21
Q

1st line tx on onychomycosis

A

terbinafine

22
Q

alternative tx from terbinafine for onychomycosis

A

itraconazole

23
Q

tx duration of oral antifungal therapy for toe and fingernail

A
  • toenail: 12 weeks

- fingernail: 6 weeks

24
Q

what is itraconazole pulse therapy?

A

intraconazole 200mg BID x1 week/month - repeat for 2 pulses for finger, 3 for toe

25
Q

ADRs for terbinafine and itraconazole

A
  • GI is common: n/d, dyspepsia, abd pain
  • severe hepatotoxicity (rare) leading to liver failure
  • itraconazole: risk of CHF
26
Q

topical antifungals

A
  • efinaconazole
  • tavaborole
  • ciclopirox
27
Q

duration of topical antifungal therapy

A

up to 48 weeks

28
Q

what is the preferred antifungal for children?

A

ciclopirox

29
Q

candidates for topical therapy

A
  • if CI or drug interactions to systemic therapy
  • if < 3 nails are involved and prefer to avoid systemic tx
  • not as high of risk for serious ADRs compared to systemic
30
Q

behaviors associated w/ paronychia

A
  • overzealous manicuring
  • nail biting
  • thumb sucking
  • DM
  • occupation where hands are frequently submerged in water
31
Q

appropriate abx for tx of acute paronychia

-if not exposed to oral flora

A

-dicloxacillin/cephalexin in areas w/ low MRSA

32
Q

appropriate abx for tx of acute paronychia

-if exposed to oral flora

A

abx that covers S. aureus, E corrodens, H. influenzae and beta-lactamase

33
Q

appropriate abx for tx of acute paronychia

-if high MRSA area

A

TMP-SMX double strength BID

34
Q

tx choice for chronic paronychia

A
  • topical corticosteroids + protective measures

- systemic antifungal if unresponsive

35
Q

RFs for ingrown toenails

A
  • poorly fitting shoes
  • excessive trimming of lateral nail plate
  • pincer nail deformity
  • trauma
36
Q

conservative therapy for mild to moderate ingrown toenails

A
  • cotton wedging/dental floss under lateral nail plate and separate nail plate from lateral fold to releive pressure
  • soak in warm soapy water for 10-20 min. TID x 1-2 weeks; pushing lateral nail fold away from plate
37
Q

topical abx tx for moderate to severe ingrown toenail

A

bacitracin/mupirocin ointment

38
Q

skin lightening agents used to tx melisma

A
  • hydroquinone
  • azelaic acid
  • mequinol in combo w/ topical retinoid
  • kojic acid

Dermatology 2 (10 decks)

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