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Basic vehicles for dermatologic products include:
ointment, cream, lotion, gel, and solution/spray/foam
What are the drug-induced severe cutaneous reactions?
Stevens-Johnson syndrome and toxic epidermal necrolysis
What occurs during these toxic skin reactions?
losing skin and breakdown of natural barrier
Drugs associated with SJSs include:
Sulfonamides, cephalosporins, penicillins, fluoroquinolones, anticonvulsants, allopurinol, NSAIDs, etc
How is SJS/TEN treated?
Stop the offending agent!
IV fluids, pain control, eye care, nasal saline, oral hygiene, topical antiseptics and wound care
What are the 3 types of dermatitis?
Acute, subacute and chronic
What are the 2 types of acute contact dermatitis?
Allergic and irritant
Poison Ivy can occur through _______ and _______ exposure
direct and indirect
_________ therapy is okay only if local enough
What are treatment options for poison ivy?
remove source, calamine lotion, topical antihistamine, oral antihistamine, topical or oral corticosteroids
Topical corticosteroids can be used to treat acute dermatitis since they are anti-_________, anti-________ and _______ immune response
anti-inflammatory, anti-pruritic; suppress
Topical corticosteroids must be applied _________ to _______ x_________ days
bid to qid x 3-14 days
oral corticosteroids are better at anti-______ effect and suppressing ____
________ corticosteroid dose packs!
AVOID (do not provide tx for long enough time)
Systemic ________ can also treat acute dermatitis
An example of a sub-acute dermatitis is ________ dermatitis and its most common form is _______
What are some characteristics of atopic dermatitis?
Itching, symmetrical red papules or plaques, scaling excoriations, overall dryness of skin, redness and inflammation, history of allergic disease, risk of 2nd infection
What are some non-pharmacologic treatments for atopic dermatitis?
Lukewarm baths, emollients; eliminate irritants, modify environment, avoid triggers; consider bleach baths; trim fingernails, wear non-irritating clothing
What is topical therapy options for atopic dermatitis?
topical corticosteroids and topical calcineurin inhibitor therapy
What is systemic therapy options for atopic dermatitis?
phototherapy, oral immunosuppressant therapy and biologics
What is the stepwise treatment of mod-severe atopic dermatitis?
medium-potency TCS BID x 3 days; if failed, phototherapy or oral immunosuppressive therapy or biologics
What are common 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 and tolerance development
TCS class 1 (very high potency) and class 2 (high potency) should _______ be used on the face!
Topical Calcineurin Inhibitors are alternative therapy that ____________ pro-inflammatory cytokine genes.
What are the Topical Calcineurin Inhibitors?
Tacrolimus and Pimecrolimus
What are some properties of these medications?
Can be used on any area; fewer side effects (burning); expensive
Crisaborole 2% ointment can be used in patients that don't want to take __________
Crisaborole 2% ointment works as a _______________ inhibitor
Dupilumab is a human monoclonal antibody against ____ indicated for mod-severe atopic dermatitis
Stasis dermatitis occurs in patients ______ and have poor __________ and most commonly around ________
>50; circulation; ankles
What are some properties of stasis dermatitis?
red, scaly, crusted plaques; edema; secondary infection and ulcers; hyperpigmentation
What is the treatment options of static dermatitis?
Emolliants: for all pts
TCS: for itching
oral antibiotics ONLY for local infections
What are some properties of seborrhic dermatitis?
Erythema with greasy yellow scaling; hairline, scalp, nose, neck, ears, back; itching
What are the treatment options of seborrhic dermatitis?
Medicated shampoos 2-3 times per week
TCS low strength
What are the 2 classes of acne?
Non-inflammatory and inflammatory
What are topical therapy options for acne?
Adapalene, Tazorotene, Tretinoin, Azelaic acid, Benzoyl Peroxide, Clindamycin, Erythromycin and Clindamycin+BP
What are the 2 combination products for mild-moderate inflammatory acne?
If no response to topical agents, treat with ______ _____________
Oral antibiotics are most effective when ________ is present
After inflammation is controlled, acne can be controlled with ___________ and/or ___________ for long periods
topical retinoids; BP
When might oral anti-androgen therapy be used?
for females who's acne flares during menstrual cycles
When is Isotretinoin used for treatment?
Used for SEVERE acne or when patients have failed other treatments or when it relapses soon after discontinuing other therapies
What are some adverse effects of Isotretinoin?
Dryness everywhere, photosensitivity, fetal abnormalities, depression/suicide, night blindness, HA
When should acne patients be followed up?
Rosacea primarily affects the _______ part of the face
Symptoms of Rosacea include facial _________, facial __________, ________ and _________
facial flushing, facial erythema, papule, pustules and telangiectasia
Rosacea affects ages _______ and _______ complexions
What are some trigger factors of Rosacea (environmental/drugs)
Temperature, food/beverages, medical conditions, vasodilators, TCS, nicotinic acid, ACE inhibitors, calcium channel blockers, statins
How is mild Rosacea treated?
1. avoid triggers
2. topical antibiotics (metronidazole)
3. topical retinoids (azelaic acid)
How is moderate Rosacea treated?
1. Oral antibiotics (doxycycline/ minocycline)
2. topical retinoids
How is severe Rosacea treated?
1. oral isotretinoin
2. laser treatments
Psoriasis is a chronic autoimmune __________ skin disorder
What is the clinical presentation of Psoriasis?
thickened, red patches covered by silvery-white scales presented SYMMETRICALLY
What are the different major types of psoriasis?
Plaque (most common), Scalp, Pubic, Plantar, Psoriatic arthritis (joints), Guttate, Erythrodermic, Inverse and Pustular
What are some general measure treatments of psoriasis?
Sun, baths, emollients and keratolytics
What is the first line treatment for psoriasis?
What is the second line treatment of psoriasis?
UV phototherapy for limited and resistant plaques
Phototherapy can be used in combination with ___________ treatment for patients with ________ psoriasis
______ penetrates ______ lesions better than ______
UVA; thicker; UVB
What is the third line for severe psoriasis?
What is the last line for severe psoriasis?
Once symptoms are controlled on systemic therapy, use general measures and ________; ______ treatment again
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