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56 Cards in this Set
- Front
- Back
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How are head, body and crab lice transferred between hosts?
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Head and body lice are transferred between hosts by personal and clothing contact.
Crab lice are transmitted by sexual contact. |
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What conditions favor the transfer of lice?
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Crowded living conditions
People who do not wash frequently Most common among school-aged children. |
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What are the steps in the life cycle of head and body lice?
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Adult fertilized female lays eggs which remain glued to hair or seams of clothing.
The oval shaped eggs (nits) hatch in 7-10 days and produce nymphs which go through a number of molts to evolve into mature adults. Both larvae and adults feed on the hosts’ blood. The lice penetrate the host skin by attaching themselves by a circlet of teeth on their head. |
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S/S of common and severe infestations of lice
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Most common complaint
- Pruritus of the scalp, ears, neck, other body parts Severe - Severe itching School children exposed frequently to head lice may have only minor pruritus affecting the scalp, ears and neck. |
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What is the duration of contact required for pyrethrin products and malathion to kill head lice?
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Pyrethrin and Lindane should be left or about 10 minutes, then rinsed out.
Malathion should be left for 12-24 hours - length is a disadvantage of this product compared to others) Application of these preparations should be followed by plain shampoo. Repeat within 7-10 days |
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What is the dose and appropriate steps to apply a pediculocide for head lice?
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Apply a sufficient quantity of shampoo or lotion to wet hair and scalp (approx. 30-50mL).
Preparation should be thoroughly massaged into the scalp. |
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Identify four products useful in treating head lice?
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Permethrin (Elimite) 5% cream and lotion
Malathion (Ovide) 0.5% lotion Pyrethrin 0.33% plus 4% piperonyl butoxide shampoo (RID) Lindane 1% lotion and shampoo - 2nd line agent for patients who have failed the other three agents - May have neurological toxicities if used inappropriately |
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What is the rationale for repeating the treatment of head lice after 7-10 days of the first treatment?
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To eradicate the organisms that have hatched after initial therapy.
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What are the adverse effects that limit the use of lindane and the methods to minimize these adverse effects?
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When left on the skin too long (especially excoriated skin), percutaneous absorption can cause neurotoxicity with symptoms including tremors, ataxia, insomnia and seizures.
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What is the role of petrolatum and ivermectin in the treatment of head lice?
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Alternative treatments
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What are the methods to remove nits from hair?
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Nits can be removed from the hair by applying a solution containing equal parts of water and vinegar and using a sturdy fine-tooth comb to remove the nits.
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What is a product used to treat body and pubic lice?
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Pyrethrin combination lotion like RID
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What is a method to remove lice from eyelids or eyelashes?
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Plain petrolatum ointment can be used.
It is applied to the eyelashes and lid margins with cotton swabs 3-4x/day. |
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What decontamination methods should be used to control infestations of lice?
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All personal articles of clothing, including bedding, should be washed, preferably in the hot cycle of the washer at >50 degrees C.
b. Hairbrushes, combs, and other plastic articles can be decontaminated by soaking in rubbing alcohol or pediculicide c. In institutions and schools where lice infestations are a problem, outer clothing (coats, hats, scarves) of individuals should be isolated in separate plastic bags at the beginning of the day, this will reduce reinfections |
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Where are the most common body locations in which the female scabies mites burrow to lay eggs?
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Fingers, wrists, elbows, peri-umbilical skin and buttocks
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What is the hallmark presentation of scabies and also the possible presentation(s) in infants?
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Intense itching with erythematous papules and excoriations.
In infants, may be vesicular or bullous - Secondary pyoderma is not uncommon |
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List three products for the treatment of scabies.
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Lindane 1% lotion and shampoo
Crotamiton (Eurax) 10% cream or lotion Permethrin (Elimite) 5% cream or lotion |
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What is the most effective scabicide?
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Permethrin 5% cream
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Outline a treatment that may be used if there is inadequate response to topical permethrin.
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Two doses of Ivermectin (Stromectol)
- 400mcg/kg on day 1 and day 8 |
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Outline the proper application procedures for permethrin, crotamiton, and lindane in the management of scabies.
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Permethrin cream should be massaged into the skin from the head (including the scalp) to the soles of the feet
- Cream should be left on for 8-14 hours before patients shower again, repeat one week later. Crotamiton should be applied to the entire body (including scalp) and left on for 24 hours after the initial bath, second 24 hour application is recommended before patients are bathed again. Lindane is applied to the entire body (avoiding the eyes and mucous membranes) and left on the body for approx. 8 hours, after 6-8 hours a cool bath should be taken. |
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What is the most persistent symptom associated with scabies and a recommended treatment for it?
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Pruritus can persist for more than 10 days
Treatment - Symptomatically with oral antihistamine (Benadryl) or low potency topical steroid. |
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State the four major etiological factors involved in development of acne.
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Increased sebum production by the sebaceous gland due to hormonal influences (primarily increased androgen).
Proliferation of keratinocytes in the sebaceous gland follicles in response to the increased sebum which is changed in composition in the presence of increased androgens- this results in obstructed sebaceous follicles called microcomedones, the characteristic lesion of acne. Bacterial colonization of the follicle by the anaerobic gram-positive rod Propionibacterium acnes which favors the environment of pooled sebum in the sebaceous glands. Inflammation from the immune response to P. acnes in the comedones, P. acnes also produces a lipase that hydrolyzes triglycerides in the sebum that also contributes to inflammation and keratinization in the sebaceous follicle. |
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Provide a definition of microcomedone, closed comedone, and open comedone.
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Microcomedone
First clinically visible lesions, become closed comedones as the disease process evolves and extends Closed comedone - “whiteheads” Open comedone As the lesions grow, they dilate the opening of the sebaceous gland follicle, “blackhead”- not dirt but likely the result of the oxidation of lipids in the sebaceous glands. |
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What is the clinical presentation of acne vulgaris and the consequences of this disease?
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Microcomedones
Closed comedomes Open comedomes As the disease process extends in some patients, inflammatory papules, pustules, nodules and cysts develop; some pts even develop deep scarring |
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What are the five basic goals of acne therapy?
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Alleviation of symptoms by reducing the number and severity of lesions.
Slowing the progression of signs and symptoms. Limiting the disease duration and recurrence. Prevention of long-term disfigurement associated with scarring and hyperpigmentation. Avoidance of psychological suffering. |
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What are the five principles of acne therapy?
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Medication regimens should be selected and altered as appropriate for the severity and staging of the clinical presentation.
Regimens should be tapered over time, adjusting to response. The smallest number of agents should be used at the lowest possible dosages to ensure efficacy, safety, avoidance or resistance and patient adherence. Once control is achieved, simplify medication regimens but continue with some suppressive therapy. It takes 8 weeks for a microcomedone to mature, thus any therapy must be continued beyond this duration in order to assess efficacy. |
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List the generic and trade names of representative members of the following agents to treat acne [i.e., those listed in the material provided]: topical retinoids, benzoyl peroxide products, topical antibiotics, and topical salicylic acid products?
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Topical retinoids
- Tretinoin (Retin-A) 0.01-0.1% cream and gel - Adapalene (Differin) 0.1% and 0.3% cream, lotion and gel - Tazarotene (Tazorac) 0.05% and 0.1% cream and gel Benzoyl peroxide products - Benzoyl peroxide (Benzac) - Combos w/ sulfur, hydrocortisone, adalapene, salicylic acid or tocopherol Topical antibiotics - Erythromycin (Ery) 2% ointment, solution, gel, pads - Clindamycin (Cleocin-T) 1% solution, gel, lotion, swab Topical salicylic acid products - Salicylic acid (Fostex) |
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What are the mechanisms of action of the following topical products for acne: retinoids, benzoyl peroxide, antibiotics, salicylic acid?
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Retinoids
- Reduce obstruction within the follicle Benzoyl peroxide - Bactericidal agent, ability to prevent or eliminate the development of P. acnes resistance Antibiotics - Antibacterial, prevents P. acne from growing, can develop bacterial resistance Salicylic acid - Comedolytic, less potent than topical retinoids |
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What is the rationale for combination products containing topical retinoids and topical antibiotics?
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The combo of topical retinoids and topical erythromycin or clindamycin is more effective than either agent used alone.
Eliminates or reduces bacterial resistance and enhances efficacy. |
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Arrange the following oral antibiotics in order of effectiveness in reducing colonization with P. acnes in acne patients: tetracycline, doxycycline, minocycline.
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Minocycline > Doxycycline > Tetracycline
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What is the indication for using oral antibiotics in the management of acne?
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Standard of care in the management of moderate to severe acne and treatment or resistance forms of inflammatory acne.
Bacterial resistance to antibiotics is an increasing problem and should not be used for patients with less severe forms of acne. |
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Which patients should receive oral erythromycin instead of a tetracycline antibiotic for acne?
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Those who cannot use tetracyclines
- Pregnant women or children < 8 years old |
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What are the adverse effects that may complicate therapy of acne with oral antibiotics?
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Vaginal candidiasis complicates use of all oral antibiotics in women with acne.
Doxycycline - photosensitivity Minocycline - pigment deposition in skin, mucous membranes and teeth, especially with long term therapy and/or high doses - pigmentation occurs most often in acne scars, anterior shins and mucous membranes |
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What is the role of oral corticosteroids in the management of acne vulgaris?
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Temporary benefit to relieve inflammatory symptoms and manifestations in patients who have severe inflammatory acne.
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What are two oral contraceptives useful in treating acne in some women?
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Norgestimate with ethinyl estradiol
- Ortho Tri-cyclen Norethindrone acetate with ethinyl estradiol - Estrostep |
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What are two oral anti-androgens useful in the treatment of acne and the adverse effects that may limit their use?
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Spironolactone (Aldactone)
- May cause hyperkalemia, especially if the patient has renal insufficiency - Occasionally can cause menstrual irregularity Flutamide - Can cause hepatic toxicity |
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What is the indication for using isotretinoin in the management of acne vulgaris?
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Treatment of severe recalcitrant nodular acne.
Also useful for the management of lesser degrees of acne that are treatment resistant or for the management of acne that is producing either physical or psychological scarring. |
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What is the dose and duration of therapy with isotretinoin (Accutane)?
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Dose
0.5-1.0 mg/kg/day, given BID with food Duration 15-20 weeks |
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What are the adverse effects of isotretinoin, specifically its mucocutaneous, musculoskeletal, ophthalmic, and CNS effects?
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Mucocutaneous effects
Dry lips, dry mucous membranes, epistaxis, dry skin, dry hair, peeling of palms and soles, photosensitivity MSK effects Usually observe arthritis, myalgia and back pain Hyperostosis, premature epiphyseal closure and bone demineralization have been observed with prolonged use of higher doses of retinoids (finding may not be found with usual course of treatment) Ophthalmic effects Dry eyes, visual disturbances, poor night vision CNS effects Headache |
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What is the appropriate laboratory monitoring for a patient on isotretinoin and the rationale for each?
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Triglycerides
May increase, increasing risk of pancreatitis Cholesterol- may increase Hepatic transaminases- may cause hepatitis CBC- may decrease RBCs, WBCs and platelets (may also increase platelets in some) |
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What is the rationale for not using isotretinoin in women who are pregnant or considering getting pregnant?
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Potent teratogen and may cause fetal abnormalities.
Patients must use iPLEDGE program and be participating in approved pregnancy prevention and management. |
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What is the indication for using intralesional corticosteroids in the management of acne?
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Effective in the treatment of individual acne nodules.
Most established and proven beneficial for large inflammatory lesions and those with cystic acne. |
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What is a corticosteroid preparation suitable for intralesional injection in a patient with acne?
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Triamcinolone acetonide (Kenalog)
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What is the role of complementary therapy and diet in patients with acne vulgaris?
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Herbal and alternative therapies have been used to treat acne. Although these products appear to be well tolerated, very limited data exists regarding the safety and effectiveness of these agents.
Psychological approaches, including biofeedback and hypnosis, to counter the psychological effects of acne are minimally helpful in the absence of effective medical therapy. Dietary restriction had not been demonstrated to be of benefit in the treatment of acne. Specifically, studies have failed to support a link between eating chocolate or sugar and the development of acne. |
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What is the lifetime prevalence of acne vulgaris in the entire population?
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90% (highest incidence in adolescents)
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What is the dose and common adverse effect(s) of retinoids for the treatment of acne.
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Dose
- Applied once a day in the evening after cleansing the affected areas. Adverse effects - skin irritation (redness, itching, burning, stinging, peeling) and photosensitivity |
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What is the dose and common adverse effect(s) of benzoyl peroxide for the treatment of acne.
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Dose
- Erythromycin - 1-2 times daily to affected areas - Clindamycin - twice daily Adverse effects - skin irritation, photosensitivity and bleaching hair |
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What is the dose and common adverse effect(s) of antibiotics for the treatment of acne.
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Dose
- Applied 1-2 times daily Adverse effects - skin irritation especially burning and tenderness |
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What is the dose and common adverse effect(s) of salicylic acid for the treatment of acne.
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Dose
- 2%, 3%, 6% preparations - 1-2 times daily Adverse effects - skin irritation |
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What is the relationship between isotretinoin and mood disorders, depression, suicidal ideation, and suicides?
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Mood disorders, depression, suicidal ideation and suicides have been reported in patients taking isotretinoin however, a causal relationship has bot been established.
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What is the oral antibiotic most associated with bacterial resistance when used chronically in the management of acne vulgaris?
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Erythromycin
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What are the main types of pediculosis?
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Lice infections can be caused by:
- Head lice (pudiculus humanus capitis) - Body lice (pediculus humanus) - Crab lice (phthirus pubis) |
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Complications of lice infections
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Scratching can result in folliculitis, hemorrhagic macules or papules, post-inflammatory skin thickening and pigmentation.
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What are the adverse effects that limit the use of pyrethrin and the methods to minimize these adverse effects?
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The primary adverse effects reported with permethrin products is local irritation.
Patients with a history of ragweed allergy occasionally react to pyrethrin. Malathion lotion 0.5% is an alternative if there is an allergy to pyrethrin. |
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Pyrethrin mechanism of action
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Blocks the transmission of nerve impulses in lice and kills them in a few minutes.
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What is the dose and common adverse effect(s) of azelaic acid for the treatment of acne.
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Dose
- 15% or 20% cream - Twice daily in the morning and evening Adverse effects - skin irritation (especially burning and pruritus), hypopigmentation, and hypersensitivity reactions |
