Derm Pharm- Acne, Rosaceae, Dermatitis, Alopecia, Nails, Skin Cancer

Front 1

What is involved in the initial treatment of MILD Acne?

Moderate or failure of mild?

Severe?

Back 1

Mild acne = topical retinoid (tretinoin, adapalene,tazarotene)
OR azelaic acid +/- benzoyl peroxide/topical antibiotic

Moderate or failure of mild TX = combination Tx: topical retinoid + oral OR topical antibiotic +/- benzoyl Peroxide

Severe acne or failure of above= systemic isotretinoin or hormonal therapy for women

Front 2

What are the 3 topical retinoids used in the treatment of Acne?

Back 2

tretinoin
adapalene
tazarotene

Front 3

What is involved in the MAINTENANCE of Acne?

Back 3

topical retinoid +/- benzoyl peroxide

Front 4

What should you warn your patients about when giving them Topical retinoids?

Are they safe in pregnancy?

Back 4

Caution in the SUN

DON'T use in pregnancy

Front 5

Which acne medication may help to lighten Scars?

Back 5

Azelaic Acid

Front 6

What are the 2 options for topical antibiotics in the treatment of acne?

Back 6

Erythromycin OR Clindamycin

Front 7

How long should you keep a patient with acne on ORAL antibiotics?

Back 7

Oral antibiotics - taper and discontinue after 6 months, or continue at low dose for persistent

Front 8

Which Acne treatment is CATEGORY X in pregnancy and may cause lipid abnormalities?

What other side effects could this drug have?

What should you monitor in patients on this drug?

Back 8

ISOTRENTINOIN

Also: Dries Skin/mucosa, photosensitivity, psychiatric disturbance, arthralgias/tendonitis

Monitor Lipids, LFT, CBC

Front 9

What is the cure for Rosaceae?

Back 9

Can only manage symptoms, we have no real cure

Front 10

What is most commonly used to manage patients with Rosaceae?

Back 10

Topical metronidazole & oral Tetracyclin!! is most commonly used; occasionally systemic metronidazole

Tetracyclines also well established

Macrolides (Erythromycin, Clarithromycin)
- Boards: Clarithromycin= Metallic Taste_

Front 11

How would you treat Acute or severe Contact Dermatitis?

Back 11

systemic steroids; systemic antihistamine only if sedation beneficial

Front 12

How would you treat Subacute/Chronic Dermatitis?

Back 12

Topical Steroids

Front 13

Under what conditions would you treat a patient with Subacute/Chronic Dermatitis with LOW- MEDIUM potency topical steroids? How long would you treat them for if you chose medium potency?

When would you use HIGH-VERY HIGH potency? How long would you treat them?

Back 13

Low-medium potency
1. Thin skin (face, skin folds, infants, elderly) Medium potency - limit to 3 months max

High-Very high potency
1. Chronic, lichenifield lesions or thick skin (palms of hands)
Limit to 3 weeks OR very small surface area

Front 14

What are the 2 types of Alopecia?

Back 14

Male Pattern Baldness

Alopecia areata
- Patchy, not male pattern, baldness

Front 15

How would you treat alopecia caused by male pattern baldness?

Back 15

finasteride (Propecia®) inhibits 5α reductase decreasing conversion of testosterone to DHT.

Front 16

What is the first step in treating a patient with Alopecia Areata?

Back 16

Treat underlying cause (hypothyroidism, secondary syphilis)

Front 17

What is the treatment for alopecia areata in kids less than 10?

What about greater than 10?

Back 17

minoxidil (Rogaine®), topical steroid, or short contact anthralin

>10 as above, but consider intralesional steroids

Front 18

What is the treatment for Alopecia areata caused by hormone imbalance?

Who would you NOT want to give this treatment to?

Back 18

iv. Hormone imbalance - finasteride (not in women of child bearing age), spironolactone (generally not first choices in alopecia areata)

Front 19

What is Onychomycosis?

Back 19

AKA "Dermatophytic onychomycosis", "Ringworm of the nail," and "Tinea unguium"- means fungal infection of the nail.

It is the most common disease of the nails and constitutes about a half of all nail abnormalities

Front 20

What are the treatment options for Onychomycosis?

Back 20

a. Nail removal
b. Nail lacquer with ciclopirox - poor compliance, gen not first line
c. Systemic

Front 21

What side effects are common to all Onychomycosis SYSTEMIC treatments?

Back 21

All are hepatotoxic, dyscrasias may occur, drug interactions

Front 22

What are the 2 systemic treatments used for Onychomycosis?

What are the major complications associated with each?

Back 22

i. Terbinafine - SJS/TEN, ocular changes
ii. Itraconazole - QT prolongation

Front 23

What is the MOST SIGNIFICANT dermatologic carcinogen?

What should your major focus be as a physicain?

Back 23

Focus on PREVENTION - *sunlight* is the most Significant dermatologic carcinogen!!!

Front 24

What are the 2 most important aspects of prevention that you should educate your patients about?

Back 24

1. Don’t fake-bake (tanning beds are still UV radiation!)
2. EVERYONE should use sunscreen or sunblock

Front 25

What structural component of sunscreen is responsible for absorbing UV radiation?

What are some examples of chemical sunscreens?

Back 25

Aromatic ring structure absorbs UV radiation; most generic names
contain -benz- (e.g., p-amino benzoic acid, sulisobenzone, padimate O is an aminobenzoic ester derivative);

Front 26

Do most chemical sunscreens absorb UVA or UVB?

Back 26

Most absorb UVB and some UVA (don’t memorize percentages);

Front 27

What chemical sunscreen has the best UVA protection?

Back 27

Avobenzone ***EXAM***

Front 28

SPF of greater than or equal to _____ is recommended.

What does SPF signify?

Back 28

SPF of ≥15 recommended

SPF = degree of UV*B* protection; = ratio of time to reddening with sunscreen to time without sunscreen -

e.g., if time to reddening is 30 minutes without sunscreen, SPF 15 increases this to 7.5 hours

Select broad spectrum.

Front 29

Sunscreen works best when applied appropriately.

a) How much sunscreen does it take to cover an entire adult body?

b) What body parts of infants should be covered?

c) Reapply every ____ hours if swimming or sweating

Back 29

a. It takes ≥ 5 tsp to cover an adult body!!
b. Exposed skin of infants should be covered
c. Reapply every 1-2 hours if swimming or sweating

Front 30

What are 2 physical sunscreen agents?

Back 30

Zinc Oxide OR Titanium Dioxide
***EXAM***

Front 31

What is the treatment for Squamous precancer or basal carcinoma?

What about treatment for metastatic Melanoma?

Back 31

Actinic keratoses - topical 5-fluorouracil or imiquimod

Metastatic melanoma = systemic treatment