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61 Cards in this Set
- Front
- Back
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Topical agents must pass through what layer of the skin to be absorbed? |
Stratum corneum |
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Percutaneous absorption is affected by what factors (6)? |
Vehicle, hydration, age, intact vs broken skin, temperature and anatomic sites |
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List the following in order of highest to lowest potency: lotions, creams, ointments, gels, foams/aerosols, solutions |
- Ointment - Gel - Cream - Lotion - Solution - Foam/Aerosol |
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In diaper rash, use of systemic antibiotics may predispose a pt to what? |
Candidiasis |
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Bacterial infections in diaper rash are usually caused by ___ and less frequently caused by ___. |
Staph aureus; group A strep pyogenes |
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OTC treatment for diaper rash |
- Frequent diaper changes - Avoid use of wipes as they could cause contact dermatitis - Use barriers such as zinc oxide or petroleum jelly - Topical glucocorticosteroids (hydrocortisone) to alleviate inflammation |
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Treatment for candidiasis diaper rash |
Nystatin cream or powder qid alone or in combination with triamcinolone for 7-10 days |
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Broader spectrum treatment than nystatin for candidiasis diaper rash |
Clotrimazole alone or in combination with betamethasone |
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Poison ivy, oak, and sumac all cause rhus dermatitis or allergic contact dermatitis through a type IV hypersensitivity reaction 1-3 days after contact due to the active chemical ___. |
Urushiol |
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Treatment for mild rhus dermatitis |
- Aveeno baths or lotion (sooth and dry) - Aluminum acetate (Burrow's solution) tablets dissolved in 12 oz water applied with gauze (drying, astringent) - Calamine lotion (drying and soothing effects) - Camphor, menthol or phenol alcohol (promotes drying of vesicles, cooling and antibacterial effects) |
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Treatment for moderate to severe rhus dermatitis |
Same as mild treatments with: Prednisone (glucocorticosteroid) po for 7-21 days with gradually decreasing dosages Oral antihistamine to relieve itching - diphenyhydramine 25-50 mg po q6h Antihistamine such as allegra, claritin or zyrtec can be substituted for daytime use to prevent drowsiness |
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This is a type I mediated hypersensitivity reaction that is thought to have a genetic predisposition. Characterized by chronic dry skin, lichenification, fissures, dry papules and patches that frequently present on flexor surfaces. Often presents with asthma and allergic rhinitis |
Atopic dermatitis/eczema |
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OTC treatment for atopic dermatitis/eczema |
- Wet dressings with burrow's solution or aveeno - Oral antihistamines - lubricate skin with Eucerin or aquaphor - low potency topical glucocorticosteroid |
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Why is it important to use a low potency glucocorticosteroid when treating those with atopic dermatitis or eczema |
Long term use will cause atrophy of the skin, increasing the risk of infection in addition to causing patches of white skin |
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Prescription treatment for atopic dermatitis/eczema |
Topical immunomodulators: - pimecrolimus 1% cream (Elidel) - tacrolimus 0.03% or 0.1% ointment (Protopic) Can be used after 2 years of age |
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Adverse affects of pimecrolimus or tacrolimus |
Immunosuppresion - increased risk of infection, local irritation and headache |
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This disease is characterized by a shortened cell cycle of keratinocytes. It presents with thick, erythematous, silvery, scaly plaques that flake and are pruritic. |
Psoriasis |
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Mainstay treatment of plaque-type psoriasis |
High potency topical glucocorticosteroid bid for 2-3 weeks then pulse therapy (2 days on, 5 off) or switch to lower potency |
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Side effects of high potency steroids in treating psoriasis |
Thinning, tearing, striae, hirsutism, telangiectasias, bruising, perioral acne HPA axis suppression esp. in children |
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What is the rule of thumb for dosages for high potency steroids in plaque-type psoriasis treatment? |
1 gram will treat four adult-size palm sizes of the body |
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This therapy is used to treat psoriasis in combination with UVB radiation. It is applied at night as an ointment, lotion or shampoo and washed off in the morning. It can stain hair, skin and bedding. Physically, side effects include folliculitis, photosensitivity and irritation. |
Coal tar (zetar, neutrogena T gel) |
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This drug for psoriasis treatment binds to intracellular receptors to modulate genes - controlling transcription causing a decrease in proliferation of and increase in differentiation of keratinocytes. It is used as a BID cream, ointment or solution about as effective as class 2 topical steroids. |
Calcipotriene vitamin D analog (Dovonex) |
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Psoriasis treatment often used in combination with salicylic acid, petroleum jelly that inactivates cellular respiration applied for one hour and then washed off. |
Anthralin |
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Side effects of anthralin |
Stains, redness and irritation - permanent staining of clothing and bathroom fixtures etc. |
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Psoriasis treatment that is a topical retinoid (gel). Applied qd. |
Tazarotene - vitamin A derivative |
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Side effects of tazarotene |
Burning, itching, skin irritation |
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Psoriasis treatment that softens and breaks down keratins layers. It removes scales for better penetration of topical agents. |
Keratolytics |
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Examples of keratolytics |
Salicylic acid combined with coal tar, emollients (mineral oil) and phenols |
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Photosensitizing agent taken orally prior to UVA irradation (1.5-2 hours prior to exposure). Treatment is 3/week and is highly effective but relapse occurs after cessation of therapy. The agent is used to treat psoriasis. |
Methoxalen |
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Adverse effects of photochemotherapy for psoriasis |
Sunburn, long term actinic keratoses, aging and cutaneous carcinomas |
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Psoriasis treatment used in combination with PUVA with major/potential side effects of dry skin, chelitis, dry mouth and eyes, hair thinning and depression. May also cause hepatotoxicity. This drug is a major teratogen. |
Oral retinoids: acitretin isotretinoin |
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Psoriasis treatment that involves treatment with an analog of folic acid. The drug is toxic and has side effects of mucositis, myelosuppression, thrombocytopenia. May also cause hepatic fibrosis and cirrhosis and pneumotis which regresses upon discontinuance of the drug. This drug is category X and can induce abortion. |
Methotrexate |
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This is a biologic agent used for chronic severe plaque psoriasis with indications for systemic therapy |
Enbrel (etanercept) |
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Psoriasis medication that works by blocking the activation of T-cells and reducing inflammation. |
Amevive (alefacept) |
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Drugs that block TNF-alpha to treat psoriasis and psoriatic arthritis (3) |
Etanercept (enbrel), adalimumab (humira) and infliximab (remicade) |
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Contraindications for TNF-alpha blockers |
Compromised immune system, active infection present |
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Pts taking TNF-alpha blockers must be screened for what prior to taking the medication? |
TB |
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benzoyl peroxide is an OTC ___-type drug for acne treatment |
Keratolytic |
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Azelaic acid cream is a ___-type drug for acne treatment and also contains what other type of properties. |
Keratolytic; antibacterial properties |
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This is the most common OTC drug for acne treatment. It is also used for psoriasis, calluses, warts and dandruff. It is a keratolytic. |
Salicylic acid |
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Tretinoin or Retin A is used or treatment of what? |
Acne - prescription medication |
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Adverse affects of Retin A or tretinoin |
Photosensitivity, redness, drying, burning and irritation |
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This acne medication is similar to retinoids but is less irritating. |
Adapelene (Differin) |
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Mild, papular acne is usually treated with a topical keratolytic and a topical antibiotic such as ___ |
Erythromycin or clindamycin |
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Moderate, pustular, inflammatory type acne is treated best with what kind of antibiotics? |
***Tetracyclines*** - Taken PO Minocycline Doxycycline Oral contraceptives also sometimes used for females |
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Drug of choice for nodulocystic acne |
Isotretinoin |
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Treatment of scalp lesions for seborrheic dermatitis |
Selenium sulfide or zinc pyrithione shampoos Ketoconazole shampoo for dandruff |
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Treatment of skin lesions for seborrheic dermatitis |
Topical steroids or ketoconazole creams and shampoos 1-2 times a weak |
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Treatment for impetigo caused by staph and strep pyogenes |
Topical mupirocin (bactroban) ointment/cream TID for 5 days |
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Topical antibiotics such as ___ and ___ may be used to prevent infection in minor cuts and lacerations |
Bacitracin and neomycin/polymyxin B |
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Folliculitis/furunculosis/abscess treatment and medication |
I&D with dicloxacillin for 10 days or cephalexin qid for 10 days with benzoyl peroxide washes |
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Mild cellulitis treatment |
Oral PCN every 6 hours for 10 days May use: - amoxicillin q8h x10d - cephalexin q6h x10d - Cerufoxime q12h x 7-10d - cefprozil qd/q12h x 7-10d |
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Severe cellulitis treatment |
PCN IM/IV q4-6h w/ maximum 24milU/day May use: - cefazolin - cefuroxime - cefotaxime - ceftriaxone - clindamycin |
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Scabies primary treatment |
Permethrin cream (5%) applied to all areas of the body from the neck down and washed after 8-14 hours |
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Alternative scabies treatment and pts who are contraindicated |
Lindane (1%) lotion/cream applied thinly to all areas of the body from the neck down and thoroughly washed off after 8 hours Can't be used in children Ivermectin may also be used |
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Lice/pediculosis treatment |
Permethrin (1%) cream applied for 10 minutes then rinsed or Spinosad (natroba) |
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What are some common antifungals used for treating dermatophytosis? |
Terbinafine, naftifine, econazole, ketoconazole Also: Butenafine, clotrimazole, oxiconazole, miconazole, sulconazole, ciclopirox, haloprogin, tolnaftate |
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Tinea versicolor or pityriasis versicolor treatment |
Selenium sulfide, ketoconazole or zinc pyrithione shampoo scrubbed into affective areas and rinsed after 3-5 minutes qd x 1wk |
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Intertrigo treatment |
Nystatin cream! |
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Onychomycosis treatment |
MUST USE SYSTEMIC ANTIFUNGAL - terbinafine (lamisil) PO qd x 6w or 12 wk (fingernail vs toenail) - Itraconazole (sporanox) - Fluconazole (Diflucan) PO qw x6-12 months until complete nail growth |
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Tinea capitis treatment |
DOC: Griseofulvin alternative could be terbinafine |
