PHRM 825: Dermatology Flashcards
(136 cards)
1
Q
What 2 primary lesions are flat, nonpalpable changes in skin color
A
- Macule
- Patch
2
Q
What 3 primary lesions are elevated and formed by a fluid in a cavity (no color change)
A
- Vesicle
- Bulla
- Pustule
3
Q
What 5 primary lesions are elevated, palpable solid masses?
A
- Papule
- Plaque
- Nodule
- Tumor
- Wheal
4
Q
What primary lesion are most drug rashes made of?
A
Macules
5
Q
What 3 secondary lesions have material on the skin surface?
A
- Scale
- Crust
- Keloid
6
Q
What 4 secondary lesions have loss of skin surface?
A
- Erosion
- Ulcer
- Excoriation
- Fissure
7
Q
What are the 4 vascular lesions?
A
- Cherry angioma
- Telangiectasia
- Petechiae
- Ecchymosis
8
Q
What does occlusive mean in regards to ointments?
A
Promotes retention of water in the skin
9
Q
What does humectant mean in regards to ointments?
A
Causes water to be retained because of its hygroscopic properties
10
Q
What does emollient mean in regards to ointments?
A
- Softens the skin
- Soothes irritation in skin or mucous membranes
11
Q
What does protective mean in regards to ointments?
A
Protects inured or exposed skin surfaces from harmful or annoying stimuli
12
Q
What form of topical agent has the greatest bioavailability of active ingredient?
A
Ointment
13
Q
What topical agent is essentially a watered-down cream?
A
Lotion
14
Q
What 4 topical vehicles are preferred for hair bearing skin?
A
- Gel
- Lotions
- Solution
- Foam
15
Q
Characteristics of oleaginous bases
A
- Absorbs no water
- Not water washable (requires soap)
16
Q
Characteristics of absorption bases
A
- Can absorb several times it’s weight of water
- Not water washable
17
Q
Characteristics of water-in-oil emulsion bases
A
- Absorbs less water than absorption bases
- Not water washable
18
Q
Characteristics of oil-in-water emulsion bases
A
- Water washable
- Add water=lotion
19
Q
What base is most commonly used therapeutically to treat skin disorders?
A
Creams
20
Q
What are 3 drug-induced skin disorders?
A
- Hypersensitivity/allergic reaction
- Photosensitivity
- Toxic Reaction
21
Q
How do you treat drug-induced skin disorders?
A
- Stop the drug
- Systemic antihistamines
- Systemic or topical corticosteroids
- Soothing baths or soaks
22
Q
What are the 2 types of photosensitivity reactions?
A
- Phototoxic
- Photo allergic
23
Q
What causes a phototoxic skin reaction?
A
Drug or its metabolite accumulates in the skin, absorbs light and undergoes a photochemical reaction resulting in local tissue damage
24
Q
What causes a photo allergic reaction?
A
Drug or its metabolite induces a cell mediated immune response which on exposure to light (longer wave length) produces a papular or eczematous contact dermatitis like picture
25
How do you prevent photosensitivity reactions?
Sunscreen SPF >30 and clothing
26
How do you treat photosensitivity reactions?
- Systemic analgesics
- Systemic antihistamines for itching
- Prevent infection
- Moisturizers
- Cooling creams and gels (Aloe)
27
What are characteristics of toxic skin reactions?
- Epidermal detachment
| - Erosive mucosal lesions
28
What causes a toxic skin reaction?
Drug protein complex reaction leads to T-cell activation which migrates to the dermis and releases cytokines
29
What drug is most commonly responsible for Steven Johnsons Syndrome?
Anti-convulsants
30
What is cellulitis and should you treat or refer?
- Infection near break in skin
- Red, warm, swollen (fever?)
- Refer
31
How do you treat cellulitis?
- Oral antibiotics
| - IV antibiotics in severe cases
32
What is impetigo and should you treat or refer?
- Topical staph skin infection
- Most common in children
- Direct spread
- Refer
33
How do you treat impetigo?
Topical or oral antibiotics
34
Where is topical candida infection most common?
- Moist areas in humid conditions
| - Obese patients
35
How do you treat topical candida infection?
- Topical antifungals
| - Dry affected area
36
What is Tinea pedis?
- Athlete's foot
- Dermatophyte infection
- Often spread in pools/showers
- Moist environments promote growth
37
How is tinea pedis (athlete's foot) treated?
Topical antifungals
38
What is tinea corporis?
- Body ring worm
- Commonly transmitted in day-care
- Hot/humid environments promote growth
- Small, circular, red scaly areas
39
How is tinea corporis/body ring worm treated?
Topical antifungals
40
What is Pediculosis and do you treat or refer?
- Head lice
- Children 3-12 years old
- Scalp redness and scaling
- Pruritus
- Refer
41
How is head lice/pediculosis treated?
- Permethrin 1%
- Malathion
- Oral Ivermectin
- Spinosad
- Topical Ivermectin
- $$$
42
What is scabies and do you treat or refer?
- Sarcoptes scabiei infestation
- Primarily in children and adolescents (LTCF)
- Raised lines caused by mites burrowing under the skin
- Extreme pruritus
- Refer to PCP
43
How is scabies treated?
- Permethrin 5%
- Crotamiton
- Oral Ivermectin
44
What is Herpes zoster and do you treat or refer?
- Shingles
- Adults >40 yo
- Especially in pts who previously had chicken pox
- Potentially contagious while blisters are present
- Triggered by stress, old age, immunosuppression
- Extreme pain along dermatome
- Tender red papules that progress to scabs
- Refer to PCP
45
How do you treat herpes zoster/shingles?
- Oral valacyclovir or famciclovir
- Manage acute pain and postherpetic neuralgia (oral opioids for acute pain, gabapentin for PHN, lipoderm patches once lesions have healed)
46
What is the most common type of skin cancer?
Basal cell carcinoma
47
What is the most deadly type of skin cancer?
Melanoma
48
How is skin cancer treated?
- Removal of lesion
- Chemotherapy
- Radiation
49
What is xerosis?
Dry skin
50
Who is at risk for xerosis?
Elderly
-decreased activity of sweat and sebaceous glands
-very warm, dry environments
Frequent bathing
51
How is xerosis treated?
- Emollients (first line for itching/restores barrier and skin function)
- Agents for itching
- Alter bathing habits
52
Dr. Martin's Rules of 3's for xerosis
- Bathe 3 times per week
- tepid water (3-5 degrees above body temp)
- Bathe for 3 mins
- Apply emollient within 3 mins
- Apply emollients 3 times daily
53
What agents reduce itching?
- Menthol and camphor
- Pramoxine
- Aluminum acetate
- Hydrocortisone
54
What is dermatitis?
Inflammatory process of the upper two layers of skin
55
What are the 3 stages of dermatitis?
- Acute
- Sub-acute
- Chronic
56
What characterizes acute dermatitis?
- Red patches or plaques
- Pebbly surface or blisters (vesicles)
- Itching is common and intense
57
What characterizes sub-acute dermatitis?
- Dry
- Less red than acute dermatitis
- Crusting, oozing
- Mild thickening
- Red scaling, fissured, patches or plaques
- Slight to moderate pruritis, pain, stinging, or burning
- Itching is common but less intense than acute dermatitis
58
What characterizes chronic dermatitis?
- Epidermal thickening
- Exaggerated skin markings
- Lichenification
- Scaling
- Less itching
59
What is the main symptom of acute contact dermatitis?
Itching
60
What are the 2 types of contact dermatitis?
Allergic and irritant
61
What is the itch-scratch cycle?
Inflammation/excitation of C-nerve fibers leads to itching which leads to scratching and repeat
62
What is an irritant?
Non-immunologic reaction to frequent contact with everyday substances
63
Which is more common: allergic or irritant contact dermatitis?
Irritant
64
What is the main symptom of poison ivy?
Intense pruritis
65
How is poison ivy treated?
Topical therapy
| If >10% BSA involved, oral therapy
66
What are poison ivy treatment options?
- Remove source
- Soaks
- Calamine lotion
- Topical antihistamines
- Oral antihistamines
- Topical corticosteroids
- Oral corticosteroids
67
When are soaks used to treat acute dermatitis?
For oozing, weeping, crusting lesions
68
When are wet-to-dry dressings useful?
For drying acutely, inflamed, wet areas
69
What is the MOA of topical corticosteroids?
- Anti-inflammatory
- Anti-pruritic
- Suppress immune response
70
How are topical corticosterois classified?
According to potency corresponding to anti-inflammatory activity
(very high-low corresponds with grades I to VII)
71
What technique enhances penetration of topical agents?
Occlusion
72
What are side effects of topical corticosteroids?
- Thinning of skin
- Dilated blood vessels
- Increased bruising
- Skin color changes
- Risk of HPA suppression with long-term use of high-potency agents
- Development of tolerance (tachyphylaxis)
73
What is the MOA of topical calcineurin inhibitors?
Blocks pro-inflammatory cytokine genes
74
What are 2 topical calcineurin inhibitors
-Pimecrolimus and tacrolimus
75
What class of medications can be used for systemic treatment of acute dermatitis?
Corticosteroids
76
What non-sedating antihistamines are used as systemic therapy for acute dermatitis?
- Loratadine
- Desloratadine
- Fexofenadine
77
What sedating antihistamines are used as systemic therapy for acute dermatitis?
- Diphenhydramine
- Cetirizine
- Hydroxyzine
- Doxepin
78
What is atopic dermatitis and its characteristics?
- Most common form of eczema
- Usually presents in infancy
- 1 in 5 children
- 1 in 12 adults
- 80% mild and 20% mod-severe
- Significant QOL issues (sleep, depression, anxiety, lack of productivity)
79
What is included in the atopic triad?
- Atopic dermatitis
- Asthma
- Allergic rhinitis
80
What is the first diseases of atopic/allergic triad to be observed?
Atopic march
81
What is atopic dermatitis and its characteristics?
- Pruritis
- Symmetrical red papules or plaques
- Scaling excoriations
- Overall dryness of skin
- Redness and inflammation
- History of allergic disease
- Risk of 2nd infection
82
What are triggers for atopic dermatitis?
- Detergents
- Infections
- Allergens
- Chemicals
- Bathing
- Soaps
- Smoke
- Dust
83
What is dupilumab and what is its MOA?
- First biologic indicated for moderate to severe AD (not well controlled with other therapies
- Human monoclonal antibody against IL-4 receptor alpha (inhibits signaling of IL-4 and IL-13 (Th2 cytokines)
84
What is stasis dermatitis and what are it's characteristics?
- Patients > 50yo
- Poor circulation
- Most common around ankles
- Aching, swelling, edema, discomfort
- Red, scaly, crusted plaques
- Secondary infection and ulcers common
- Hyperpigmentation (retention of iron in skin)
85
How is stasis dermatitis treated?
- Topical corticosteroids (for itching)
- Emollients (for all pts)
- Oral antibiotics for local infections (cephalexin)
- Support/compression stockings to relieve edema
86
What is chronic dermatitis and what are it's characteristics?
- Well documented lichenified, thickened plaques
- Excoriations, fissures, scaling
- Itching predominates (minor irritations or trauma worsens itching)
87
How is chronic dermatitis treated?
- Emollients
- Avoid long-term corticosteroids
- UV light
88
What patients are at risk for topical fungal infections?
- Obese!
- Infants
- Elderly
- Immunosuppressed
- Incontinence
- Warm and humid climates
- Usually a combination of risk factors
89
Should you treat or refer topical fungal infections?
- Most can be treated with OTC
- Refer if systemic symptoms
- Refer if patient is immunocompromised
90
OTC products for topical fungal infections
- Miconazole
- Clotrimazole
- Terbinafine
91
Rx products for topical fungal infections
- Nystatin
- Ciclopirox
- Ketoconazole
92
Treatment options for diaper rash
- Remove irritant (frequent diaper changes)
- Air dry
- Keep clean
- Antifungal agents +/- corticosteroids
93
What is seborrhic dermatitis?
- Erythema with greasy yellow scaling
- Hairline, scalp, nose, neck, ears, back
- Itching
- Includes cradle cap in infants
94
How to treat cradle cap
- Baby oil to soften
- Baby shampoo
- No drug tx usually required
95
Treatment options for seborrhic dermatitis
- Medicated shampoos (contact time is critical)
| - Topical corticosteroid (low strength ideal for lesions on face and ears)
96
Acne definition
Chronic inflammatory disease of the sebaceous glands and hair follicles of the skin characterized by comedones, papules, and pustules
97
What percentage of the adolescent population experiences acne?
90%
| Corresponds to increased androgen production
98
80% of patients with acne are within what age range?
- 12-30
- Males more severe during puberty
- Females more severe during adulthood
99
Factors that exacerbate acne
- Oil-based cosmetics
- Emotional stress
- Irritation/physical pressure
- Drugs
100
What drugs exacerbate acne?
- Androgenic steroids!!!
- Corticosteroids
- Lithium
- Anti-epileptics (phenytoin)
- Tuberculostatic drugs
- Oral contraceptives
101
What is a comedone?
Hair follicle plugged with sebum, keratin, and dead skin
102
What bacteria naturally colonizes the skin and sebaceous glands and causes acne?
Propionibacterium acnes
103
What are the 2 classes of acne?
Non-inflammatory and inflammatory
104
What are the non-inflammatory lesions of acne?
Whiteheads and blackheads
105
What are the inflammatory lesions of acne?
- Papules
- Pustules
- Ruptured contents
106
What constitutes a whitehead?
Trapped contents in a closed comedo
107
What constitutes a blackhead?
- Trapped contents
- Dilated opening
- Open comedo
- Melanin accumulates
108
What is the difference between a papule and a pustule?
Papules are red and inflamed while pustules are yellow and inflamed
109
What are complications of acne?
- Excoriations
- Erythematous macules
- Hyperpigmented macules
- Scars
110
What are treatment options for complications of acne?
- Dermabrasion
- Chemical peels
- Laser resurfacing
- $$$
111
What are the goals for treatment of acne?
- Long-term control
- Prevent scars
- Relieve discomfort
- Improve skin appearance
- Minimized psychological stress
112
What oral antibiotics are used for acne?
- Minocycline
- Doxycycline
- Erythromycin
- Azithromycin
- TMP/SMX
113
What type of therapy is ideal for females who's acne flares during the menstrual cycle?
Hormone treatment/oral contraceptive
114
What is isotretinoin and what is it used for?
Used for severe acne or when patients have failed other treatments or when it relapses soon after discontinuing other therapies
115
How long must someone wait to determine if an acne treatment regimen has been successful?
2-4 months
116
What is rosacea?
- Chronic, progressive inflammatory dermatosis based upon vascular instability
- Primarily affects central part of face
- Characacterized by facial flushing/bluching, facial erythema, papules, pustules, and telangiectasia
- 25-75 years of age
- Women > men
117
What characterizes telangiectatic rosacea?
- Visibly dilated blood vessels
| - Very red skin
118
What characterizes papulopustular rosacea?
- Resembles acne
| - Often referred to as "adult acne"
119
What characterizes phytmatous rosacea?
- Enlarged sebaceous glands
- Especially the nose
- More common in males
120
What characterizes ocular rosacea?
- Watery eyes
| - Bloodshot eyes
121
What are triggers for rosacea?
- Temperature!
- Drugs!
- Foods
- Weather
- Beverages
- Medical conditions
- Emotional influences
- Physical exertion
- Skin products
122
What drugs are the main trigger for rosacea?
Vasodilators
123
What is psoriasis and how does it present clinically?
- Chronic autoimmune inflammatory skin disorder
- T-lymphocyte mediated disease
- Keratinocyte proliferation
- Thickened, red patches covered by silvery-white scales
- Results from rapid skin growth (7x faster than normal)
124
How do you treat psoriasis?
- Not curable!
| - Attempt long remissions
125
What is psoriatic arthritis?
- Usually in joint area
- Defined with red patches on skin topped with silvery scales
- Usually psoriasis diagnosed first and then psoriatic arthritis
- Joint problems can begin before skin lesions appear
126
What is guttate psoriasis?
- Usually in children or young-adults
- Small, pink-red spots often appearing on trunk, upper arms, thighs, scalp due to URI, stress, skin injury, or commonly beta-blockers
127
What is erythrodermic psoriasis?
- Inflammatory form of psoriasis, often affects most of body surface
- Usually rare, and usually develops from pustular psoriasis or unstable plaque psoriasis
- Characterized by redness and severe itching throughout the entire body
128
What is inverse psoriasis?
- Develops in body's skin folds: armpits, genitals, under breasts, buttocks
- Painful and difficult to treat
129
What BSA% characterizes "limited psoriasis"
<5%
130
What BSA% characterizes "moderated psoriasis"
5-10%
131
What BSA% characterizes "severe psoriasis"
>10%
132
What are comorbidities of psoriasis?
- Psoriatic arthritis
- Crohn's disease
- Psychiatric disorders
- Metabolic syndrome (CV disease/stroke)
133
When is topical therapy most effective to treat plaque psoriasis?
When it covers <20% of BSA
134
What technique enhances penetration of topical therapies?
Occlusion (increases penetration by 10x)
135
What is goeckerman therapy?
All day occlusive coal tar followed by light therapy
136
What infection can biologic therapy activate?
TB
