Dermatology Conditions PDF

**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: - - -  Atopic Dermatitis  Fungal  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: - - -