skin conditions (NAPLEX)

Topical retinoids (2)

Tretinoin (Altreno, Atralin, Renova, Retin-A)

Adapalene (Differin)

Oral retinoids (1)

Isotretinoin (Absorica, Amnesteem): RX capsules

Only FDA approved for severe, recalcitrant nodular acne

Oral retinoids BW/REMS

Birth defects

REMS (iPLEDGE) with 1 month at a time

Must have 2 negative pregnancy tests prior to starting

May not get pregnant for 1 month before or 1 month after stopping

Oral retinoids DDI (4)

Vitamin A supplements

Tetracyclines

Progestin only contraceptives

St Johns Wort

How many forms of birth control are required with PO retinoids?

2 forms (cannot use a progestin only pill)

Retinoids are a vitamin __ derivative

A

How do retinoids work?

Reducing cohesion of follicular epithelial cells

Apply a pea sized amount nightly

T/F: Retinoids are teratogenic

True

Retinoids take ___-___ weeks to work, and can worsen initally

4-12 weeks

Oral ABX used for acne (2)

Doxycycline

Minocycline

_____ gel should be avoided in G6PD deficiency

Dapsone

______ can cause HPA axis suppression during acne TX

clascoterone

Cold sore OTC vs RX TX (2)

Docosanol (Abreva): OTC applied 5x a day at first sign of outbreak

Acyclovir cream/ointment (Zovirax): applied 5x a day for 4 days

Dandruff TX (5)

Ketoconazole 1% shampoo (Nizoral A-S)

Selenium Sulfide

Pyrithione Zinc (head and shoulders)

Coal Tar shampoo (T/gel)

ketoconazole 2% shampoo (RX)

Can cause hair loss

A. Hypothyroidism

B. Hyperthyroidism

A. Hypothyroidism

Alopecia TX (4)

Finasteride (Propecia): 5-alpha reductase type 2; dosing: 1mg daily, may take >3 months for results

Baricitinib (Olumiant)

Minoxidil foam/solution (Rogaine)

Bimatoprost (Latisse) for thinning eyelashes (hypotrichosis)

Where do you apply bimaprost to eyelashes?

Base of upper eyelashes only

Eczema OTC TX

Aquaphor, eucerin

Eczema RX TX (5)

Topical steroids

Topical calcineurin inhibitors

Topical PDE-4 inhibitors

IL receptor antagonists

JAK inhibitors

Do not used topical calcineurin inhibitors with children aged < ___ years associated with lymphoma and skin cancer

2

Fungal skin TX's OTC (6) & RX (2)

OTC:

butenafine (Lotrim Ultra)

clotrimazole (Lotrimin AF)

miconazole (Lotrimin AF)

terbinafine (Lamisil AT)

tolnaftate (Tinactin)

undecyclenic acid

RX:

Betamethasone/clotrimazole

Ketoconazole

How long should topical antifungals be used?

Apply 1-2 inches beyond rash and use for 2-4 weeks after even if it appears healed

Toenail fungal infection TX (2)

Terbinafine

Itraconazole

Vaginal fungal infection TX

Clotrimazole

Miconazole (Monistat 3)

Butoconazole (Gynazole-1) topical RX

Fluconazole 150mg x 1 dose

If complication or pregnant treat for 7-10 days

Diaper rash PPX & TX

PPX: skin protectant - petrolatum ointment or petrolatum with zinc oxide (Desitin)

TX: nystatin or miconazole

Example of a desiccant

Zinc oxide (in diaper rash)

Hemorrhoids TX (4)

Increase fiber intake to reduce straining with psyllium

Preparation H (phenylephrine) OTC

Hydrocortisone (Anusol-HC)

Witch hazel (cooling pads)

It can take up to ____ tape tests to identify pinworm eggs

3

Pinworm TX

OTC: Pyrantel pamoate

RX: albendazole, mebendazole

Scabies TX

A. Permethrin cream 5%

B. Permethrin lotion 1%

A. Permethrin cream 5%

Lice TX

A. Permethrin cream 5%

B. Permethrin lotion 1%

B. Permethrin lotion 1%

What is topical ivermectin approved for?

Head lice

Pediculus humanus capitis causes _____.

Lice

What lice treatment option is flammable?

Malathion lotion 0.05%

Lice TX (4)

Permethrin 1% lotion (Nix)

Pyrethrin/Piperonyl butoxide (RID)

Ivermectin lotion

Malathion lotion (RX)

Scabies TX (2)

Permethrin 5% cream

Ivermectin oral

What can be applied to burns to reduce infection risk and promote healing?

Silver sulfadiazine (Silvadene; SSD)

Burns TX (3)

neomycin/polymyxin/bacitracin (Neosporin)

mupirocin (Bactroban) RX

Bacitracin/neomycin/polymyxin B/hydrocortisone (Cortisporin) RX

Aluminum acetate is an ______

astringent

Skin irritation TX

Hydrocortisone 0.5% or 1% OTC

Potency from highest to lowest for topical steroids *** (6)

Ointment>cream>lotion>solutions>gel>spray

What RX can be used for severe itching/hives?

Hydroxyzine (Vistaril)

How do you know how much topical steroids to apply?

Use the fingertip test to estimate amount

SPF stands for...

sun protection factor

How often should sunscreen be applied?

Every 2 hours

Reapplied after swimming or sweating

Keep babies < ___ months old out of the sun

6

Time to burn (TTB) equation *

TTB (with sunscreen in mins) = SPF x TTB (without sunscreen)

If someone who would normally burn in 10 mins, an SPF of 5 would extend time they would burn to 50 minutes

Which of the following medications are acceptable treatments for lice? (SATA)

A. Lindane

B. Nix

C. RID

D. Imiquimod

E. Permethrin

NIX

RID
Permethrin

What topical steroid formulations are available OTC? SATA

A. Hydrocortisone 2.5%

B. Hydrocortisone 0.5%

C. Hydrocortisone 1%

D. Betamethasone 0.25%

E. Bethametasone 0.5%

hydrocortisone 0.5%

hydrocortisone 1%

which medications discolor the skin brown? (3)

entacapone

levodopa

methyldopa

which drugs discolor the skin brown/yellow? (1)

nitrofurantoin

which medication discolors the skin black/green? (1)

iron (stool)

which drugs discolor the skin orange/yellow? (1)

sulfasalazine

which medications discolor the skin green? (1)

propofol

which medication discolors the skin red/orange? (2)

phenazopyridine

rifampin

which medications discolor the skin red? (1)

anthracyclines

which medications discolor the skin blue? (2)

methylene blue

mitoxantrone

which medications discolor the skin blue/grey? (1)

amiodarone

Natural products used for skin conditions (5)

aloe: sunburn

tea tree oil: acne

lysine: cold sore prevention and treatment

biotin: hair loss and brittle nails

vitamin d: diaper rash and psoriasis

what medications can cause hair loss?

valproate

lamotrigine

tacrolimus

calcineurin inhibitors for eczema (2)

tacrolimus (Protopic)

pimecrolimus (Elidel)

phosphodiesterase-4 inhibitor for eczema (1)

crisaborole (Eucrisa)

interleukin receptor antagonists for eczema (2)

dt (mabs)

dupilumab (Dupixent)

tralokinumab (Adbry)

janus kinase inhibitors for eczema (3)

aur

tinib

abrocitinib (Cibinqo)

upadacitinib (Rinvoq)

ruxolitinib (Opzelura)

topical steroid potency (highest to least)

clobetasol

fluocinonide 0.1% cream

betamethasone

fluocinonide 0.05% ointment

mometasone 0.1% ointment

fluocinonide 0.05% cream

mometasone 0.1% lotion

triamcinolone

hydrocortisone