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StylizedWhistle2284

Uploaded by StylizedWhistle2284

UNC School of Nursing

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dermatology skin care acne treatment medical conditions

Summary

This document provides an overview of various skin conditions, treatments, and considerations. It details different topical and systemic treatments for acne and other skin problems. It includes information on medications, side effects, and specific instructions for certain conditions.

Full Transcript

**Name/Type** **MOA** **Indications** **SE** **Considerations** **ACNE** **Wash hands after application of all of these** **Benzoyl Peroxide** **1-3x/day** Antibacteriial agent that kills P. acnes through the release of free oxygen radicals and is also mildly comedolytic Mild to mod acne...

**Name/Type** **MOA** **Indications** **SE** **Considerations** **ACNE** **Wash hands after application of all of these** **Benzoyl Peroxide** **1-3x/day** Antibacteriial agent that kills P. acnes through the release of free oxygen radicals and is also mildly comedolytic Mild to mod acne -Results can be seen in as soon as 5 days -may bleach hair, clothes, bedding -Preg cat C -Approve in pts \>/= 12yo **Topical ABX** Mild to moderate Acne **Clindamycin** **(Clindagel)** inhibits bacterial protein synthesis by binding to the 23S RNA of the 50S subunit of the ribosome. Clindamycin is bacteriostatic -preferred ABX d/t potent action and lack of absorption **Erthyromycin** **(Erygel)** a macrolide antibiotic, inhibits protein synthesis by binding to the 50S subunit of the bacterial ribosome in susceptible organisms -reduced efficacy due to resistance to staph and s. acnes **Topical Retinoids** Vitamin A derivitive **Tretinoin** Binds to alpha, beta, and gamma retinoic acid receptors Comedonal acne -dryness -peeling -erythema -irritation -photosensitvity -wait 30 minutes after washing face prior to applying to minimize irritation and redness -apply at different times as Benzoyl peroxide Approved in pts \>/= 10 -preg Cat C **Adapalene** Selectively binds to beta and gamma retinoic raptors, comedolytic and anti-inflammatory effects Comedonal acne -Preg Cat C -approved in pts \>/=12 **Systemic ABX** **Tetracycline** Can decrease keratin in sebascous follicles and has greater affinity for inflammatory cells and bacteria thus is more concentrated in the area of inflammation -First line treatment of moderate to severe acne -permaent teeth discoloration Approved for pts \>/= 8yo **Minocycline** \--antimicrobial effect by the inhibition of protein synthesis -Enhanced penetration to tissues and sebaceous glands Mod to severe inflammatory acne -tooth discoloration -tinnitus -dizzyness **Doxycycline** -nhibits bacterial protein synthesis by binding to the 30S ribosomal subunit. -Enhanced penetration to tissues and sebaceous glands Mod to severe inflammatory acne -photosensitivity -GI disturbances **Amoxicillin** semisynthetic beta-lactam antibiotic which inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins in the cell wall Mod to severe inflammatory acne GI disturbances Hypersensitivities -Alternative treatment during pregnancy **Others** **Sulfone Agent:** **Dapsone** **Aczone Gel** Anti-inflammatory Slows groth of bacteria acne -redness -burning Drying itching -may be oxidized by Benzoyl peroxide and cause orange-brown discoloration that can be brushed off -approved for \>/= 12 -Preg Cat C -caution in use of sulfa allergy **Azelaic Acid** Comedolytic Antibacterial Anit-inflammaotry Interferes with DNA synthesis of bacteria -Mild to moderate acne -Alternative to topical retinoids -putular rocasea -use in sensitive skin for Fitzpatrick skin type IV or greater -burning -irritation -approved in pts \>/= 12 -Preg cat B **Hornonal agents** Ethinyl -estradiol/norgestimate -Ethinyl estradiol/norethindrone acetate/ferrous fumarate -Ethinyl estradiol/Drosperinone -Ethinyl estradiol/drospirenone/levomefolate Inflammatory and comedonal lesions -VTE -MI -Breast CA -Cervical Ca -Osteopenia **Oral Retinoid: Isotretinoin** **(Accutane)** An isomer of retinoic acid that decreases sebum prodution, P. acnes growth, and inflammation -moderate acne that is treatment resistant or that produces physical scarring or psychological distress -photosensitivity -Cheilits -skin desquamation -hypertriglyceridemia -depression -routine monitoring of serum lipid levels and LFTs -approved for pts \>/= 12yo -Preg Cat X -Teratogenic -iPLEDGE program-abstain from sex or use 2 contraceptive methods **Atopic Derm** **Derm infections** **Chronic Pruritis** Most common form of eczema Most common in kids **Emollients** Aveeno Excema -colloidal oatmeal Vanicream moisturizer Maintenance therapy for atopic dermatitis -apply after bathing **Topical Corticosteroids** First line therapy in patients unresponsive to good skin care and regular use of emollients **Low** Desonide hydrocortisone(least) face -longer duration of maintenance therapy **Low- Medium** Desonide Fluocinolone **Medium** Mometasone Triamcinolone body -short term management of exacerbations **High** Desoximetasone Fluocinide Halcinonide -thining of the skin -short term management of exacerbations -short term treatment 1-2 weeks of lichenified areas in adults **Super-High** Clobetasol Fluocinide Flurandrenolide Halobetasol -avoid face, genitalia And intertriginous areas in young infants -thining of the skin -short term treatment 1-2 weeks of lichenified areas in adults -Adrenal function should be monitored in children on high potency and adults over 50g weekly **Topical** **Immunomodulators:** **Tacrolimus** Calineurin inhibitors 2nd line treatment due to risk of cancer Use in unresponsve to corticosteroids or if large surface body area -may be use on face, eyelids, and skin folds -moderate to severe cases -burning -irritation -apply sunscreen risk of skin cancer -approved in pts 2yo **Mupirocin** **(Bactroban)** Inhibits protein synthesis bactericidal Impetigo MRSA S. aureus S. pyogenes -TID for 10 days -cream 2% is expensive -ointment 2% is cheap **Ketaconazole \[Nizoral\]** -Ergosterol inhibitor -imidazole antifungal agent that inhibits the CYP450 dependant enzyme lanosterol 14 alpha-demethylase which is responsible for the conversion of lanosterol to ergosterol in the fungal cell membrane. -fungal infections=candidiasis, blastomycosis, histoplasmosis, paracoccidiomycosis, -Seborrheic dermatitis -Tinea vesicolor cause by Malassezia furfur Seborrheic derm Prostate cancer Skin irritation Hepatotoxicity QTI prolong -Requries gastric acidity for absoprtion -teratogenic in animal studies **Tolnaftate \[Tinactin\],** distort the hyphae and to stunt mycelial growth in susceptible organisms Tinea Superficial fungal infections Skin irritation -OTC **Griseofulvin \[Grifulvin\]** Fungistatic, targets new skin where it will bind to keratin therby preventing new fingal infections of keatinous structures -binds to microtubules in the mitotic spindle this inhibiting mitosis -ringworm of the scalp 2-4 weeks -ringworm of the finger and toe nails 4-6 months -althletes foot 4-8 weeks Limited to: -Micorsporumnea spp, Trichophyton spp -HA -Hypersensistivity -Hepatisis -leukopenia -granulocytopenia -failure of BC Preg Cat D/X -high affinity for fat -caution with hepatic dz -contraindicated in preg -CMP and CBC q2 months Disrupts NA channel current on neurons\> paralysis of lice 10 day residual activity Pediculosis Capitias (head lice) Skin irritation Burning Pruritis Contact dermatitis \>2 months of age -apply treatment per directions, remove nits with comb -reapply in 1 week Absorbed through exoskeleton, blocks Na channel of neuron- paralysis and death Pediculosis Capitias (head lice, Nix) Head, body, pubic lice Skin irritation Burning Pruritis Contact dermatitis **Nystatin oral Suspension** Polyene Binds to ergosterol in the cell wass thereby causing increased permeability, leakage of cellular contents and then cell death -cutaneous, mucocutaneous, oral fungal infections caused by Candida spp. -skin irritation -too toxic for IV admin -frequency of dosing QID which is biggest issue -hold in mouth then swallow -preferred in breast infections in lactating women **Systemic agents** **-**Cyclosporine -Azathioprine -Methotrexate -refractory, severe atopic dermatitis -**cyclosporine**: HTN, Nephrotoxicity, Increases TGs, skin malignancies -**Azathioprine**: N/V, GI symptoms **-Methotrex**:Hepatotoxicity -short term use -**Cyclo**: BP and renal q week for 3ms then q month, CBC, LFTS and lipids q month -**Methotrex:** off 3 month prior to conception, LFTs monthly x6 months then q1-3 months, supplement folate **Systemic Steroids** -exclusively reserved for acute, severe exacerbations as a short term bridge therapy to other systemic therapy -Avoid if possbile -taper off Both Acne Articles: **Understanding Acne Vulgaris** ------------------------------- ### Pathophysiology - - ### Psychosocial Impact - **First-Line Treatment Options** -------------------------------- ### Topical Retinoids Topical retinoids are vitamin A derivatives crucial for treating acne by normalizing follicular hyperkeratinization and blocking inflammatory pathways. #### **Adapalene** - - - - #### **Tretinoin** - - - - #### **Tazarotene** - - - - ### Benzoyl Peroxide (BPO) BPO is an oxidizing agent effective against Cutibacterium acnes and is available in various formulations. - - - ### Antibiotics #### **Topical Antibiotics** - - #### **Oral Antibiotics** - - - - ### Isotretinoin Reserved for severe nodulocystic and treatment-resistant acne, isotretinoin is a potent systemic retinoid. - - - **Cost Analysis and Insurance Considerations** ---------------------------------------------- - - - Acne non-pharm therapy: - - Chronic Prutitis: Causes: Dermatologic, Systemic: meds, malignancy, Neurologic, Psychogenic, Mixed, undetermined - - - - - - - - - - - - - **Chronic Prurits Article info:** **Categorizing Pruritus** ------------------------- **Chronic pruritus can be categorized into six primary etiologies:** 1. 2. 3. 4. 5. 6. **Evaluation of Pruritus** -------------------------- ### **Medical History and Physical Examination** The initial approach involves a comprehensive medical history and physical examination: - - - ### **Laboratory Tests and Imaging** When the cause of pruritus is not immediately apparent, laboratory tests and imaging studies can offer valuable insights: - - **Management Strategies** ------------------------- ### **Topical Therapies** #### **Emollients and Cleansers** Topical moisturizers are fundamental in treating mild, localized itch, especially associated with xerosis or eczema. Emollients should be free of irritants like lanolin and fragrances. #### **Corticosteroids and Calcineurin Inhibitors** - - #### **Anesthetics and Coolants** - - #### **Phosphodiesterase Inhibitors and Cannabinoids** - - ### **Systemic Therapies** #### **Antihistamines** While less effective for most chronic itches, oral antihistamines like hydroxyzine and diphenhydramine are valuable for conditions like urticaria and nocturnal pruritus. #### **Anticonvulsants** Gabapentin and pregabalin, initially for chronic pain, effectively manage neuropathic and idiopathic itching, although they may cause drowsiness and weight gain. #### Opioid Modulators - - #### **Antidepressants** Medications like mirtazapine and SSRIs (fluvoxamine, paroxetine) target serotonergic pathways to relieve pruritus from various origins. Side effects often include drowsiness and weight gain. ### **Holistic Approaches** Stress exacerbates pruritus, thus stress management techniques, including mindfulness, cognitive behavioral therapy, and acupuncture, are beneficial adjuncts to medical treatments. ### **Emerging Treatments** Advancements in the understanding of itch have led to the development of novel treatments: - - - ![](media/image3.jpg) Atopic Dermatitis ![](media/image1.jpg) Fungal ![](media/image5.jpg) Atopic Dermatits Article: **Diagnostic Criteria** ----------------------- ### Essential Features - - - - - - - - ### Important Features - - - - ### Associated Features - - - ### Exclusionary Conditions - - - **Management Strategies** ------------------------- ### Basic Management for All Patients - - - - ### Acute Treatment of Flares - - - - - - ### Maintenance Therapy for Moderate-to-Severe Disease - - - - ### Individualized Treatment Plans - - - ### Patient and Caregiver Education - - - - **Adjunctive Therapies and Measures** ------------------------------------- ### Wet-Wrap Therapy (WWT) - - ### Antiseptic Measures - - - - ### Mental Health Considerations - - **Resources for Patients and Caregivers** ----------------------------------------- - - - - - - Atopic Dermatitis: non-pharm therapy: - - -

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