Dermatology Therapies – Flashcards
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they are for drying (acute inflammation)
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what do aqueous preparation do
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moisturizing (chronic inflammation)
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What do oil based products do?
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moist locations - intertriginous
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What are powders used for?
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when therapy needed for large surface areas
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What are liquids used for?
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a preparation for topical use containing a water based - essentially a preparation of oil in water
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What is a lotion?
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weeping eczema, or those who have dry skin that is on the mild side
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What are lotions best use for
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Lotions are better for parts of the body where there is more hair, such as the chest for men
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Do you use lotion on hair parts of body
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a preparation for topical use that contains a water base, but is thicker than a lotion
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What is a cream
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they are good at absorbing into the skin and are the best moisturizer choice in the winter wind
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What are creams used for
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a preparation for topical use that contains an oil base - essentially a preparation of water in oil
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What is an ointment
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lichenified lesions with thick crusts
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What skin conditions need oinments
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Dyshidrotic eczematous dermatitis
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presents with a pruritic, erosive, and erythematous rash that appeared in a recurrent pattern on the bottom of his feet. scaling and eep-seated (tapioca-like) vesicles were also observed. What is the condition
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the lesions of dyshidrotic eczematous dermatitis can appear on soles, palms, and sides of toes and fingers.
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What is characteristic about dyshidrotic eczematous dermatitis
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a genetically determined state of hypersensitivity to envirnomental allergens. Type I allergic reaction is associated with the IGE antibody and a group of diseases, prinicpally astma, hay fever, and atopic dermatitis
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What is atopy
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symptomatic, aimed at controlling inflammation and relieveing itching. It consists of high-potency topical corticosteroid therapy combined with a gel containing coal tar
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What is the treatment for dyshidrotic eczematous dermatitis
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pomphylox
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what is dyshidrotic eczema's other name
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high strength topical steroids & cold compresses
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what is a typical first line treatment for dyshidrotic eczema
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short course of oral steroids
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What is second line treatment for dyshidrotic eczema
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use compresses with Burow solution (10% aluminum acetate) in a 1:40 dilution until bullae resolve
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If bullae are present in dyshidrotic eczema, how do you treat
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skin atrophy and pigmentation changes
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What will chronic use of topical steroids do to a patient with atopic dermatitis
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it begins with IgE associated reaction causing the release of numerous cytokines, including various interleukins
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What is the inflammatory response in atopic dermatitis
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soften skin, lipids and oils that allow the skin to retain water and lubricate the skin, fill cracks between clusters of desquamating cells
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What do emollients do to your skin
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aloe vera, jojoba oil, vitamin A&E
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What are examples of emollinets
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add moisture, made in a emollient base to seal in moisture, containing multiple ingredients
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What do moisterizers do to the skin
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after a shower to seal in the moisture
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what is the best way to apply moisturizers
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fruit oils, shea butter, aloe, green tea
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What are some ingredients of moisturizers
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used in derm products and cosmetics to help retain or absorb ambient water
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What is humectant?
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gylcerol or glycerin
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What is frequently used in moisturizers or creams
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creates a barrier over the skin to reduce water loss. works best when applied to dampened skin
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What does occlusive mean
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odor, allergenicity, greasy feel
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What is the limitations to an occlusive dressing
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petroleum jelly, lanolin, topical mineral oil
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what are examples of occlusive dressings
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look for topicals with ingredients like pertoletum, glycerin, hyaluronic acid and cyclomethicone (humectants & occlusives) - all of which help prevent water loss from your skin
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What should you look for in a lotion to reapply to hands after washing to hold in moisture
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AHA's smooth fine lines and surface wrinkles, improves the texture and tone of skin, unblocks pores, and improves the overall condition of the skin
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What do alpha-hydroxy acids do?
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cause exfoliation of the surface skin. extent of exfoliation dependent on concentration & pH of AHA "skin peelers"
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How do AHA's work?
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burning, dermatitis, edema, pigmentary changes, and blisters or welts
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What is an adverse effect of AHA?
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Lac-Hydrin is 12% lactic acid, a formulation of AHA, acts as a humectant, influencing hydration
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What is 12% Lactic Acid?
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yes
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Is Lac-Hydrin and OTC?
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the treatment of xerosis, keratosis pilaris, and ichthyosis vulgaris and for temporary relief of itching associated with these conditions
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What is Lac-Hydrin indicated for?
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pathological dryness of the skin (xeroderma), the conjunctiva, or the mucous membranes
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What is xerosis?
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burning, peeling, erythema, dryness, hyperpigmentation - also PG - B
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What are adverse effects of Lac-Hydrin?
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a form of vitamin A that plays an important role in anti-aging skin care. the purest and most active form of vitamin, retinol aids in the resurfacing and rejuvenating of skin, helping to impart a clearer, more vibrant complexion for all ages and skin types
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What is Retinol?
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*normalize hyperkeratinization and have demostrated significant anti-imflammatory effects *reduce hyperkeratinization and allow enhanced penetration of adjunctive topical agents
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How does Retinol help the skin?
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promotes reversal of comedogenesis, leading to a reduction in microcomedos, which is a precursor of both inflammatory and noninflammatory acne lesions
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What does Retinol help reverse?
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reverses thickening of the stratum corneum and the abnormal desquamation of keratinocytes
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What does Retinoic acid (tretinoin) do?
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Propionibacteria acnes are anaerobic bacteria that cause acne
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What is the bacteria that causes acne?
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antibacterial (oxidizes bacterial proteins).
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What is the primary effect of Benzoyal Peroxide?
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inflammatory Acne (papules, pustules, cysts). beneficial for comedones, but less so than Retin-A. *also reduces the concetration of FFA's
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What does benzoyal peroxide work best for?
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*water-based gel: less irritating & less effective *alscohol-based gel: more irritating & more effective
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What type of vehicle does benzoyl peroxide come in?
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drying and peeling (desquamation) and bleaching of clothing & lines
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What are adverse effects of benzoyl peroxide?
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proactive, Adapalene, benagel
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Name a couple trade names of benzoyal peroxide
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produces desquamation of the horny layer of skin while not affecting qualitative or quantitative changes in structure of the viable epidermis
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What does Salicylic Acid do?
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clearsil & stri-dex
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Name a couple OTC brands of salicylic acid
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treats - acne, dandrugg, psoriasis, sevorrheic dermatitis, calluses,corns, warts, depending on preparation dosage and strength. High potency products are by prescription only
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What does salicylic acid treat?
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Aspirin association (acetylsalicylic acid) salicylic acid & other salicylates occur naturally in fruits & plants
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Where can salicylic acid naturally occur?
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anti-pruritics - which are used to relieve itching (it doesn't treat the cause, it treats the symptoms)
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What class of medications does calamine lotion belong to?
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is a topic treatment that combines zinc oxide and iron (III) oxide to produce a lotion that is utilized to help mitigate irritants associated contact dermatitis
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What does calamine lotion do?
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insect bites, rhus dermatitis & chicken pox
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What type of conditions have calamine lotion used for?
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twice daily, may cause drying of the skin
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How often should calamine lotion be applied to the skin?
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a product that consists of oats that have been ground very fine for use as a home remedy for itchy or dry skin
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What is colloidal oatmeal
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*avenacin compounds, which have antifungal properties; saponin, which can help in cleansing; and flavanoids,which help with UVA absorption
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what are the active ingredients in colloidal oatmeal
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the cellulose and fiber released from the oats yields a softening emollient, which sooths skin and lower the pH of the skin
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How does a colloidal oatmeal bath work?
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dries the oozing and weeping of rhus dermatitis
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What do Diphenhydramine creams work
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temporary relief of itching and pain associated with minor skin irritation due to insect bites, poison ivy, etc
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What does diphenhydramine help
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skin sensitization and subsequent contact dermatitis
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what can diphenhydramine cause
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drying agents that draw out protein, causing the skin to contract. constricts blood vessels, helping to soothe inflammation
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What are astringents?
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external use only: for insect bites, rhus, edema, allergies and bruises
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what can you use an astringent on
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Burow's solution (Aluminum Acetate) Domeboro solution (Aluminum Sulfate)
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Name a couple of preparations of astringents
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*powerful antihypertensive with serious adverse effects *peripheral vasodilator that reduces elevated systolic and diastolic blood pressure by decreasing peripheral vascular resistance
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What is Loniten?
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pericardial effusion, tamponade, angina pectoris and hypertrichosis
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What are the adverse effects of Loniten?
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hypertensive patients unresponsive tonmaximum therapeutic doses of a diuretic & two other antihypertensive agents
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What is Loniten reserved for?
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Male & Female: stimulates hair growth after several months and last only as long as the medicine continues to be used. hair starts within a few months after minoxidil treatment is stopped
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What does Minoxidil (Rogaine) do?
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BID to scalp
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How many times should minoxidal be applied
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scalp itching, dryness, scaling, flaking, irritation, or burning. Stop Rogaine if: Wt. gain, swelling of the face, ankles, hands, difficulty breathing, rapid heartbeat, chest pain, lightheadedness
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what are the adverse effects of minoxidal
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the ratio of the least amount of UVB energy required to produce a minimum erythema reaction through a sunscreen product film, to the amount required to produce the same amount of erythema w/o a screen. SPF or 8 = 8x longer to develop erythema
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What is the sun protective factor (SPF)
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they penetrate the atmosphere and cause premature skin aging, cataracts, and skin cancers
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What will UVA & UVB do to you?
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*95% of the UV radiation reaching the earth's surface *penetrates the skin more deeply than UVB *major part in the skin aging and wrinkling (photoaging), and initiates skin cancer *UVA: dominant tanning ray *tanning booths primarily emit UVA
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What do we need to know about UVA
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*primary cause of erythema & sunburn, damages the superficial epidermal layers *key role in the development of skin cancer contributes to tanning and photoaging *most significant amount of UVB hits the US between 10-4 *minimal glass penetration
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What do we need to know about UVB
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a relatively common benign vascular lesion of the skin and mucosa with questionable cause
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What is a pyogenic granulosum
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they are neither infectious nor granulomatous
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Why are pyogenic granulomas misnamed
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the lesion usually occurs in children and young adults as a solitary, glistening red papule or nodule that is prone to bleeding and ulceration
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Who does the pyrogenic granulomas effect
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trauma, hormonal influences, viral oncogens, underlying microscopic arteriovenous malformations, the production of angiogenic growth factors, and cytogenetic abnormalities
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What have been postulated as causes of pyrogenic granulomas
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remove it
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If a clearly traumatic cause exists for its development, what should you do
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Topical imiquimod cram and alitretinoin gel
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Have any medications help pyrogenic granulomas
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(antifungal) drugs interfere with the normal life cycle of fungi by inhibiting normal functioning of one or several vital cellular entities (altered patterns of growth, differentiation, transformation, and viability of the fungus)
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What is an antimycotic
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derivatives disturb membrane integrity by interfering with the biosynthesis of lipids
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What does Imidazole do to fungi
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targets certain cellular organelles
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What does Griseofulvin do to fungi
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although different in their modes of action, have cellular membranes as the common target organeele, with cell membranes being affected, imidazoles seem to be more selective and thus less toxid to the host then polyene antibiotics
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What are similar with Polyenes Antibiotics and Imidazoles
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inhibit squalene epoxidase, another ezyme required for ergosterol synthesis
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What the allylamines do fungi
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active against dermatophytes, dimorphic fungi, and yeasts, and they also possess prominent antibacterial activity
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What is Imidazoles broad sprectrum of activity?
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the imidazole dertivatives inhibit the biosynthesis of ergosterol, the main sterol in membranes of fungi. these agents alos affect the synthesis of triglycerides and phospholipids
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How do imidazoles inhibit fungi?
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imidazoles cause an intracellular buildup of toxic concentrations of hydrogen peroxide, may contribute to the observed deterioration of subcellular organelles and to cell necrosis
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what can build up in certain bacteria if using imidazoles
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Clotrimazole (Lotrimin) Miconazole (Monostat) Ketoconazole (Nizoral) Fluconazole (diflucan) Itraconazole (Sporanox)
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Name 3 Imidazoles
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topical, oral troches, intravaginal uses
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How is Miconazole used?
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tinea pedis, tinea cruris, tinea versicolor, ringworm, and oral & vaginal candidiasis
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What does Miconazole help cure
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Trichophyton rubrum, Trichophyton mentagrophytes, and epidermaophyton floccosum in the treatmentof cutaneous candidiasis
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What does Miconazole help treat
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apply topical area BID PV AHS Troche daily
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How should Miconazole be used daily
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wide systemic spectrum of dermatophytes and yeast
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What does ketoconazole treat
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oral (mostly)and shampoo
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How can ketoconazole be used
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requires gastric acidity for absorption
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What is required for ketoconazole to be used
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most serious is hepatitis, resolves on discontinued use. has caused hepatic failure with long term use. also causes jaundice, anorexia, malaise, and N&V
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What are the adverse effects of ketoconazole
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100 & 400mg doses for once daily dosing
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How much suggest of ketoconazole per day
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inhibits fungal cell membrane ergosterol - cell rupture
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What does fluconazole do the the fungis
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Crytococcus neoformans & coccidioidoycosis
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Fluconazole is drug of choice for what bugs
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pigeon droppings - opportunistic infection in decreased immunity
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What is crytococcus neoformans cause from
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*no endocrine side effects and great CSF penetration *less systemic SE than ketoconazole *not dependent of GI acidity
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What is good about Fluconazole compared to other imidazoles
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itraconazole has no endocrine sides effects, poor CSF penetration, but same MOA as fluconazole
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What is the differnence between itraconazole and fluconazole for CSF penetration
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blastomycosis,histoplasmosis, sportotrichosis
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Itraconazole is the drug of choice for what conditions
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highly infectious soil is found near areas inhabited by bats and birds - missionary worker may have the pulmonary form
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What causes histoplasmosis
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yes need Gi acidity
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Is itraconazole dependent on GI acidity?
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dermatophyte infections (onychmycosis) also works for candida albicans
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What is Terbinafine (Lamisil) the drug of choice for?
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griseofulvin & itraconazole
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Terbinafine is better tolerated and shorter course than what durgs?
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An allylamines that inhibits fungal squalene epoxidase, resulting in fungal cell death
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What is Terbinafine MOA
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#1 is GI disturbances (N/V/D) also HA and rash - rare is hepatoxicity
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What is the adverse effect of terbinafine
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boggy red areas characterized by a sever inflammatory infiltrate with pustule formation
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What is a kerion
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dermatophyte infection only
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What is Griseofulvin effective against
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on actively growing dermatophyte, by inhibiting cell wall synthesis
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When does griseofulvin work best
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sweating increases the concentration nin the stratum corneum
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what increases the concentration of griseofulvin
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typically due to inadequate dosing
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What would treatment of griseofluvin fail
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once or twice daily with meals for absorption
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When should a patient take griseofluvin
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HA, GI sypmtoms. Rarely hepatoxicity, leukopenia, photosensitivity
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What are the adverse affects of griseofulvin
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concomitant use of Azole antifungals (ketoconazole, itraconazole, etc) and Cisapride (Propulsid) causes serious cardiac effects
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What antifungal combination can cause serious cardiac effects
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oral anticoagulants and antihypoglycemics
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What other interaction can Azoles and grisefulvin affect?
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>2 yo
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What are the age restrictions of ketoconazole
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special consideration for systemic infections
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What are the age restrictions of itraconazole
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>4yo
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What are the age restrictions of Terbinafine
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>2yo
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What are the age restrictions of fluconazole
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>30#
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What are the age restrictions of griseofulvin
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yeast +/- bacterial
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What is Perleche or angular chelitis caused by
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anifungal with steriod
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What is the treatment of angular chelitis
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Cutaneous T-cell Lymphoma
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Presentation - pruritic area on neck and occiput area. been there for the past year or two, but has become itchier and now is slightly raised and scaly. no wt. loss, chronic illness,not taking any meds. been feeling run down. plaques are raised, fine scale, annular, well dearcated and erythematous with irregular borders. KOH shows only skin cells what is the condition
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systemic symptoms as fever, fatigue, and weight loss may be present
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What symptoms can show up later in CTCL
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patches, plaques, or tumors which may have a long natural history.
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What would the skin rash of mycosis fungoides look like
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peripheral lymphadenopathy
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what is the most frequent site of extracutaneous involvement in mycosis fungoides
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may affecta any area of the skin, but they are often distributed asymmetrically in the sun-protected areas that a bathing suit would cover (hips, buttocks, groin, lower trunk, axillae, breasts)
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How are the patches and plaques distributed over the body of myocis fungoides
