scott dermatologic disorders Flashcards
(113 cards)
1
Q
Cost of derm products
A
2009-2019
many brand products have increased 100% to 500%
many generic products have increased 100% to 200%
2
Q
- look at condition of the skin
A
desired effect from the base
dry the skin vs moisturize (ointment)
water resistant vs washes right off
3
Q
- area of application
A
i.e we dont use ointment on the scalp
4
Q
- patient acceptability
A
5
Q
- the nature of the incorporated medication
A
bioavailability
stability
compatibility
6
Q
ointment advantages
A
best for hydration
best for drug delivery
removes scales
7
Q
ointment disadvantages
A
greasy
low pt acceptance
not ideal for hairy area
8
Q
cream advantages
A
good for hydration
good for drug delivery]
can apply to most areas: hair, groin, face
high pt acceptance
9
Q
lotion advantages
A
watered down creams
easy to apply
good pt accpetance
10
Q
lotion disadvantages
A
requires freq applications
not ideal for very dry skin
11
Q
gel advantages
A
excellent for EtOH soluble drugs
can apply to most areas: hairy, groin, face
high patient acceptance; non-greasy
12
Q
gel disadvantages
A
can be drying
13
Q
solution; foam; spray advantages
A
can apply to most areas
easy to apply in hairy and groin areas
not ideal for drug delivery
14
Q
solution; foam; spray disadvantages
A
can be drying
not ideal for hydration
requires freq applications
15
Q
hair bearing skin
A
solution/spray
foam
gel
CREAM**
16
Q
dry skin (xerosis)
A
fall and winter
feet, lower legs
hands, elbows, face
rough, dry, scales, cracks
itching is common sx
17
Q
who is at risk for dry skin
A
elderly
decreased acrtivity of sweat and sebaceous glands
very warm, dry environemyns
frequent bathing
18
Q
tx options for xerosis
A
emollients**
1ST LINE FOR ITCHING
restores barrier and skin function
Agents for itching
alter bathing habits
19
Q
menthol and camphor
A
1/2 to 1%
create a sensation of cooling
REDUCES ITCHING
20
Q
pramoxine
A
REDUCES ITCHING
1%
local anesthetic
21
Q
aluminum acetate
A
REDUCES ITCHING
0.2%
alter C-fiber nerve transmission
22
Q
Hydrocortisone
A
0.5% and 1%
anti-inflammatory
REDUCES ITCHING
23
Q
dermatitis
A
inflammatory process of upper two layers of skin
24
Q
acute dermatitis
A
ITCHING IS INTENSE
25
sub-acute dermatitis
crusting and oozing
ITCHING IS COMMON BUT LESS INTENSE
26
CHRONIC dermatitis
Lichenification-skin has become thickened and layered
27
general tx rpinciples
STOP THE ITCH SCRATCH CYCLE
activate the fibers in skin and causes more itching in skin
28
irritant of acute contact dermatitis
Non-immunologic reaction to frequent contact with everyday substances
metals
cosmetics
adhesives
29
contact dermatitis-poison ivy
direct exposure
broken plant
resin-2 weeks
indirect
clothing, dog, smoke
does not spread from lesions
prevention is key
Ivy Block
30
Poison Ivy
dermatitis occurs 24 to 48 hours after exposure
PRURITIS is intense
-can cause secondary infections
wash skin and nails within 10 minutes
-wash clothing as well
Topical therpay okay if <10% BSA involved
31
MOA of topical corticosteroids: ANTI-INFLAMMATORY
increase the expression of anti-inflammatory genes and indirectly inhibit inflammatory transcription factors, such as Nfkb, to decrease the expression of pro-inflammatory genes
31
tx options for limited rash
remove source
calamine lotion
topical antihistamines
oral antihistamines
topical corticosteroids vs. oral corticosteroids
32
MOA of topical corticosteroids: anti-mitotic
inhibits cell proliferation
33
MOA of topical corticosteroids: immunosuppresive
inhibition of humoral factors involved in the inflammatory response
34
topical corticoseroids application
apply BID-QID x 3-14 days
35
corticosteroids******
AVOID DOSE PACKS ****
do not provide x for long enough period of time
START AT PREDNISONE 40-60 MG PER DAY; taper every 3 days
Minimum 10-14 days of tx
36
non-sedating antihistamines for SYSTEMIC tx
loratidine
desloratidine
fexofenadine
37
SEDATING antihistamines for systemic tx of acute derm
diphenhydramine
cetrizine
hydroxyzine-rx
doxepin-rx
38
atopic dermatitis
most common form of eczema
usually presents in ifancy
1 in 5 children
1 in 12 adults
**80% mild; 20% mod-severe**
significant QOL issues
-sleep, depressions, anxiety, productivity
39
atopic triad
atopic dermatitis, allergic rhinitis, asthma
40
problems with atopic dermatitis
PRURITIS!!!!
symmetrical red papules or plaques
scaling excoriations
overall dryness of skin
redness and inflammation
history of allergic disease
risk of 2nd infection
41
common locations of atopic dermatitis
cheeks on infants
42
triggers of atopic dermatitis
allergens
chemicals
bathing
DETERGENTS
soaps
smoke
dust
INFECTIONS
43
step 1 of mgmt of atopic dermatitis (NON-PHARM)
lukewarm or tepid baths
EMOLLIENTS
emliminate irritants, modify environment, avoid triggers
trim fingernails; non-irritating clothing
44
step 2 of mgmt of atopic dermatitis (TOPICAL THERPAY)
topical corticosteroids
topical calcineurin inhibitor therapy
topical JAK inhibitor
strength/duration of use based on severity
45
step 3 of mgmt of atopic dermatitis (SYSTEMIC)
photosensitivity
oral immunospressant therapy
oral JAK inhibitors
Injectable biologic agents
46
step 1 mgmt of MOD-SEVERE atopic dermatitis (ACUTE THERAPY)
moderate to severe: medium-potency TCS BID for up to 3 days beyond clearance of lesions
47
step 1 mgmt of MOD-SEVERE atopic dermatitis (REFrACTORY)
refractory to topical agents or widespread lesions: phototherapy or oral immunosuppressive therapy
Inadequate response to all therapies: consider emerging biologic agents
48
step 1 mgmt of MOD-SEVERE atopic dermatitis (MAINTENANCE)
-moderate to severe: basic measures plus daily application of low-potency TCS OR 2-3 times weekly application of TCS or other topical anti-inflammatory agent
***WRITTEN ACTION PLAN***
49
TCS
choice of vehicle based upon:
location of lesions
type of lesion
severity of lesion/degree of inflammation
degree of skin penetration desired
50
how are TCS classified?
according to potency which corresponds to anti-inflammatory acitivty and vasocontrictive potency
Very high= I
low= VII
Vehicle impacts delivery AND potency of corticosteroids
only 2% is absorbed when applied to normal intact skin
OCCLUSION ENHANCES PENETRATION
51
side effects of TCS
thinning of skin
dilated blood vessels
increased bruising
skin color changes
risk of HPA suppression with long term use of high potency agents
tachyphylaxis
52
halobetasol proprionate
VERY HIGH POTENCY
used for severe lesions and on thicken skin whem maximum penetration is needed
DO NOT use on face
Avoid using super-potent agents or >2 weeks
Limit no more than 50 g per week
52
clobetasone proprionate
VERY HIGH POTENCY
used for severe lesions and on thicken skin whem maximum penetration is needed
DO NOT use on face
Avoid using super-potent agents or >2 weeks
Limit no more than 50 g per week
53
betamethasone dipropionate ointment
VERY HIGH POTENCY
used for severe lesions and on thicken skin whem maximum penetration is needed
DO NOT use on face
Avoid using super-potent agents or >2 weeks
Limit no more than 50 g per week
54
Flucinolide
HIGH POTENCY CLASS 2
used for severe lesions and on thicken skin whem maximum penetration is needed
DO NOT use on face
Avoid using super-potent agents or >2 weeks
Limit no more than 50 g per week
55
mid potency classes 3-5
betamethasone valerate
triamcinolone
mometasone
betamethoasone dipropionate
56
low potency classes 6-7
hydrocortisone
desonide
57
topical calcineurin inhibitors
MOA: blocks pro-inflammatory cytokine genes
***primecrolimus and tacrolimus***
can be used to any area
equivalent to mid-potency corts
no risk of atrophy
few side effects-burning
$$$
(elidel, tacrolimus, protopic)
58
topical calineurin inhibitors
NOW CONSIDERED 2ND LINE TX
intermittent use only
recent concern regarding long-term use
(elidel, tacrolimus, protopic)
59
crisaborale 2% ointment
phosphodiesterase-4 inhibitor (non-steroidal)
Alternative to TCS and TCIs
(steroid phobia)
Mild or moderate AD
BID for 28 days
SUPER EXPENSIVE
60
Ruxolitinib (Opzelura 1.5% cream)
mild to mod atopic dermatitis
MOA: JAK inhibitor
(mediates siganling of cytokines)
apply a thin layer BID up to 20% of BSA
Short term use
max 60g per week
avoid in immunocompromised pts
$$$
61
Upadacitinib (Rinvoq)
MOD-SEVERE atopic dermatitis
not well controlled with other therapies
MOA: JAK inhibitor
(mediates signaling of cytokines and growth factors)
15 mg to 30 mg PO once daily
well tolerated
higher rates of major CV events and thrombosis***
62
dupilumab (dupixent)
first biologic for mod-severe AD
MOA: inhibits signaling of IL-4 and IL-13
600 mg initially, then 300 mg SC q 2 weeks
$$$$
63
anything that ends in NIB
JAK INHIBITOR
64
Ends in -LAST
PDE-4 inhibitor
65
Nemolizumab
IL-31 antagonist
66
factors that exacerbate acne
oil-based cosmetics
stress
irritation/physcial pressure
drugsD
67
Drugs that excerbate acne
androgenic steroids
corticosteroids
lithium
anti-epileptics (phenytoin)
tuberculostatic drugs
oral contraceptives
68
comedone
hair follicle plugged with sebum, keratin, and dead skin
69
bacteria in acne
propionibacterium acnes naturally colonize the skin and sebaceous glands
proliferates in sebum environment
bacteria converts TG (triglycerides) to FFA(free fatty acids) which irritates local cell resulting in inflammation
70
non-inflammatroy acne
whiteheads and blackheads
71
inflammatory acne
papules
pustules
ruptured contents
72
secondary lesions
excoriations
erythematous macules
hyperpigmented macules
scars
73
goals of therpay for acne
long term control
relieve discomfort
improve skin appearance
minimize psychological stress
prevent scars
74
MOA of acne therapy
antimicrobial
anti-inflammatory
decrease sebum production
keratolytic
comedolytic
75
keratolytic
compunds that break down the outer layers of the skin, decrease the thickness, and promote sloughing
use salicylic acid, urea, a-hydroxy acids
76
Comedolytic
a product or medication that inhibits the formation of comedones
use tret, adapalene, azelaic acid
77
best keralytic/comedolytic agents
topical retnoids
accutane
adapalene
78
best decreased sebum production
accutane
oral contraceptives
79
which agents DO NOT HAVE GOOD ANTIINFLAMMATORY
oral contraceptives
salicylic acid
80
best agents for antimicrobial
oral antibiotics
topical antibitoics
benzoyl peroxide
81
tx in ALL PATIENTS
follow a regular skin cleansing regimen using a mild facial soap BID
minimize the use of products that cause irritation or stinging
use TEPID, NOT HOT, water to clean affected area
******NO QUICK FIX: WEEKS TO MONTHS*****
82
COMEDONAL, NONINFLAMMATORY acne (mild)
FIRST CHOICE: topical retinoids (adapalene)
alternatives: benzoyl peroxide and azelaic acid
83
Mild-moderate papulopustular inflam acne
adapalene and BP
Clindamycin and BP
ALTERNATIVES: alt retnoids, adalapalene and oral antibiotics
84
SEVERE PAPULOPUSTULAR OR MODERATE ACNE
ORAL ISORETINOIN
85
NODULAR OR CONGLOBATE ACNE
oral isotretinoin
86
maintenance therapy
adapalene
alt: tazarotene
tret
azelaic acid
benzoyl peroxide
87
combo products
clinda + BP
adap + BP
88
TYPES oral antibiotics
minocycline
doxycycline
erthromycin
axithromycin
TMP/SMX
89
What do oral antibitoics do
decrease bacteria and inflammation
90
when is OA most effective
when inflammation is present
91
how long should you use OA for
6-8 weeks to prevent resistance
92
after inflammation is controlled, what can you use to controll acne?
topical retinoids and/or benzoyl peroxide for long periods
93
spironolactone
decreases androgen production (reduces sebum and comedone formation)
94
clascoterone 1% cresm
stops androgen activity
BID
most common SE is local erythema
95
isotret
vitamin A derivative
reduces sebum production and shrinks sebaceous glands.
96
isotret dosing
0.5-2 mg/kg/day in doses with food for 15-20 weeks
acne will get worse before it gets better
97
rosacea
inflammatory deratosis based upon vascular instability
98
telangiesctasia
spidery veins
99
who is affected most by rosacea
ages 25-70
people with fair complexions
women>men
CHRONIC
99
papilopustular
resembles acne
often referred to as "adult acne"
100
phytamatous
enlarges sebaceous glands
especially the nose
more common in MEN
101
ocular
water eyes
bloodshot eyes
102
drugs that make roceasea worse
vasodilators
topical corticosteroids
nicotinic acid
ACE inhibitors
calcium channel blockers
statins
103
lifestyle modifications
avoid triggers known to exacerbate
avoid excessive exposure to the sun
use mild soaps and cleaners
stress adherence to topical meds
topical meds should be allowed to penetrate the skin for 5-10 mins before applying make up
104
tx for mild roseasea
avoid triggers
topical antibiotics (metronidazole)
topical retinoids
105
tx for mod rosacea
oral antibiotics
topical retinoids
106
rx severe ros
oral isotret
laser tx
107
topical antibiotics for ros
metronidazole 1%
BID
108
topical retinoids
azelaic acid- finacea gel 15%
109
brimonidine
tx for persistent facial erythema
drops for ocular ros
110
