DOCSLIB.ORG

Dermatologic Therapeutics: Bread and Butter and Beyond

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Dermatologic Therapeutics: Bread and Butter and Beyond Dermatologic Therapeutics: Bread and Butter and Beyond Bonnie Mackool, MD, MSPH Assistant Professor of Dermatology, Harvard Medical School Massachusetts General Hospital Disclosures Neither I nor my spouse/partner has a relevant financial relationship with a commercial interest to disclose. Medication Overview: Anti-microbial Anti-inflammatory Anti-histaminic Anti-neoplastic Retinoids Biologics Immunosuppressive Hormonal Therapy Systemic Agents Topical Agents Balneotherapy Cryotherapy Phototherapy Laser Radiation Surgical Dermatologic Medical Armamentarium Includes: • Adapalene (Differin) cream/gel • Cyclosporine (Neoral) • Azelaic acid (Azelex) cream • Adalimumab (Humira) • Topical steroids • Etanercept (Enbrel) • Tetracycline • Intravenous Immunoglobulin IVIG • Minocycline • Doxycycline • Anthralin (Drithrocream) • Dapsone (Aczone) gel • Mupirocin (Bactroban)ointment • Benzoyl peroxide + clinda or erythro • Tacrolimus ointment • Finasteride (Propecia) • Pimecrolimus cream • Tazarotene • Metronidazole (Metrocream/gel) • Tretinoin cream • Hydroxyzine (Atarax) • Methotrexate • Tri-Luma cream (tret, hydroquinone, ster) • Sodium thiosulfate IV • Hydroxychloroquine • Mycophenolate mofetil (cellcept) • Chloroquine • Azathioprine (Imuran) Dermatologic Medical Armamentarium (cont.): • Spironolactone • Calcipotriene (Dovonex) oint/cr • Isotretinoin (Accutane) • Acyclovir (Zovirax) tabs/oint/cr • 5 Fluorouracil (Efudex) cream/solution • Naltrexone • Imiquimod (Aldara) cream • Gabapentin (Neurontin) • Rituximab (Rituxan) • Doxepin Hydrochloride • Ciclopirox (Loprox) cream • Amitriptyline • Efinaconazole (Jublia) solution • Permethrin cream • Naftifine (Naftin) gel/cream • Ivermectin • Terbinafine HCl (Lamisil) po • Lindane cream • Acitretin (Soriatane) • Santyl (Collagenase) ointment • Thiabendazole • Colchicine • Silver Sulfadiazine (Silvadene) • Thalidomide Dermatologic Medical Armamentarium – Watch Points • Side effects: • Monitoring – Topical steroids – Hydroxychloroquine – Topical antibiotics – Minocycline – Tretinoin cream – Anthralin (Drithrocream) • Drug Interactions: – Tri-Luma cream (tretinoin, – Methotrexate hydroquinone, steroid) – Cyclosporine (Neoral) – Mycophenolate mofetil (cellcept) • Phototoxicity/side effects – Doxycycline • Choosing the appropriate patient” – Tetracycline – Adalimumab (Humira) – Minocycline – Etanercept (Enbrel) ?Newer? Therapeutics • Dupilumab(Dupixent) s.c. – Asthma, Atopic dermatitis, sinusitis • Dapsone 5% and 7/5% Gel(acne) – (FDA: Dermatitis herpetiformis, Leprosy, acne) – Non FDA include: PCP prophylaxis, idiopathic urticaria*) • IXEKIZUMAB (Taltz) *Morgan M, Cooke A, Rogers L et al. Double blind – (psoriasis, ankylosing spondylitis- psoriatic arthritis, placebo controlled trial of dapsone in antihistamine non-radiographic axial spondyloarthritis refractory chronic idiopathic urticaria. J Allergy Clin Immunol Pract 2014, 2(5), 601-606. – Ankylosing spondylitis, non-radiographic axial spondyloarthritis, psoriasis, psoriatic arthritis, rheumatoid arthritis(not FDA approved for RA) • Efinaconazole 10 % solution (Jublia) • Melanoma Immunotherapy First Do No Harm • Side effects of systemic and topical agents • The informed patient – is she/he? • Drug Interactions • Topical does not necessarily mean safe • Systemic Effects of Topical Agents • Compounding dangers Side Effects of Topical Glucocorticoids Topical Side Effects Systemic Side Effects • Atrophy (sheen) • Sodium Retention • Telangiectases • Hyperglycemia • Striae • CHF • Acne (perioral dermatitis) • Femoral Head Necrosis • Worsening cutaneous fungal infection • Cataracts • Tachyphylaxis • Glaucoma • Hypokalemia (digoxin toxicity) • Adrenal suppression • Growth retardation 30 year old woman with purpuric eruption and peri-areolar dermatitis Betamethasone valerate applied bid x 3 weeks Skin Thickness Dictates Choice for Topical Steroid Potency Eyelid < Face < creases,genitals, breast< neck< palms/soles,Back 758.9. 1969.2 micrometer 4629 micrometers 5834 micrometer . Additional Factors Related to Absorption Increasing Potency for All Topical Agents • Occlusion increases potency(band aids, skin folds) • Sweating and Moisture increase absorption/potency • Atrophy increases absorption • Loss of barrier function(erosions/ulcers) • Host(elderly and infant factors: – Infant: high ratio of skin surface/body weight results in increase relative dose – Elderly: thinned skin, consider renal function for topicals like sal acid Topical Steroids – Potency Mild Mid Strength High Hydrocortisone ointment 2.5% Fluocinolone acetonide ointment .025% Clobetasol propionate ointment Hydrocortisone cream 2.5% Hydrocortisone Valerate 02% Clobetasol propionate cream Hydrocortisone cream 1 % Triamcinolone ointment* *Betamethasone dipropionate Hydrocortisone ointment 1 % ointment Lower Mid Strength valerate gel Fluocinolone acetonide cream .025% Triamcinolone cream *Note: clotrimazole and betamethasone cream – high potency TAC: cream, dental paste, lotion, ointment Atopic Dermatitis Treatment options include: Topical Steroids Tacrolimus/Pimecrolimus Dupixen Bleach baths Tacrolimus Ointment and Cream and Pimecrolimus: Calcineurin Inhibitors • Do not have the topical nor systemic side effects of topical steroids • “Considered second-line therapy” for atopic dermatitis • Expect typically improvement over 4 to 6 weeks • Low systemic absorption: levels decrease as skin improves from atopic dermatitis Tacrolimus (Protopic) ointment • Children 2 years and older: .03 percent bid • Adults .1 percent bid • For atopic dermatitis (FDA approved), vitiligo, refractory seborrheic dermatitis, lichen planus, oral lichen planus, LSA • No tachyphylaxis • No atrophy • Black box warning • Most common side effect: irritation • Crosses placenta, excreted in human breast milk Vitiligo Topical steroids Calcineurin inhibitors Psoriasis Topical Treatment: Calcipotriene ointment/cream/solution Tazarotene cream .05%, .1 Topical tar (MG217, Exorex cream) Salicylic acid Psoriasis – Common Therapies Topical Systemic • Glucocorticoids • Acitretin (systemic Vit A) – • Calcipotriene contraindicated in women of child cream/ointment/solution (Dovonex) bearing age • Topical tar preparations • Methotrexate • Salicylic acid(beware of systemic • TNF alpha inhibitors: Etanercept, absorption) Adalimumab, Infliximab • Tazarotene(topical vit a) (Tazorac) • Newer: ixekizumab (Taltz), Ustekinumab (Stelara), Secukinumab (Cosentyx) Calcipotriene • Ideal for intertrigo • Ointment and cream for skin • Scalp solution • Used twice daily • Maximum use: cream/ointment – 100 gram tube every week Psoriasis Systemic Agents (Partial list) TNF alpha inhibition Methotrexate (oral) Contraindications to TNF Alpha Treatment Include: • Demyelinating disorders • CHF • Recent malignancies • Acute and chronic infections Tinea pedis Scale is fine, branny. Onychomycosis Systemic vs Topical Treatment Onychomycosis Systemic Topical • Terbinafine (Lamisil) • Efinaconazole 10% solution • Mycologic cure rate: 70 percent • Mycologic cure rate: 55.2% – Mycologic + clinical cure: 38% – Complete cure: 17.8 % • 250 mg po qd x 6 week (fingernails) • Applied daily x 48 weeks • 250 mg po qd x 12 weeks (toenails) • Interactions include: – Cimetidine (increased GI symptoms, • Ciclopirox lacquer 8% (data at 48 weeks) ha, LFT abnormalities) – Negative mycology: 29% – Caffeine (decreased clearance) – Complete cure: 5.5% – Metoprolol (bradycardia) – Fluoxetine (risk of QT prolongation) Terbinafine HCL • Adults: • 250 mg daily x 6 weeks(fingernails), x 12 weeks (toenails) • Pediatric: tinea capitis: 4 years + Granules and dosing is by weight – <25 kg: 125 mg qd x 6 weeks – 25-35 kg: 187.5 mg qd x 6 weeks – >35 kg: 250 mg qd x 6 weeks • Contraindications: Chronic or active Liver disease • Adjustments; Geriatric (Cr cl < 50 mL/min not studied • Monitoring: LFTS baseline and periodically during treatment Terbinafine Hydrochloride (Lamisil) Tabs, Granules tabs granules • Dermatologic 5.6 % • 2% • Diarrhea 5.6%; • 3% • Taste disorder: 2.8% • Nausea: • 2 % • Fever • 7 % • Hepatic (Increased enzymes) 3.3 % • Headache 12.9% • 7% Terbinafine Is an Inhibitor of CYP450 2D6 Isozyme • Drugs metabolized by this isozyme are: – Tricyclic antidepressants – Selective serotonin reuptake inhibitors – Beta-blockers – Antiarrhythmics class 1C – Monoamine oxidase inhibitor Terbinafine Hydrochloride: Serious Side Effects • Skin: Cutaneous LE, • Hepatic: Liver failure Erythema multiforme, • Immunologic: DRESS, SLE Generalized exanthematous • Otic: hearing loss pustulosis, SJS, TEN • Hematologic: Neutropenia, thrombotic microangiopathy Acne Topical (benzoyl peroxide, topical antibiotics- clindamycin, erythromycin, salicylic acid, azelaic acid, topical retinoids) Systemic (antibiotics, hormonal, systemic retinoids) Acne • Excess sebum • Idea: retinoid through effect • Keratin Disturbance on keratin allows antibiotic • Propionbacterium acnes to enter pilosebaceous duct colonizing pilosebaceous duct • Inflammation Golmick. Jour of Eur Acad of Derm and Vene29, 1-7, 2015. Combination Products for Acne • Clindamycin + benzoyl peroxide • Duac (1.2%/5%) Benzaclin (1%/5%) • Benzoyl peroxide + erythromycin • Benzamycin • Tretinoin cream + clindamycin • Ziana gel • Adapalene .1% + benzoyl peroxide • Epiduo 2.5% gel • Epiduo Forte • Adapalene .3% + benzoyl peroxide 2.5% Tetracycline Class • Permanent discoloration of teeth during tooth development (last half of pregnancy, infancy and childhood to age of 8 yo) • Sun AVOIDANCE (“sunscreen or sunblock should be considered.” Micromedex) • Cross
Load more

Recommended publications
  • Folic Acid Antagonists: Antimicrobial and Immunomodulating Mechanisms and Applications
    International Journal of Molecular Sciences Review Folic Acid Antagonists: Antimicrobial and Immunomodulating Mechanisms and Applications Daniel Fernández-Villa 1, Maria Rosa Aguilar 1,2 and Luis Rojo 1,2,* 1 Instituto de Ciencia y Tecnología de Polímeros, Consejo Superior de Investigaciones Científicas, CSIC, 28006 Madrid, Spain; [email protected] (D.F.-V.); [email protected] (M.R.A.) 2 Consorcio Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain * Correspondence: [email protected]; Tel.: +34-915-622-900 Received: 18 September 2019; Accepted: 7 October 2019; Published: 9 October 2019 Abstract: Bacterial, protozoan and other microbial infections share an accelerated metabolic rate. In order to ensure a proper functioning of cell replication and proteins and nucleic acids synthesis processes, folate metabolism rate is also increased in these cases. For this reason, folic acid antagonists have been used since their discovery to treat different kinds of microbial infections, taking advantage of this metabolic difference when compared with human cells. However, resistances to these compounds have emerged since then and only combined therapies are currently used in clinic. In addition, some of these compounds have been found to have an immunomodulatory behavior that allows clinicians using them as anti-inflammatory or immunosuppressive drugs. Therefore, the aim of this review is to provide an updated state-of-the-art on the use of antifolates as antibacterial and immunomodulating agents in the clinical setting, as well as to present their action mechanisms and currently investigated biomedical applications. Keywords: folic acid antagonists; antifolates; antibiotics; antibacterials; immunomodulation; sulfonamides; antimalarial 1.
    [Show full text]
  • FLAMAZINE™ CREAM 1.0% W/W
    PRODUCT INFORMATION NAME OF THE MEDICINE: FLAMAZINE™ CREAM 1.0% w/w Silver sulfadiazine 1% w/w Composition: Active ingredient. Silver sulfadiazine. Excipients. Polysorbate 60 Ph. Eur, Polysorbate 80 Ph. Eur, Glyceryl Monostearate Ph. Eur, Cetyl Alcohol Ph. Eur, Liquid Paraffin Ph. Eur, Propylene Glycol Ph. Eur and Purified Water Ph. Eur. DESCRIPTION: A sterile white hydrophilic cream containing silver sulfadiazine 1%. The cream is a semisolid oil-in-water emulsion. The silver sulfadiazine is in a fine micronised form. Silver sulfadiazine is a white or creamy-white, odourless or almost odourless crystalline powder, which becomes yellow on exposure to light. Practically insoluble in water; slightly soluble in acetone; practically insoluble in alcohol, chloroform or ether; freely soluble in strong ammonia solution. Chemical name: Silver salt of N’-(pyrimidin-2-yl)sulfanilamide. C10H9AgN4O2S. M.W. 357.1 CAS 22199-08-2 Chemical structure: PHARMACOLOGY: Silver sulfadiazine is a sulfonamide and has broad antimicrobial activity against both Gram- positive and Gram-negative organisms. Silver sulfadiazine acts on the cell membrane and cell wall. Unlike sulfadiazine or other sulfonamides, the antibacterial action of the silver salt of sulfadiazine does not appear to depend on inhibition of folic acid synthesis. Its action is not antagonised by p-aminobenzoic acid. Flamazine Cream: 1 June 2010 1 of 6 Microbiology: Silver sulfadiazine has broad antimicrobial activity against both Gram-positive and Gram-negative organisms including Pseudomonas aeruginosa, some yeasts and fungi. It has also been reported to be active in vitro against herpes virus and Treponema pallidum. Sulfonamides act by interfering with the synthesis of nucleic acids in sensitive micro- organisms by blocking the conversion of p- aminobenzoic acid to the co-enzyme dihydrofolic acid.
    [Show full text]
  • (CD-P-PH/PHO) Report Classification/Justifica
    COMMITTEE OF EXPERTS ON THE CLASSIFICATION OF MEDICINES AS REGARDS THEIR SUPPLY (CD-P-PH/PHO) Report classification/justification of medicines belonging to the ATC group D07A (Corticosteroids, Plain) Table of Contents Page INTRODUCTION 4 DISCLAIMER 6 GLOSSARY OF TERMS USED IN THIS DOCUMENT 7 ACTIVE SUBSTANCES Methylprednisolone (ATC: D07AA01) 8 Hydrocortisone (ATC: D07AA02) 9 Prednisolone (ATC: D07AA03) 11 Clobetasone (ATC: D07AB01) 13 Hydrocortisone butyrate (ATC: D07AB02) 16 Flumetasone (ATC: D07AB03) 18 Fluocortin (ATC: D07AB04) 21 Fluperolone (ATC: D07AB05) 22 Fluorometholone (ATC: D07AB06) 23 Fluprednidene (ATC: D07AB07) 24 Desonide (ATC: D07AB08) 25 Triamcinolone (ATC: D07AB09) 27 Alclometasone (ATC: D07AB10) 29 Hydrocortisone buteprate (ATC: D07AB11) 31 Dexamethasone (ATC: D07AB19) 32 Clocortolone (ATC: D07AB21) 34 Combinations of Corticosteroids (ATC: D07AB30) 35 Betamethasone (ATC: D07AC01) 36 Fluclorolone (ATC: D07AC02) 39 Desoximetasone (ATC: D07AC03) 40 Fluocinolone Acetonide (ATC: D07AC04) 43 Fluocortolone (ATC: D07AC05) 46 2 Diflucortolone (ATC: D07AC06) 47 Fludroxycortide (ATC: D07AC07) 50 Fluocinonide (ATC: D07AC08) 51 Budesonide (ATC: D07AC09) 54 Diflorasone (ATC: D07AC10) 55 Amcinonide (ATC: D07AC11) 56 Halometasone (ATC: D07AC12) 57 Mometasone (ATC: D07AC13) 58 Methylprednisolone Aceponate (ATC: D07AC14) 62 Beclometasone (ATC: D07AC15) 65 Hydrocortisone Aceponate (ATC: D07AC16) 68 Fluticasone (ATC: D07AC17) 69 Prednicarbate (ATC: D07AC18) 73 Difluprednate (ATC: D07AC19) 76 Ulobetasol (ATC: D07AC21) 77 Clobetasol (ATC: D07AD01) 78 Halcinonide (ATC: D07AD02) 81 LIST OF AUTHORS 82 3 INTRODUCTION The availability of medicines with or without a medical prescription has implications on patient safety, accessibility of medicines to patients and responsible management of healthcare expenditure. The decision on prescription status and related supply conditions is a core competency of national health authorities.
    [Show full text]
  • Fucidin H Cream Patient Leaflet
    Scale Get-up Material No Sent by e-maiL l 100% GB 059516-XX Subject Date Date INS 175 x 280 mm 02/04/19 Colour Sign. Sign. Black RBE Preparation Place of production 213 Strength ® Packsize Fucidin H cream Ireland Comments: Page 1 of 2 Pharmacode 213 Font size: Heading: 9 pt, section: 8 pt, linespacing: 3 mm Mock-up for reg. purpose 175 mm IIE007-01 - 175 x 280 mm 175 x 280m Insert 100% PACKAGE LEAFLET: INFORMATION FOR THE USER Fucidin® H cream Fusidic acid and hydrocortisone acetate m Read all of this leaflet carefully before you start using this medicine because it contains important information for you. • Keep this leaflet. You may need to read it again. • If you have any further questions, ask your doctor, pharmacist or nurse. • This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours. • If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4. 20/01/2004 11/06/2018 IIE007-01 What is in this leaflet: Other medicines and Fucidin H cream 213 1. What Fucidin® H cream is and what it is used for Tell your doctor or pharmacist if you are taking, or have 2. Before you use Fucidin® H cream recently taken or might take any other medicines. 3. How to use Fucidin® H cream 4. Possible side effects Pregnancy and breast-feeding 5.
    [Show full text]
  • Acute-Onset Alopecia
    PHOTO CHALLENGE Acute-Onset Alopecia Justin P. Bandino, MD; Dirk M. Elston, MD A previously healthy 45-year-old man presented to the dermatology department with abrupt onset of patchy, progressively worsening alopecia of the scalp as well as nausea with emesis and blurry vision of a few weeks’ duration. All symptoms were temporally associated with a new demoli- tion job the patient had started at an industrial site. He reportedcopy 10 other contractors were simi- larly affected. The patient denied paresthesia or other skin changes. On physical examination, large patches of smooth alopecia without ery- thema,not scale, scarring, tenderness, or edema that coalesced to involve the majority of the scalp, eye- brows, and eyelashes (inset) were noted. Do WHAT’S THE DIAGNOSIS? a. alopecia areata b. dioxin-induced alopecia c. phosgene-induced alopecia d. syphilitic alopecia CUTIS e. thallium-induced alopecia PLEASE TURN TO PAGE E25 FOR THE DIAGNOSIS From the Department of Dermatology, Medical University of South Carolina, Charleston. The authors report no conflict of interest. Correspondence: Justin P. Bandino, MD, 171 Ashley Ave, MSC 908, Charleston, SC 29425 ([email protected]). E24 I CUTIS® WWW.MDEDGE.COM/DERMATOLOGY Copyright Cutis 2019. No part of this publication may be reproduced, stored, or transmitted without the prior written permission of the Publisher. PHOTO CHALLENGE DISCUSSION THE DIAGNOSIS: Thallium-Induced Alopecia t the time of presentation, a punch biopsy speci- pencil point–shaped fractures that shed approximately men of the scalp revealed nonscarring alopecia 1 to 2 months after injury. The 10% of scalp hairs in A with increased catagen hairs; follicular minia- the resting telogen phase have no matrix and thus are turization; peribulbar lymphoid infiltrates; and fibrous unaffected.
    [Show full text]
  • Dovobet Gel Patient Information Leaflet
    L Scale Get-up Material No Sent by e-maiL l Scale Get-up Material No Sent by e-mail 100% Used for: GB 000000-XXComments: Insert, 2 columns Page 1 IIE015-02Subject Daivobet®, Dovobet®, Xamiol ® Date gel. SpaceDate for text: 2 X 67,5 x 580 mm. Subject Date Date INS 160 x 600 mm 05/05/20 Colour Sign. MaterialSign. number must be printed on both sides Colour Sign. Sign. 160 x 600 mm 08/09/2010 JUG Black RBE Material number on page 1, OCRB 8pt kerning+10(Quark)/ Preparation 100% 08/06/2018 OMA Place of productionOCRB MEDIUM 8pt kerning+50(Indesign) Preparation Place of production Strength ® Strength Packsize Dovobet gel Ireland Packsize Ireland Comments: Comments: Page 1 of 2 Font size: 9 pt Mock-up for reg. purpose 160 mm IIE015-02 - 160 x 600 mm - Page 1 of 2 2. 05/05/20 Package leaflet: Information for the user Dovobet® 50 micrograms/g + 0.5 mg/g gel RBE calcipotriol/betamethasone SOP_00867 SOP_003993 and SOP_000647, SOP_000962 Read all of this leaflet carefully before you start using this medicine because it contains important information for you. • Keep this leaflet. You may need to read it again. • If you have any further questions, ask your doctor, pharmacist or nurse. 6 • This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours. • If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet.
    [Show full text]
  • PSORCON® E Emollient Ointment (Diflorasone Diacetate Ointment) 0.05%
    PSORCON® E Emollient Ointment (diflorasone diacetate ointment) 0.05% For Topical Use Not For Ophthalmic Use DESCRIPTION Each gram of Psorcon E Emollient Ointment contains 0.5 mg diflorasone diacetate in an ointment base. Chemically, diflorasone diacetate is: 6α,9-difluoro-11β,17,21-trihydroxy- 16β-methyl-pregna-1,4-diene-3,20-dione 17,21-diacetate. The structural formula is represented below: Psorcon E Emollient Ointment contains diflorasone diacetate in an emollient, occlusive base consisting of polyoxypropylene 15-stearyl ether, stearic acid, lanolin alcohol and white petrolatum. CLINICAL PHARMACOLOGY Topical corticosteroids share anti-inflammatory, antipruritic and vasoconstrictive actions. The mechanism of anti-inflammatory activity of the topical corticosteroids is unclear. Various laboratory methods, including vasoconstrictor assays, are used to compare and predict potencies and/or clinical efficacies of the topical corticosteroids. There is some evidence to suggest that a recognizable correlation exists between vasoconstrictor potency and therapeutic efficacy in man. Pharmacokinetics: The extent of percutaneous absorption of topical corticosteroids is determined by many factors including the vehicle, the integrity of the epidermal barrier, and the use of occlusive dressings. Topical corticosteroids can be absorbed from normal intact skin. Inflammation and/or other disease processes in the skin increase percutaneous absorption. Occlusive dressings substantially increase the percutaneous absorption of topical corticosteroids. Thus, 1 occlusive dressings may be a valuable therapeutic adjunct for treatment of resistant dermatoses (see DOSAGE AND ADMINISTRATION). Once absorbed through the skin, topical corticosteroids are handled through pharmacokinetic pathways similar to systemically administered corticosteroids. Corticosteroids are bound to plasma proteins in varying degrees. They are metabolized primarily in the liver and are then excreted by the kidneys.
    [Show full text]
  • Dermatology Dr Matt Smialowski GP, Tunbridge Wells Introduction
    Dermatology Dr Matt Smialowski GP, Tunbridge Wells Introduction . Overview of General Practice Dermatology . Based on curriculum matrix . Images from dermnet.nz . Management from dermnet.nz and NICE CKS . Focus on the common presenting complaints and overview of treatments . Quiz and Questions Dermatology Vocabulary . Useful to be able to describe the problem in notes / referrals . Configuration . Nummular / discoid: round or coin-shaped . Linear: often occurs due external factors (scratching) . Target: concentric rings . Annular: lesions grouped in a circle. Serpiginous: snake like . Reticulate: net-like with spaces Dermatology Vocabulary . Morphology . Macule: small area of skin 5-10mm, altered colour, not elevated . Patch: larger area of colour change, with smooth surface . Papule: elevated, solid, palpable <1cm diameter . Nodule: elevated, solid, palpable >1cm diameter . Cyst: papule or nodule that contains fluid / semi-fluid material . Plaque: circumscribed, palpable lesion >1cm diameter . Vesicle: small blister <1cm diameter that contains liquid . Pustule: circumscribed lesion containing pus (not always infected) . Bulla: Large blister >1cm diameter that contains fluid . Weal: transient elevation of the skin due to dermal oedema Skin Function . Prevention of water loss . Immune defence . Protection against UV damage . Temperature regulation . Synthesis of vitamin D . Sensation . Aesthetics Skin Structure Eczematous Eruptions Cheilitis / Peri-oral Dermatitis . Common problem . Acute / relapsing / recurrent . Causes . Chelitis . Environmental: sun damage . Inflammatory . Angular cheilits . Infection: fungal . Vitamin B / iron deficiency . Perioral dermatitis . Potent topical steroids Pompholyx . Vesicular form of hand or foot eczema. Commonly affects young adults. Causes . Sweating . Irritants . Recurrent crops of itchy deep-seated blisters. Pompholyx . General Measures . Cold packs . Soothing emollients . Gloves / avoid allergens . Prescription: . Potent topical steroids . Oral steroids .
    [Show full text]
  • Therapies for Common Cutaneous Fungal Infections
    MedicineToday 2014; 15(6): 35-47 PEER REVIEWED FEATURE 2 CPD POINTS Therapies for common cutaneous fungal infections KENG-EE THAI MB BS(Hons), BMedSci(Hons), FACD Key points A practical approach to the diagnosis and treatment of common fungal • Fungal infection should infections of the skin and hair is provided. Topical antifungal therapies always be in the differential are effective and usually used as first-line therapy, with oral antifungals diagnosis of any scaly rash. being saved for recalcitrant infections. Treatment should be for several • Topical antifungal agents are typically adequate treatment weeks at least. for simple tinea. • Oral antifungal therapy may inea and yeast infections are among the dermatophytoses (tinea) and yeast infections be required for extensive most common diagnoses found in general and their differential diagnoses and treatments disease, fungal folliculitis and practice and dermatology. Although are then discussed (Table). tinea involving the face, hair- antifungal therapies are effective in these bearing areas, palms and T infections, an accurate diagnosis is required to ANTIFUNGAL THERAPIES soles. avoid misuse of these or other topical agents. Topical antifungal preparations are the most • Tinea should be suspected if Furthermore, subsequent active prevention is commonly prescribed agents for dermatomy- there is unilateral hand just as important as the initial treatment of the coses, with systemic agents being used for dermatitis and rash on both fungal infection. complex, widespread tinea or when topical agents feet – ‘one hand and two feet’ This article provides a practical approach fail for tinea or yeast infections. The pharmacol- involvement. to antifungal therapy for common fungal infec- ogy of the systemic agents is discussed first here.
    [Show full text]
  • Pediatric Periorificial Dermatitis
    PEDIATRIC DERMATOLOGY Pediatric Periorificial Dermatitis Roselyn Kellen, BA; Nanette B. Silverberg, MD symptoms unless patients have comorbid conditions such 5 PRACTICE POINTS as atopic dermatitis. Although this condition has been • Periorificial dermatitis (POD) affects young children well examined in the literature on adults, data in the pedi- and presents as flesh-colored papules around the atric population are far more limited, consisting of case mouth, nose, and even groin. series and retrospective chart reviews. In 1979, Wilkinson 6 • Periorificial dermatitis has been associated with prior et al published a study of more than 200 patients with use of topical or inhaled steroids. perioral dermatitis, but only 15 patients younger than • Children with POD can be treated with oral erythromycin. 12 years were included. Etiology copy Although the exact pathogenesis of POD is unknown, Periorificial dermatitis (POD) has been documented in the pediatric a common denominator among many patients is prior population in patients as young as 3 months, with a slight predomi- exposure to topical corticosteroids.3,7-9 Periorificial der- nance in girls compared to boys. Many patients have a personal or matitis also has been linked to the use of systemic cor- family history of atopic disorders. Periorificial dermatitis typically ticosteroidsnot in pediatric patients.10 The exact relationship presents with erythematous to flesh-colored papules and rarely between steroid use and dermatitis is unknown; it may pustules near the eyes, nose, and mouth. Although the etiology be related to a change in the flora of hair follicles and is unknown, many patients have had recent exposure to a topical or less commonly an inhaled or systemic corticosteroid.
    [Show full text]
  • Management of Otitis
    Chronic and recurrent otitis is Management of Otitis frustrating! • Otitis externa is the most common ear disease in the cat and dog • Reported incidence is 10-20% in the dog Lindsay McKay, DVM, DACVD and 2-10% in the cat [email protected] • It is a common reason for referral to VCA Arboretum View Animal Hospital dermatology specialists and very common clinical problem for general practitioners 1- Primary causes- directly Breaking down the problem induce otic inflammation • ALLERGIES (atopy and food allergies) • Step 1- Identify the primary cause of otitis • Parasites (Otodectes cyanotis, Demodicosis) • Step 2- Assess for predisposing factors of • Masses (tumors and polyps) otitis • Foreign bodies (ex plant awns, hair, • Step 3- Treat the secondary infections ceruminoliths, hardened medications) • Step 4- Identify the perpetuating factors of • Disorders of keratinization (hypothyroidism, otitis primary seborrhea, sebaceous adenitis) • Immune mediated disease (pemphigus, juvenile cellulitis, vasculitis) What are most common causes of 2- Predisposing factors of ear disease recurrent otitis…. • These factors facilitate inflammation by changing • Allergic disease in the dog- over 40% cases environment of the ear! in one study • Ear conformation- stenotic • Polyps and ear mites in the cat canals, hair in canals, pendulous ears • Excessive moisture or cerumen production • Treatment effects- irritation from meds/contact allergy or trauma from cleaning 1 3- Secondary bacterial and/or 4- Perpetuating factors- prevent yeast infections the resolution
    [Show full text]
  • “The Red Face” and More Clinical Pearls
    “The Red Face” and More Clinical Pearls Courtney R. Schadt, MD, FAAD Assistant Professor Residency Program Director University of Louisville Associates in Dermatology I have no disclosures or conflicts of interest Part 1: The Red Face: Objectives • Distinguish and diagnose common eruptions of the face • Recognize those with potential implications for internal disease • Learn basic treatment options Which patient(s) has an increased risk of hypertension and hyperlipidemia? A B C Which patient(s) has an increased risk of hypertension and hyperlipidemia? A Seborrheic Dermatitis B C Psoriasis Seborrheic Dermatitis Goodheart HP. Goodheart's photoguide of common skin disorders, 2nd ed, Lippincott Williams & Wilkins, Philadelphia 2003. Copyright © 2003 Lippincott Williams & Wilkins. Seborrheic Dermatitis • Erythematous scaly eruption • Infants= “Cradle Cap” • Reappear in adolescence or later in life • Chronic, remissions and flares; worse with stress, cold weather • Occurs on areas of body with increased sebaceous glands • Unclear role of Malassezia; could be immune response; no evidence of overgrowth Seborrheic Dermatitis Severe Seb Derm: THINK: • HIV (can also be more diffuse on trunk) • Parkinson’s (seb derm improves with L-dopa therapy) • Other neurologic disorders • Neuroleptic agents • Unclear etiology 5MinuteClinicalConsult Clinical Exam • Erythema/fine scale • Scalp • Ears • Nasolabial folds • Beard/hair bearing areas Goodheart HP. Goodheart's photoguide of common skin disorders, 2nd ed, Lippincott • Ill-defined Williams & Wilkins, Philadelphia
    [Show full text]