Dermatology and Sensory Exam 2

reduce inflammation/increase skin turnover rate

treatment goals for seborrheic dermatitis (2)

medicated shampoos/topical corticosteroids

primary treatments for seborrheic dermatitis (2)

7 days

the length of time corticosteroids can be used for without a referral

baby oil

first line of treatment for infant seborrheic dermatitis

protectant/emollient

first line of treatment for diaper rash

7 days

length of time that diaper rash treatment can be used without a referral

restore skin barrier

treatment goal for atopic dermatitis

emollients

first line treatment for atopic dermatitis

corticosteroids

first line treatment for contact dermatitis

aluminum acetate

treatment option for oozing dermatitis (contact or atopic)

ointment

the corticosteroid vehicle that usually has the most potency

lotion

the corticosteroid vehicle that usually has the least potency

when affected area is over 20% of BSA

when will systemic corticosteroids be used in contact dermatitis?

they will never be used

when will systemic corticosteroids be used in atopic dermatitis?

Eucrisa (Crisaborole)

a treatment for atopic dermatitis that is a PDE-4 inhibitor ointment (Dr. Herring says it has poor efficacy)

calcineurin inhibitors (pimecrolimus and tacrolimus)

a treatment for atopic dermatitis that is not a corticosteroid but is an alternative for long-term use of topical corticosteroids

long term use has been linked to basal cell and squamous cell carcinomas as well as lymphomas (mostly seen in oral use in mice)

black box warning for calcineurin inhibitors (pimecrolimus and tacrolimus)

Zanfel

barrier product for poison ivy (only removes oil on skin - does not treat allergic reaction)

topical corticosteroids

first line therapy for mild-moderate psoriasis

decrease redness, scaling, and itching

treatment goals for topical corticosteroids for psoriasis

vitamin d

topical psoriasis treatment that downgrades skin cell production and can dry out the skin

phototherapy

topical psoriasis treatment that causes DNA damage and decreased cell growth

coal tar

topical psoriasis treatment that inhibits cell reproduction

systemic treatment

first line therapy for moderate-severe psoriasis

methotrexate

systemic psoriasis treatment that is a folate antagonist leading to decreased cell replication

cyclosporine

systemic psoriasis treatment that is a immunosuppressant by reversible inhibition of lymphocytes

acitretin (soriatane)

systemic psoriasis treatment that is a vitamin A derivative where pregnancy is not allowed until 3 years after the last dose

pseudotumor cerebri

major side effect for acitretin

PDE4 inhibitor

apremilast (Otezla) class

oral

apremilast (Otezla) dosage form

PDE4 inhibitor

roflumilast (Zoryve) class

topical

roflumilast (Zoryve) dosage form

TYK2 inhibitor

deucravacitinib (Sotyktu) class

oral

deucravacitinib (Sotyktu) dosage form

no

do PDE4 inhibitors cause immunosuppression?

yes

do TYK2 inhibitors cause immunosuppression?

TNF inhibitor

adalimumab (Humira) class

subcutaneous

adalimumab (Humira) dosage form

subcutaneous

etanercept (Enbrel) dosage form

TNF inhibitor

etanercept (Enbrel) class

Enbrel

which TNF inhibitor is best for pediatric patients?

TNF inhibitor

certolizumab (Cimzia) class

subcutaneous

certolizumab (Cimzia) dosage form

TNF inhibitor

infliximab (Remicade) class

intravenous

infliximab (Remicade) dosage form

yes

are IL-17 inhibitors immunosuppressing?

IL-17 inhibitor

secukinumab (Cosentyx) class

subcutaneous

secukinumab (Cosentyx) dosage form

IL-17 inhibitor

ixekizumab (Taltz) class

subcutaneous

ixekizumab (Taltz) dosage form

yes

are IL-12/23 inhibitors immunosuppressing?

IL-12/23

ustekinumab (Stelara) class

subcutaneous

ustekinumab (Stelara) dosage form

yes

are IL-23 inhibitors immunosuppressing?

IL-23

guselkumab (Tremfya) class

subcutaneous

guselkumab (Tremfya) dosage form

IL-23

risankizumab (Skyrizi) class

subcutaneous

risankizumab (Skyrizi) dosage form

IL-23

tildrakizumab (Ilumya) class

subcutaneous

tildrakizumab (Ilumya) dosage form

IL-4/13 inhibitor

dupliumab (Dupixent) class

subcutaneous

dupliumab (Dupixent) dosage form

yes (immunomodulating)

are IL-4/13 inhibitors immunosuppressing?

IL-13 inhibitor

tralokinumab (Adbry) class

subcutaneous

tralokinumab (Adbry) dosage form

no

are IL-13 inhibitors immunosuppressing?

JAK inhibitor

abrocitinib (Cibinqo) class

oral

abrocitinib (Cibinqo) dosage form

JAK inhibitor

ruxolitnib (Opzelura) class

topical

ruxolitnib (Opzelura) dosage form

JAK inhibitor

upadacitinib (Rinvoq) class

oral

upadacitinib (Rinvoq) dosage form

yes

are JAK inhibitors immunosuppressing?

TB, hep B, hep C, HIV

what are the 4 baseline labs that are needed before being started on an immunosuppressing medication?

keratinization

refers to skin turnover

teratogen

an agent that causes malformation of an embryo

benzoyl peroxide

topical antimicrobial acne treatment that targets abnormal keratinization by increasing skin turnover, best used in the morning

redness, dryness, light sensitivity

side effects of benzoyl peroxide (and salicylic acid)

salicylic acid

topical acne treatment that targets abnormal keratinization, less potent than benzoyl peroxide

retinoids

topical acne treatment that reverses abnormal keratinization that leads to plugging, introduce slowly to avoid burning, peeling, or skin dryness, best used at night

topical antibiotics

topical acne treatment that is best for small papules/pustules, important to use this treatment in combination with either retinoids or benzoyl peroxide or resistance can occur

azelaic acid

topical acne treatment that decreases redness and inflammation, safest product to use in pregnancy

oral antibiotics

systemic acne treatment used for moderate and widespread papulopustular/cystic acne, risk of resistance

tetracyclines

specific class of oral antibiotics that risk skin hyperpigmentation, tooth discoloration, and photosensitivity

isotretinoin

systemic acne treatment used for severe, recalcitrant acne, decreases sebum production and decreases follicular hyperkeratosis, known teratogen

oral contraceptives

hormonal acne treatment that decreases androgen production, which leads to decreased sebum production

spironolactone

hormonal acne treatment that blocks androgen receptors which lowers sebum production

clascoterone cream (Winlevi)

topical anti-androgen therapy for acne treatment

aphthous stomatitis (canker sores) and lichen planus

what are the two most common types of non-microbial mucositis?

ace inhibitors and diuretics

two of the most common implicated drugs for non-microbial mucositis

corticosteroids

best way to treat non-microbial mucositis

angular cheilitis and herpes infection

two of the most common types of microbial mucositis

angular cheilitus

caused by loss of vertical dimension, xerostomia, or presence of an upper denture

herpes virus

presence of lesions that are over bone

valacyclovir

abortive therapy for herpes virus

fluconazole

systemic treatment for oral mucosal candidosis infection

ketoconazole, clotrimazole, miconazole

three topical treatments for oral mucosal candidosis infection

trichophyton rubrum

the dermatophyte that is the most common cause of skin and nail fungal infections

topicals are generally effective

efficacy of topical steroids on tinea corporis (ringworm)

topical agents are ineffective alone

efficacy of topical steroids on tinea capitis