Naplex - Common Skin Conditions

Aloe vera provides a ____ effect

soothing

_____ oil could be used for acne treatment

Tea tree

_____ is a topical that can be used for cold sores (herpes simplex labialis) prevention and treatment

lysine

Drugs that can cause brown skin secretions

levodopa

entacapone

methyldopa

Drugs that can cause brown/yellow secretions

nitrofurantoin

Drugs that can cause yellow/green skin secretions

propofol

Drugs that can cause red-orange skin secretions

phenazopyridine

rifampin

Drugs that can cause red skin secretions

anthracyclines

Drugs that can cause blue skin secretions

mitoxanthrone

methylene blue

Drugs that can cause blue/gray skin secretions

amiodarone

____ are the primary determinant of acne

androgens

Acne generally involves this bacteria along with sebum in oil glands

P. acnes

Acne is generally treated by these agent groups

OTC benzoyl peroxide and salicyclic acid

retinoids

topical/systemic antibiotics

systemic isotretinoin

Retinoids are known as human

teratogens

must be avoided in pregnancy or breastfeeding

Retinoids are vitamin _ derivatives

A

Retinoids mechanism

reduce adherence of the karatinocytes in the oil glands

Retinoid dosing instructions

should be started at night or every other night and used a pea sized amount

Retinoids take approximately ___ weeks to start working

4-12 weeks

Oral retinoid isotretinoin has many safety considerations and is reserved for

severe nodular acne only

____ and ____ are required for oral retinoid isotretinoins

Cholesterol

pregnancy tests

Azelaic acid (azelex/finacea) is a topical cream for

acne

rosacea

dicarboxylic acid cream/gel

First line treatment in mild acne

BPO

Topical retinoid

Topical combo therapy

Alternative: topical dapsone

First line treatment for moderate acene

Topical combo therapy

oral abx + BPO + topical retinoid +/- topical ABX

Oral contraceptives or spironolactone for females as alternative therapy

oral isotretinoin

First line treatment for severe acne

topical combo therapy + oral abx

oral isotretinoin

Topical retinoid agents

tretinoin (atralin/renova/retin-A/avita)

Adapalene (differin)

Isotretinoin

Tazarotene (tazorac/avge/fabior)

Benefits of Retin-A Micro and Avita

slower release formulation

less skin irritation with microsphere gel

Topical retinoids safety/counseling

limit sun exposure

apply daily, usually at bedtime about 20 mins after washing face

If irritation, use lower strength or every other night

topical abx and combination agents

erythromycin + BPO (benzamycin)

Clindamycin + BPO (acanya/benzaclin/duac/neuac)

Dapsone gel (aczone)

Isotretinoin (absarica/amnesteem/claravis/myorisan) boxed warnings

birth defects have been document

can only be dispensed by a pharmacy registered and activated with the pregnancy REMS (iPLEGE) program

1 month RX at a time

Isotretinoin requires that patients also ahve

two forms of birth control

female patients must sign consent form about birth defects

Additional isotretinoin notes regarding pregnancy

must have 2 negative pregnancy tests prior to treatment

cannot get pregnant 1 month before and 1 month after completing therapy

Oral abx used for acne

minocycline (solodyn)

Solodyn is used for patients older than

12 years

dosed by weight

Solodyn safety/counseling

photosensitivity

Fetal risk

May cause permanent teeth discoloration

Drugs that could contribute to alopecia

chemotherapeutics mainly because hair cells are rapidly dividing and are affected

Heparin

Valproate

spironolactone

___ and vitamin ___ can contribute to hair loss

zinc

vitamin D

Drugs used to treat alopecia

Finasteride (Propecia)

Minoxidil tppical

Bimatoprost solution for eyelashes

Finasteride moa

5-alpha reductase inhibitor that can be used to treat bph

Finasteride dosing

1 mg tablet daily at least 3 months to begin to see effect

finasteride CI

pregnancy

Finasteride warnings

hazardous drug for females of childbearing age

can damage male fetus

Latisse dosing

apply nightly to the skin at the base of the upper eyelashes only

use an applicator brush

Bimatoprost caution

do not use with PG analogs used for glaucoma due to risk of increased IOP

Cold sores can spread mostly with

active lesions

kissing

sharing drinks

Agents for treating cold sores

Docosanol (Abreva) otc

Acyclovir topical cream/ointment (zovirax) RC

Agents to treat dandruff

Selenium sulfide

Pyrithion zinc

Coal tar shampoos

Ketoconazole shampoo (Nizoral A-D) OTC

Ketoconazole shampoo (Nizoral) RX

Skin protectants for diaper rash

petrolatum ointment

+zinc oxide (a desiccant) used to dry the skin

agents for treating diaper rash

Petrolatum + zinc oxide (desitin)

Plain petrolatum (A&D ointment)

Vusion (miconazole + zinc oxide + petrolatum) rx

Eczema presents as

skin rashes which can become crusty and scaly

Treatment for Eczema

hydration and moisturizers

topical steroids

antihistamines

calcineurin inhibitors if steroids/hydration is not adequate

OTC options for Eczema

moisturizers with petrolatum/lanolin (aquaphor/eucerin)

RX options for Aczema

Topical steroids

Topical calcineurin inhibitors

Topical phosphodiesterase 4 inhibitors

Monoclonal antibodies (IL-4 antagonists)

Calcineurin inhibitor agents

tacrolimus (protopic) ointment

Pimecrolimus (elidel) cream

Phosphodiesterase 4 inhibitor agents

crisaborole (eucrisa) ointment

IL-4 antagonist agents

Dupilumab injection

Do not use calcineurin inhibitors in children under

2 years of age

Topical eczema treaments safety/counseling notes

associated with lymphoma and skin cancer, use only as second line agents for short term

wash hands after application

photosensitizers

Atheletes foot is considered a ____ infection

fungal

Jock itch (tinea curis) affects the

genitals

inner thighs

buttocks

Ringworm (tinea corporis) notes

not a worm, but a skin fungal infection

Can appear anywhere in the body

Tinea capitis is considered ringworm on the

scalp

Topical candida infections cause

red, itchy rashes most commonly in the groin, armpits, or anywhere the skin folds

Fungal drug treatments for the skin

Terbinafine (lamisil)

Clotrimazole (lotrimin AF)

Miconazole (lotrimin AF)

Betamethasone/Clotrimazole (lotrisone) rx

Ketoconazole cream/foam (extina)

Fungal skin treatment safety/counseling notes

terbinafine and butenafine are highly effective

Apply medications 1-2 inches beyond the rash

use for at least 2-4 weeks

Reduce moisture to affected area

Do not walk barefoot if foot infection

Onychomycosis is a fungal infection of the

nail, often caused by tinea unguium

____ and ____ are approved for treatment of onychomycosis and commonly used

itraconazole

terbinafine

For onychomycosis therapy, pulse therapy can be used but

it may not be as effective

A _____ is essential for diagnosis of onychomycosis

20% potassium hydroxide smear

Terbinafine dosing

250 mg po daily for 6 weeks for fingernails or 12 weeks for toenails

Itraconazole boxed warning

avoid use in heart failure

requires gastric acid for absorption

Terbinafine SE

headache

rash

risk of hepatotoxicity

In caginal infections, a pH >4.5 indicates the presence of

Candida

trichomoniasis

OTC vaginal ph testing kit

Vagisil screening kit

_____ or ____ has been thought to reduce vaginal infection occurrence

lactobacillus

yogurt with active cultures

stated as possibly ineffective by natural medicines database

OTc drugs for treatment of vaginal infections

1/3/7 day treatments

butoconazole (gynazole-1)

Clotrimazole (gyne lotrimin)

Miconazole (monistat 3)

Terconazole (terazol 7)

RX treatments for vaginal infections

fluconazole (diflucan) 150 mg po x 1

If patient is pregnant and has a vaginal infection, treat for

7-10 days

Genital warts are caused by

human papillomavirus

____ vaccine protects against the hpv strains that cause most genital warts and reduces risk of cervical and other cancers

Gardasil

Drugs to treat genital warts

imiquimod cream (aldara/zyclara)

Aldara is also approved for

superficial basal cell carcinoma and actinic keratosis

Hemmorhoids symptoms

pruritus

burning and rectal bleeding

blood is usually bright red

Hemmorhoids treatment options

increasing fiber intake to reduce straining - psyllium

Phenylephrine (preparation H)

Hydrocortisone (anusol HC)

Witch hazel

Preparation H function

vasoconstrictor that shrinks the hemorrhoid and reduces burning and itching

Primary treatment for scabies

permethrin in a ctream formulation (elimite)

Ivermectin (stromectol) as oral or topical formulation (sklice)

Lice (pediculus humanus capitis) occurs msot commonly in

school children

____ and ___ are the OTC agents of choice for lice/scabies

pyrethrins

permethrin

Malathion lotion 0.5% (ovide) is considered an

organophosphate and is only used by patients >6 years of age

____ shampoo is not recommended for lice treatment due to neurotoxicity

lindane 1%

During nit treatment, make sure to check the hair and use a nit comb to remove nits every

2-3 days

OTC agents for lice treatment

permethrin (nix) for ages >2 months

Pyrethrin/piperonyl bultoxide (RiD)

Repeat treatments on day 9

RX agents for lice treatment

ivermectin lotion (sklice) for patients >6 months

Degree of burns

first degree - red/painful with minor swelling

second degree - thicker, very painful, blisters

third degree - damage to all layers of skin, appears white/charred

ointments such as _____ should be used for skin protection over a minor bone to hold in moisture and reduce scarring risk

aquaphor (80% oil/20% water)

silversulfadiazine has some use in burn treatment by

reducing infection risk and promoting healing

OTC agents for treating burns

triple abx ointment (neosporin)

Polysporin (bacitracin/polymycin) or bacitracin alone if patient has neomycin allergy

RX treatments for burns

mupirocin (bactroban)

Bacitracin/neomycin/polymyxin B/hydrocortisone (cortisporin)

Mupirocin notes

abx cream or ointment

very good staph/strep coverage including mrsa. Can be used for nasal mrsa colonization

Pinworms infection are common in

children and presents as anal itching

Enterobius cermicularis

___ test can be used to identify eggs from pinworm

tape test

can take up to 3 tests to identify