Term
|
Definition
| deepest layer of the epidermis. contains large stem cells and is where new cells are generated. Forms epidermal ridges that extend into hte dermis for nutrient diffusion. Also may include melanocytes and nerve receptors for touch. |
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Term
|
Definition
| Originates from the daughter cells of the S. germinativum layer which continue to divide to increase the thickness of the epidermis. |
|
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Term
|
Definition
| Consists of cells displaced from the spinosum later, cells stop dividing and make a large amount of a protein called Keratin. |
|
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Term
|
Definition
| A glassy clear layer that cover the S. granulosum in THICK skin of palms and soles. Cells are flattened and denselly packed an filled with keratin |
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Term
|
Definition
| Most superficial layer consisting of 15-30 layers of flattened and dead epithelial cells that have accumulated large amounts of keratin. Dead cells remain tightly connected by desmosomes. |
|
|
Term
|
Definition
1. Stratum Germinativum
2. Stratum Spinosum
3. Stratum Granulosum
4. Stratum Lucidum
5. Stratum Corneum |
|
|
Term
| Which layer of skin contributes most to the thickness of skin in thick skin? |
|
Definition
| Epidermis - stratum lucidum |
|
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Term
|
Definition
| glue that holds keratinocytes together and gives a lot of structural integrity. |
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Term
|
Definition
| produce and contain melanin |
|
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Term
|
Definition
| Pigment manufactured and stored in the cells of the S. Germanitivum and S. Spinosum layers of the epidermis. Adds color to the skin, hair and iris. Production determined by genetics and exposure to sunlight |
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Term
|
Definition
| Nerve cell that is the sensory receptor for touch. |
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Term
|
Definition
| Immature dendritic cells found in upper stratum spinosum layer of epidermis. |
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Term
|
Definition
| Replacement of epidermis can occur in 3-4 weeks |
|
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Term
|
Definition
| lifeless protein found in hair, nails and skin. Type I (acidic protein) paired with Type II keratin molecule(basic protein) |
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Term
|
Definition
| produce IL-1a, IL-6 and IL-8 and are responsive to vitamin A and vitamin D3. Likely role in homeostasis |
|
|
Term
| Important signaling system involved in homeostasis of skin |
|
Definition
|
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Term
|
Definition
| upper layer of the dermis. Loose connective tissue and contains capillaries and pain and touch sensory receptors |
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Term
|
Definition
| lower layer of the dermis. Collagen and elastic fibers rich in vessels and nerves. |
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Term
|
Definition
| branched areolar glands located over the surface of the skin surrounded by endodermis even though they are enveloped by epidermis and open to hair follicles |
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Term
|
Definition
| simple coiled tubular glands originating in the dermis and rising through the epidermis to the skin surface that is innervated by sympathetic nervous system though it has cholinergic control and NOT adrenergic. |
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Term
|
Definition
type of sweat gland that regulates temperature and waste excretion. Most common type and found everywhere on skin with highest numbers in skin of palms, soles and forehead.
exits body through the surface of the skin. |
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Term
|
Definition
| type of sweat gland that is responsible for the smell of sweat. Found in the axillae and perineum. Does not reach surface of the skin, instead exits into hair shaft that is open to the surface. |
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Term
|
Definition
| secretion from sebaceous gland that is a mixture of squalene, cholesterol, wax esters, cholesterol esters and triglycerides. Secretion is sensitive to sex hormone changes |
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Term
|
Definition
-prevents hair from becoming brittle
-moisturizes skin and prevents dehydration
-has a bactericidal action
excessive sebum secretion is a major cause of acne during adolescence |
|
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Term
|
Definition
layer of tissue below the dermis. Subcutaneous tissue or superficial fascia
Not considered part of skin. |
|
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Term
|
Definition
-stores fat
-insulates lower level tissues to prevent heat loss
-absorbs shocks to protect deeper tissues. |
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Term
|
Definition
|
|
Term
|
Definition
|
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Term
|
Definition
| large mature hair. Ex. hair on scalp |
|
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Term
|
Definition
-protection
-sensory
-abrasion resistance |
|
|
Term
|
Definition
scalp - injury, sun, heat loss
eyebrows and eyelashes - sun, foreign particles
nostrils - filter air
ear canal - foreign particles |
|
|
Term
|
Definition
-contains capillaries and nerve ending
-papilla contains melanocytes that determine hair color
-external layer of hair follicle formed from dermis and internal layer is formed from epidermis
-as cells divide, the daughter cells are pushed toward the surface to keratinize and die. |
|
|
Term
| Why does hair color lighten as we age? |
|
Definition
-decreased melanin
-presence of air bubbles in the air shaft |
|
|
Term
|
Definition
Anagen, Catagen, Telogen
85-90% of scalp hair is in Anagen which lasts 4-8 years, 1% in Cataben and about 10-15% in Telogen which lasts 4 months. |
|
|
Term
|
Definition
| active hair growth that may last 4-10 years |
|
|
Term
|
Definition
| degeneration cycle without growth of hair |
|
|
Term
|
Definition
| Resting phase of hair growth, getting ready to grow again |
|
|
Term
| number of hair growth cycles during lifetime |
|
Definition
|
|
Term
|
Definition
| on average we lose about 50 hairs from the head a day |
|
|
Term
| Causes of increased hair loss |
|
Definition
1. drugs
2. dietary factors
3. radiation
4. high fever
5. stress
6. hormonal factors |
|
|
Term
|
Definition
-protection
-tools
-weapons |
|
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Term
|
Definition
| consist of hard plates of tightly packed keratinized cells |
|
|
Term
|
Definition
| hard, translucent, from from compacted stratum corneum. |
|
|
Term
|
Definition
| highly vascularized and consistes of S. Germinativum and S. spinosum |
|
|
Term
|
Definition
|
|
Term
|
Definition
fingernails:
-0.1 mm/day or 3 mm/month
toenails:
-1 mm/month
5.5 months for entire nail to grow and 12-18 months for entire toe |
|
|
Term
| primary barrier of skin to drug absorption |
|
Definition
|
|
Term
| Drug metabolism of topical drugs |
|
Definition
| CYP 1A1, 1B1, 2D6 and Phase II enzymes such as Glucuronyl transferase are found in keratinocytes of epidermis. |
|
|
Term
|
Definition
R = DSK(Cout – Cin) / h
quantifies the amount of a substance diffusing across a given surface area in a certain amount of time under a specified concentration gradient of the substance. |
|
|
Term
|
Definition
|
|
Term
| Common drug substances responsible for allergic reactions on skin |
|
Definition
-penicillin
-sulfonamides
-barbiturates
-anticonvulsants
-insulin preparations
-local anesthetics (Novocain)
-iodine preparartions (X-ray contrast dye) |
|
|
Term
| percentage of patients that will experience cutaneous drug eruptions |
|
Definition
|
|
Term
| most common organ affected by drugs |
|
Definition
|
|
Term
| many cutaneous drug reactions are due to: |
|
Definition
-direct toxic effect on skin tissue or direct action to release histamine from mast cells
-does not involve antibodies or T-cells directly |
|
|
Term
| Immune mediated allergic reactions |
|
Definition
-drug may be an immunogenic molecule (MW >1000)
-small drug molecules may also elicit immune response by covalently binding to protein
-drug-protein interaction may be mediated by metabolic enzyme (CYP)
-drug-protein complex is processed by Langerhans cells in skin which then present fragment to T cells]
-T-cells may produce TH1 response (innate) or TH2 (adaptive) cells. |
|
|
Term
|
Definition
classic immediate hypersensitivity - anaphylaxis.
-antibody (IgE) mediated
-minutes to hours |
|
|
Term
|
Definition
cytotoxic antibody reaction
-antibody (IgG or IgM) interacts with complement system resulting in cell lysis
-onset within several hours and may last less than one day |
|
|
Term
|
Definition
immune complex reaction
-IgG or IgM antibodies formed against drugs to form an immune complex which triggers inflammation
-onset within several hours and may last less than one day |
|
|
Term
|
Definition
delayed hypersensitivity reaction
-sensitized T-lymphocytes; cytokines and inflammation
-late time course of reaction, often >2dose |
|
|
Term
| Examples of Type I hypersensitivity |
|
Definition
| urticaria, angioedema, bronchospasm, adrenal/CV reflex |
|
|
Term
| Example of Type II hypersensitivity |
|
Definition
|
|
Term
| Examples of Type III hypersensitivity |
|
Definition
| vasculitis, serum sickness, urticaria, angioedema |
|
|
Term
| Examples of Type IV hypersensitivity |
|
Definition
| contact dermatitis, exanthematous reactions, photoallergic reactions. |
|
|
Term
| Type I Reaction treatment options |
|
Definition
Epinephrine - 0.3-0.5cc 1:1000 1:10000IV
Diphenhydramine - H1 blocker: 50-100mg po/IM
Hydrocortisone - 100 mg IM
Bronchodilators, IV fluids, and H2 antihistamines |
|
|
Term
| Type II and III Treatment options |
|
Definition
H1 and H2 blockers (Doxepin)
Hydrocortisone (100mg IM in severe case) |
|
|
Term
| Type IV Reaction Treatment options |
|
Definition
| oral antihistamine or corticosteroids |
|
|
Term
|
Definition
rash or eruption that may be maculopapular (flat, red), morbilliform, erythematous
-most common drug eruption
-occurs 2-3 days after drug administration
-treat with antihistamines, wet dressing or systemic corticosteroids is severe reaction occurs |
|
|
Term
|
Definition
Hives
-acute or intermediate reaction
-lesions raised from a few mm to larger cm
-treat with H1 and H2 blockers
-systemic corticosteroids in severe cases
-symptoms clear in 1-2 days
-Usually drugs |
|
|
Term
|
Definition
-oval lesion with dusky red-blue appearance
-lesion can reoccur 30min-8hr after rechallenge (mostly in oral mucosa and genitalia)
-drug treatment is may not be very effective
-lesions typically heal 7-10 days after drug termination |
|
|
Term
|
Definition
skin becomes sensitive to sun exposure
-phototoxic if effect is seen within hours of exposure
-photoallergic if response within 1-2 days |
|
|
Term
| Drugs that may cause photosensitivity |
|
Definition
| topical corticosteroids, amiodarone, carbamazepine, furosemide, naproxen, oral contraceptives, phenothiazines, retinoids, sulfonamides, tetracyclines, thiazide |
|
|
Term
|
Definition
hair loss
toxic reaction that interferes with normal growth phases of the hair
drug culprits - warfarin, heparin, chemotherapy drugs |
|
|
Term
|
Definition
acne like lesions usually on the neck, chest or back.
-2-4week time to onset
-uniform size and symmetrical distribution |
|
|
Term
| Drugs that can cause acneiform eruptions |
|
Definition
ACTH, oral contraceptives, corticosteroids ("steroid acne"), iodide, lithium
Delayed type of reaction |
|
|
Term
|
Definition
red, painful nodules
heals over 2-3 weeks after drug termination |
|
|
Term
| Drugs that can cause erythema nodosum |
|
Definition
| oral contralceptives, iodides and bromides, penicillin |
|
|
Term
|
Definition
abundant flaky desquamation, skin sloughs 20-30 g/day
loss of fluid
treat with fluids, steroids, pain meds and antibiotics |
|
|
Term
| Drugs that can cause exfoliative dermatitis |
|
Definition
| barbituates, phenytoin, penicillin, carbamazepine |
|
|
Term
| Toxic Epidermal Necrolysis (TEN) |
|
Definition
widespread erythema, necrosis, and bullous detachment of the epidermis and mucous membranes resulting in exfoliation
life threatening and mediated by cytotoxic T-lymphocytes.
30% mortality seen due to 2nd infection |
|
|
Term
| Drugs that can cause toxic epidermal necrolysis |
|
Definition
| sulfonamides, barbituates, penicillin, phenylbutazone, allopurinol, carbamazepine |
|
|
Term
|
Definition
maculopapular bullae, vesicles, hemorrhagic lesions on mucus membranes of mouth, lips and conjunctiva
life threatening and mediated by cytotoxic T cells.
mortality rate 5-18% |
|
|
Term
| drugs that can cause Stevens-Johnson Syndrome |
|
Definition
| sulfonamides, barituates, penicillins, daptomycin |
|
|
Term
| Toxic Epidermall Necrolysis |
|
Definition
->30% of body
-Mucosal involvement mild
-more diffuse lesions, large areas of skin slough away
-severe skin pain
-maximal intensity occurs at 1-3 days |
|
|
Term
|
Definition
-<10% of body
-mucosal involvement severe
-patchy targetoid lesions, cough, fever, headache
-mild skin pain
-maximal intensity occurs at 7-15 days |
|
|
Term
| First Generation H1 Antagonist |
|
Definition
| -crosses the BBB for anticholinergic CNS sedation. |
|
|
Term
| Examples of first generation H1 Antagonist |
|
Definition
Hydroxyzine (Atarax)
Chlorpheniramine
Dephenhydramine
Cyproheptadine (Periactin) |
|
|
Term
| Second Generation H1 Antagonist |
|
Definition
Do not penetrate CNS, non-sedating, but metabolized by CYP3A4 and 2D6.
-so avoid use with imidazole antifungals and macrolide antibiotics |
|
|
Term
| Examples of second generation H1 antagonist |
|
Definition
Loratadine (Claritin)
Cetirizine (Zyrtec) |
|
|
Term
| Examples of H2 Antagonist |
|
Definition
Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)
Nizatidine (Axid) |
|
|
Term
| Leukotriene Receptor Antagonist |
|
Definition
| blocks the cys-LT1 receptor to reduce inflammation and itching |
|
|
Term
| Examples of Leukotriene Receptor Antagonist |
|
Definition
Zafirlukast (Accolate)
Montelukast (Singulair) |
|
|
Term
| Antidepressants use in therapy for hypersensitivity |
|
Definition
reuptake blockers that increase norepinephrine and dopamine effective levels in synapse.
Antihistaminic and anticholinergic sedating properties.
Central mood-elevating effects as used in psychiatry |
|
|
Term
| Examples of Antidepressants use in therapy for hypersensitivity |
|
Definition
Doxepin (Adapin, Sineguan) used by oral route
Topical cream form of doxepin (Zonalon) |
|
|
Term
| Examples of Steroids use in therapy for hypersensitivity reactions |
|
Definition
Hydrocortisone for anaphylaxis
Methyprednisolone for serious eruptions and drug reactions
Prednisone for milder conditions |
|
|
Term
| Steroids use in therapy for hypersensitivity reactions |
|
Definition
exert profound effects on immune system function, both via altered gene expression and direct receptor-mediated effects.
Decreased response to sun, chemical, mechanical, infectious and virtually all immunological stimuli.
both antibody and cell-mediated processes are affected.
decreased functions of virtually all components and immune pathways such as functions of lymphocytes, macrophages, monocytes, endothelial cells, basophiles, fibroblasts, eosinophils, and decreased actions of inflammatory cytokines such as IL-1,2,3,6,8,12 and TNF-alpha. |
|
|
Term
| Two primary types of expected toxicity and adverse effects from steroids |
|
Definition
1. Withdrawal of therapy - flare up of the underlying disease fro which steroids were prescribed and acute adrenal insufficiency due to long term suppression of the hypothalamic-pituitary axis by the steroid.
2. Metabolic/Organ System Dysfunction - continued use at higher level may develop: fluid/electrolyte imbalances, increased BP, increased glucose, infections, osteoporosis, risk of peptic ulcer, myopathy, behavioral distrubances, cataracts, acne, fat redistribution, growth arrest and a variety of other metabolic changes. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Methotrexate - folic acid analog used to inhibit dihydrofolate reductase (DHFR) and reduce the functions of very active immunocompetent cells of skin. |
|
|
Term
| Cautions when using Methotrexate for hypersensitivity reactions |
|
Definition
| take care to avoid drug interactions with other folate antagonists (trimethoprim/sulfas) and avoid co-administration with aspirin or NSAIDS that may displace the drug from bind sites to promote toxicity |
|
|
Term
|
Definition
| darkened - due to deposits of melanin |
|
|
Term
|
Definition
| lightened - due to lack of melanin |
|
|
Term
|
Definition
| yellow - increased billirubin or carotene |
|
|
Term
|
Definition
| cyanotic blue - lack of oxygenation |
|
|
Term
|
Definition
| Erythematous - dilation of blood vessels |
|
|
Term
|
Definition
| Violaceous - aging lesion that was erythematous |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| below the plane of the skin |
|
|
Term
|
Definition
| a curcumscribed, flat lesion less than 1 cm in diameter that differs from surrounding skin because of its color |
|
|
Term
|
Definition
a solid, circumscribed, elevated lesion less than 1 cm in diameter
-may result from metabolic deposits in the dermis, local dermal cellular infiltrates or hyperplasia of the dermis or epidermis. |
|
|
Term
|
Definition
| A palpable, solid mass of tissue that is differentiated from a papule by the depth of its involvement. |
|
|
Term
|
Definition
| a mesa-like elevated, flat lesion greater than 1 cm in diameter and relatively large surface area in comparison to the height about the surface. |
|
|
Term
|
Definition
| A transitory, elevated papule or plaque caused by edema of the skin |
|
|
Term
|
Definition
| hives, an eruption of itching wheals |
|
|
Term
|
Definition
| Blister; a small, circumscribed elevation of the skin filled with clear fluid. |
|
|
Term
|
Definition
| a vesicle greater than 0.5 cm in diameter |
|
|
Term
|
Definition
| a vesicle or bulla (usually less than 1.0 cm in diameter) filled with purulent exudate |
|
|
Term
|
Definition
results when serum, blood, or purulent exudate dries on the skin surface and are characterisitci of injury and pyogenic infection.
Color depends on what has dried. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| loose epidermal cells and can be white, yellow or brown, skinny or dull, and dry or greasy. |
|
|
Term
| Tumors are elevated lesions |
|
Definition
| > 2-3 cm in diamter and usually rounded |
|
|
Term
|
Definition
| represents thickening of the skin and accentuation of skin markings. Not as well defined as plaques and may show signs of itching, excoriations and crusts. |
|
|
Term
|
Definition
| sac-like lesion that contains fluid or solids but they are not translucent |
|
|
Term
|
Definition
red lesions from blood extravasation.
-if "pin point" - petichea
-if >2 cm it is ecchymoses |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| result from abrasion to the skin such as from trauma from fingernail scratching. May result in exudates and crusting. |
|
|
Term
|
Definition
| superficial destruction of the epidermis |
|
|
Term
|
Definition
| describes linear breaks in the skin to the dermis |
|
|
Term
|
Definition
| used to describe the depth of a lesion. the skin is destroyed to the dermis or subcutaneous layers. May have irregular, but sharp, borders. |
|
|
Term
|
Definition
enlargements of capillaries near the skin. May be visible through the skin.
Ex. spider veins |
|
|
Term
|
Definition
| inflammation of the hair follicle caused by an infection, irritation or physical injury to the hair follicle. |
|
|
Term
|
Definition
| Walled of collection of pus and is associated with localized inflammation and tissue destruction. Generally occurs in areas where frication occurs and minor traumas. Areas affected usually include surface beneath a belt, anterior thighs, buttocks, groin, axillea and waist. |
|
|
Term
|
Definition
| a deep seated nodule or abscess that is painful, firl, re, and hot. This type of lesion is generally associated with S. aureus. |
|
|
Term
|
Definition
| a cluster of furuncles (boils) |
|
|
Term
|
Definition
| fast spreading bacterial infection below the surface of the skin characterized by redness, warmth, inflammation that generally affects extremities and is associated with a staph or strep bacteria. |
|
|
Term
|
Definition
| common, contagious superficial skin infection that generally affects children and is associated with S. aureus. Starts as a vesicle and generally involves the face but can spread to any body surface. |
|
|
Term
|
Definition
| a superficial infection that generally occurs on the legs or buttocks. Primarily affects children andis often associated with poor hygiene. Similar to impetigo and is associated with strep and staph bacteria. |
|
|
Term
|
Definition
| sheet or band of fibrous tissue that covers underlying tissue and separates different layers of tissue. Encloses muscles or organs. |
|
|
Term
|
Definition
| a gas-forming necrotic infection of the superficial and deep fascia. Can result in thrombosis and gangrene or underlying tissues. It is caused by multiple pathogens and is associated with diabetes. |
|
|
Term
| Capillary vasodilatation results in... |
|
Definition
| transudation of fluid into the surrounding tissues. |
|
|
Term
|
Definition
| raised, defined, erythematous, pruritic, round to oval lesion that varies in number and size. |
|
|
Term
| Several hives can converge and form... |
|
Definition
|
|
Term
| Common causes of Urticaria |
|
Definition
Drugs:
-ACE Inhibitors, ASA, Sulfa Agents
Foods:
-Shell fish, nuts, chocolate, strawberries, tomatoes, pork, cows milk, wheat, yeast.
Insect Stings
Latex
Physical exercise (physical urticarias) |
|
|
Term
|
Definition
| Urticaria caused by physical exercise |
|
|
Term
|
Definition
| Onset occurs within 12-36 hours and resolves within 1-3 days |
|
|
Term
| Chronic cases of Urticaria |
|
Definition
| Defined as hives lasting longer than 6 weeks. Cases may last from months to years and cause is often unknown. |
|
|
Term
|
Definition
Hives, pruritis -intensity varies
Angioedema:
-thick plaques or hives that extend into the dermis and subcutaneous tissue.
-Pruritus is less because there are less sensory receptors located in the dermis or subcutaneous layers. |
|
|
Term
| Treatment options for Urticaria |
|
Definition
Preventative measures
Stop ASA
Antihistamines
Corticosteroids
Doxepin
Epinephrine
Methotrexate |
|
|
Term
| Antihistamines used for Urticaria |
|
Definition
First Generation H1 antagonists:
-Hydroxyzine
-Diphenhydramine
-Cyproheptadine
Second Generation H1 Antihistamines:
-Fexofenadine
Desloratadine
Loratadine
Cetirizine |
|
|
Term
| percentage of histamine receptors that in the skin that are H1 |
|
Definition
|
|
Term
| percentage of histamine receptors that in the skin that are H1 |
|
Definition
|
|
Term
| H2 receptor antagonist used for Urticaria |
|
Definition
Ranitidine 150 mg BID
Famotadine 20 mg BID |
|
|
Term
| Dose of Ranitidine for Urticaria |
|
Definition
|
|
Term
| Dose of Famotadine used for Urticaria |
|
Definition
|
|
Term
| Dose of Hydroxyzine used for Urticaria (Adults) |
|
Definition
10-25 BID to QID or single dose at bedtime
Max dose - 50mg QID |
|
|
Term
| Dose of diphenhydramine used for Urticaria (Adults) |
|
Definition
25-50 BID or can use single doses up to 100 mg
Max dose - 50 mg QID |
|
|
Term
| Dose for Cyproheptadine for Urticaria (Adults) |
|
Definition
4 mg TID-QID]
Max dose - 8 mg QID |
|
|
Term
| Dose of Hydroxyzine used for Urticaria (Children) |
|
Definition
<6: 10mg BID-QID
Max - do not exceed 50 mg/day
6-12:10-25 mg BID-QID
Max - do not exceed 100 mg/day |
|
|
Term
| Dose of Diphenhydramine used for Urticaria (Children) |
|
Definition
2-6: 6.25 mg BID-QID
Max - do not exceed 37.5 mg/day
6-12: 12.5 mg BID-QID
Max - do not exceed 150 mg/day |
|
|
Term
| Dose of Cyproheptadine used for Urticaria (Children) |
|
Definition
2-6: 2mg q 8-12 hours
Max - do not exceed 12 mg
7-14: 4mg q 8-12 hours
Max - do not exceed 16 mg/day |
|
|
Term
| Dose of Fexofenadine (Allegra) used for Urticaria (Adults) |
|
Definition
180 mg every day
Max - 180 mg BID |
|
|
Term
| Dose of Desloratadine (Clarinex) used for Urticaria (Adults) |
|
Definition
5mg every day
Max - 10 mg every day |
|
|
Term
| Dose of Loratadine (Claritin) used for Urticaria (Adults) |
|
Definition
10 mg every day
Max - 20 mg BID |
|
|
Term
| Dose of Cetirizine (Zyrtec) used for Urticaria (Adults) |
|
Definition
10 mg every day
Max - 10 mg BID |
|
|
Term
| Dose of Fexofenadine (Allegra) used for Urticaria (Children) |
|
Definition
|
|
Term
| Dose of Desloratadine (Clarinex) used for Urticaria (Children) |
|
Definition
1-5: 1.25 mg every day
6-11: 2.5 mg every day |
|
|
Term
| Dose of Loratadine (Claritin) used for Urticaria (Children) |
|
Definition
2-5: 5 mg every day
>6: 10 mg every day |
|
|
Term
| Dose of Cetirizine (Zyrtec) used for Urticaria (Children) |
|
Definition
6-12 months: 2.5 mg every day
1-5: 2.5 every day or BID
>6: 5-10 every day |
|
|
Term
| Side effects of Antihistamines |
|
Definition
CNS:
-Sedation for 1st generation
-Stimulation for children
Anticholinergic:
-Dry mouth, constipation, blurred vision, dizziness
Weight gain associated with Cyproheptadine |
|
|
Term
| Use of Corticosteroids in Urticaria |
|
Definition
Prednisone or Methylprednisolone dose pack
-signs of angioedema
-give along with antihistamines |
|
|
Term
| Dose of Prednisone in Urticaria |
|
Definition
40 mg everyday for 5-10 days
Taper dose:
40 mg every day for 3 days
20 mg every day for 3 days
10 mg every day for 3 days |
|
|
Term
| Medrol dose pack (Methylprdnisolone) |
|
Definition
contains 21, 4 mg pills
lasts for 6 days
-take 6 tabs the first day then decrease by 1 tab every day thereafter
Take pills with meals |
|
|
Term
|
Definition
Tricyclic antidepressany with potent H1 and H2 histamine blockage.
Used in CHRONIC urticaria |
|
|
Term
| Dose for Doxepin use in Urticaria |
|
Definition
10-25 mg TID
Side Effects:
- Dry mouth and constipation |
|
|
Term
| Methotrexate use in Urticaria |
|
Definition
Corticosteroid resistant chronic urticaria.
For patients with long history of disease, debilitating symptoms. |
|
|
Term
| Dosing for Methotrexate for Urticaria |
|
Definition
| 2.5 BID for 3 days a week for total duration of therapy of 4 weeks. |
|
|
Term
| Use of Epinephrine in Urticaria |
|
Definition
| for sever urticaria or acute urticaria with intolerable itching |
|
|
Term
| Acute Urticaria Treatment plan |
|
Definition
1. If the patient is experiencing moderate to severe pruritis use once a day non-sedating antihistamine agent every morning with a sedating antihistamine at night
2. Non-sedating H1 antagonist plus H2 antagonist
3. If there is extensive involvement and the patient has moderate to severe discomfort level you may consider short course of an oral corticosteroid. |
|
|
Term
| Chronic Urticaria Treatment plan |
|
Definition
1. Antihistamines
-Hydroxyzine - may decrease discomfort
-Non-sedating antihistamine in the morning with hydroxyzine at night.
2. Doxepin
3. Corticosteroids |
|
|
Term
| Angioedema can affect which areas? |
|
Definition
skin surface
lips - watch for sore throat, tightness, swelling and shortness of breath
eye lid involvement
mucosa of GI tract
extremities
scrotal swelling |
|
|
Term
|
Definition
| Transudation of fluid into the dermis |
|
|
Term
| Angioedema treatment plan |
|
Definition
Diphenhydramine or Hydroxyzine plus Prednisone or Medrol dose pack
-if signs of respiratory involvement give epinephrine IM or SQ and follow up with antihistamine and corticosteroid |
|
|
Term
| Use of Epinephrine for angioedema |
|
Definition
Angioedema with signs of facial or respiratory involvement
Anaphylaxis
1:1000 solution (1 mg/ml)
0.2 - 1 mL SQ or IM
EpiPen ro EpiPen Jr. |
|
|
Term
|
Definition
Acute onset of skin and mucosal lesions that may progress to GI symptoms, respiratory involvement, peripheral involvement, shock and death
patient complains of feeling hot, flushed and may be having difficulty breathing and hives may be presenting symptom |
|
|
Term
|
Definition
Females > Males
20-40 yo
Effects higher economic status
Biphasic reaction:
-give EpiPen once, patient responds but then reaction returns few hours later
Do not underestimate severity of reaction |
|
|
Term
| Management of Anaphylaxis |
|
Definition
Epinephrine:
-0.2-1 mL SQ or IM
EpiPen:
-one dose of 30 mg (0.3mL)for injection
EpiPen Jr:
-one dose of 15 mg (0.3ml of 1:2000) |
|
|
Term
| Inhibitors of cell wall synthesis (antibiotics) |
|
Definition
| Penicillin, cephalosporins, monobactams, carbapenems |
|
|
Term
| Protein synthesis inhibitors (antibiotics) |
|
Definition
30S types - tetracyclines and aminoglycosides
50S - erythromycin, clindamycin or chloramphenicol |
|
|
Term
| Inhibitors of nucleic acid function or synthesis (antibiotics) |
|
Definition
| rifampin, quinolones and the antimetabolite sulfonamides and tripethoprim |
|
|
Term
| Inhibitors of cell membrane permeability/function (antibiotics) |
|
Definition
| daptomycin and polymixins |
|
|
Term
| reasons to use folate synthesis as antibiotic drug target |
|
Definition
| Vitamin for humans because we don't synthesize it and drug target for bacteria because they must synthesize it |
|
|
Term
| Factors affecting drug choice and drug activity for antibiotics |
|
Definition
1. identity and drug sensitivity of the organism
2. Status of host defenses/immune function
3. Bacteriocidal vs. Bacteriostatic mechanism of action
-some antibiotics kill the bug, some only inhibit the growth
4. Antimicrobial Resistance
5. Site of infection
6. Absorption, Distribution and Pharmacokinetic issues
7. Metabolism and Elimination pathways
8. Pharmacogenetics of the host
9. Drug interactions
10. Pregnant or Nursing |
|
|
Term
Development of Resistance in Bacteria
(6 P's) |
|
Definition
1. Poor penetration into human cells
2. Decreased entry of drug into microorganism (porins)
3. Up-regulation of active efflux systems (pumps)- pump drugs back out of cell
4. Altered receptor - Penicillin Binding Proteins (PBP's)to reduce binding
5.Penicillinase enzymes that break down Penicillin to make it inactive.
6. Alternative metabolic pathway, variation in structure or modification of targeted system by organism (ex. Peptidoglycan) |
|
|
Term
| Complications with antibiotic therapy |
|
Definition
1. Development of Resistance
2. Therapy fails from onset
3. Drug interactions/antagonism or Patient genetics
4. Hypersensitivity (allergic reaction)
5. Direct toxicity to the host
6. Superinfections |
|
|
Term
| Common oral Antibiotics for Dermatological practice |
|
Definition
-Tetracycline, Minocycline, Doxycycline - 30S inhibitors
-Macrolides-Erythromycin and Clarithromycin - 50S inhibitors
-Clindamycin (more active than tetracyclines)
-Ampicillin, Amoxacillin - cell wall systhesis inhibition
-Quinolones (ciprofloxacin) - inhibits topoisomerase
-Caphalosporins - cell wall inhibition
-sulfamethoxazole/Trimethoprim - antifolate
-Metronidazole - reactive intermedate that damages DNA and enzymes |
|
|
Term
| Common antibiotics used topically for Dermatological practice |
|
Definition
-Bacitracin - cell wall inhib
-Chloramphenicol - 50S inhib
-Gentamycin - 30S inhib
-Metronidazole - reactive intermediates that damages DNA
-Mupirocin - inhibits tRNA synthetase for leucine
-Neomycin - 30S inhib
-Polymixin B - cationic detergent
-Povidone-iodine - betadyne ointment
-Mafenide - acts on G proteins
-Silver Sulfadiazine - Silvadene cream |
|
|
Term
|
Definition
| eukaryotic organism with two layer nuclear membrane, rigid cell wall composed or chitin and cellulose and a cell membrane that contains ergosterol instead of cholesterol. |
|
|
Term
| Antifungal that acts on Fungal cell membrane |
|
Definition
|
|
Term
| Antifungal that acts on Fungal cell wall |
|
Definition
|
|
Term
| Antifungals that acts on Fungal cell by inhibiting synthesis of Lanosterol from Squalene |
|
Definition
Terbinafine
Naftifine
Amoroifine |
|
|
Term
| Antifungals that acts on Fungal cell by inhibiting synthesis of Ergosterol from Lanosterol |
|
Definition
|
|
Term
| Antifungals that acts on Fungal cell microtubules |
|
Definition
|
|
Term
| Antifungals that acts on Fungal cell by inhibiting transcription/translation |
|
Definition
|
|
Term
|
Definition
| Antifungal that disrupts mitosis by acting on the microtubule system. |
|
|
Term
|
Definition
Antifungal that inhibits conversion of squalene to lanosterol by squalene epoxidase. "Allylamine" along with naftifine.
40% drug loss due to first-pass metabolism and long T(1/2) because it can accumulate in nails, skin, and fat. |
|
|
Term
| Drug interactions with Terbinafine |
|
Definition
-Rifampin decreases and Cimetidine increases plama concentration of Terbinafine from effects on CYP.
-Adverse Drug Reactions with antidepressants (fluoxtine and venlafaxine) and the immune system suppressant cyclosporine |
|
|
Term
| Azoles (Imidazoles and Triazoles) |
|
Definition
1. Imidazoles: 2 N in azole ring
-ketoconazole and mirconazole
2. Triazole: 3 N in azole ring
-fluconazole, itraconazole, voriconazole, posaconazole
Fluconazole and itraconazole are most common for dermatological conditions |
|
|
Term
| Azoles - Mechanism of Action |
|
Definition
Blocks fungal P450 dependent synthesis of ergosterol. (14-alpha-sterol demethylase)
-may also inhibit gonadal and andreal steroid synthesis in humans supressing testosterone and cortisol synthesis |
|
|
Term
| Itraconazole metabolic interactions |
|
Definition
|
|
Term
| Fluconazole metabolic interactions |
|
Definition
inhibits CYP3A4 and CYP2C9
-raises plasma levels of cyclosporine, phenytoin, tacrolimus, theophylline, and warfarin |
|
|
Term
| Voriconazole metabolic interactions |
|
Definition
| Inhibits CYP2C19, 2C9, 3A4. |
|
|
Term
| Posaconazole metabolic interactions |
|
Definition
| not known to be CYP inhibitor |
|
|
Term
| Adverse effects and toxicity of antifungals |
|
Definition
-Metabolic drug interactions
-Hepatotoxicity (more common in ketoconazole)
-GI distress with N/V and diarrhea
-skin rash and alopecia
-QT (EKG all over the place) prolongation with ketoconazole, voriconazole, and itraconazole
-Visual disturbances and some hallucinations (with voriconazole)
-should not be used in pregnancy |
|
|
Term
|
Definition
Tinea unguium
most common nail disorder (50%)
4x more common in toenails than in fingernails |
|
|
Term
| Pathogens causing Onychomycosis |
|
Definition
Dermatophytes (80-90%)
-Trichophyton rubrum
-Trichophyton mentagrophytes
Yeast (2-8%)
-Candida albicans
-Candida parapsilosis
Nondermatophytes (2-10%)
-Aspergillus
-Scopulariopsis |
|
|
Term
|
Definition
1. Distal Subungual Onychomycosis
2. White Superficial Onychomycosis
3. Proximal Subungual Onychomycosis
4. Candida Onychomycosis |
|
|
Term
| Distal Subungual Onychomycosis |
|
Definition
Most common type of onychomycosis.
Infection begins in the distal area of the nail bed.
Nail becomes thick, brittle and begins to affect how the nail grows making it difficult to trim |
|
|
Term
| White Superficial Onychomycosis |
|
Definition
Toenail infection only.
Involves only the surface of the nail and nail plate does not become thickened.
Nail is soft, dry and can be easily scraped off. |
|
|
Term
| Proximal Subungual Onychomycosis |
|
Definition
Infection begins at the nail fold/cuticle area and then moves distally.
Marker of immunosuppressant disease such as HIV
May see separation of the nail from the nail bed. |
|
|
Term
| Increased risk of infection in... |
|
Definition
| immunocompromised and diabetic patients |
|
|
Term
|
Definition
Nails appearance is generally opaque and do not crumble (?)
Color is yellow-brown
More commonly affects fingernails |
|
|
Term
| People at risk for Onychomycosis |
|
Definition
Diabetics
use of immunosuppressants and systemic antibiotics
HIV/AIDS
-present at younger age (20-30)
-proximal subunual onychomycosis
Geriatric population (>60)
- >60: 20% of population affected
- >70: up to 50% of population affected
Institutional living (communal bathing)
Athletes (Tinea pedis)
Health Clubs |
|
|
Term
| Clinical Presentation/Symptoms of Onychomycosis |
|
Definition
Thickening of the nail (hyperkeratosis)
Discoloration of the nail (white or brown)
Brittleness
Onycholysis (seperation of the nail from the nail bed)
Paronychial inflammation
Recurrent tinea pedis
Pain |
|
|
Term
| Find agent that meets following criteria: |
|
Definition
1. good concentrations in the nail bed and matrix
2. high sliinical/mycologic cure rate
3. low rate of relapse
4. short term therapy that is efficacious
4. Few adverse drug reactions and drug interactions
5. cost-effective |
|
|
Term
| Treatment options for Onychomycosis |
|
Definition
Nail removal
Griseofulvin
Ketoconazole
Itraconazole
Fluconazole
Terbinafine |
|
|
Term
| Disadvantages of nail removal |
|
Definition
patient discomfort
permanent nail deformity
high relapse rate |
|
|
Term
| Nail Care to help onychomycosis |
|
Definition
Nails should be kept short and clean
Nails shoule be cut straight across
File hypertrophic nails
Clean all nail instruments
avoid nail nails
Avoid high heels or narrow toed shoes
Apply antifungal foot powder daily to shoes to absorb moisture from foot
Use of cotton gloves for dry work and vinyl gloves for wet work |
|
|
Term
|
Definition
PenLac - Ciclopirox Nail Lacquer
-should be used for 48 weeks
Antifungal agents:
-solutions (clotrimazole, tolnaftate, Terbinafine)
-creams (Clotrimazole, tolnaftate, Terbinafine)
-powder (Tolnaftate) |
|
|
Term
| Topical Nail therapy problems |
|
Definition
cannot penetrate harden nail mass
requires multiple daily applications and long duration of therapy
may use as adjunctive therapy with oral antifungal agents. |
|
|
Term
| Disadvantages of Griseofulvin used for Onychomycosis |
|
Definition
High rate of resistance
High rate of relapse
Low cure rate
Long duration of therapy (6-18 months)
Intolerable Adverse Drug Reactions |
|
|
Term
| Dosage Forms of Griseofulvin for use in Onychomycosis |
|
Definition
Microsize (Grifulvin) - 250 mg and 500 mg
-need to take with a fatty meal to increase absorption
Ultramicrosize (Gris-Peg) - 125, 165, 250 and 330 mg
-increased absorption
Suspension 125mg/mL |
|
|
Term
| Dose of Griseofulvin for use in Onychomycosis |
|
Definition
500 mg QD-BID
1000 mg/day at $280/month |
|
|
Term
| Monitering parameters for Griseofulvin for use in Onychomycosis |
|
Definition
Baseline AST, ALT and CBC
Repeat AST and ALT if treatment is >6 weeks.
Test liver function and may be indication of inflammation of liver. |
|
|
Term
| Adverse Drug Reactions to Griseofulvin for us in Onychomycosis |
|
Definition
Skin rashes or urticaria
GI
Photosensitivity
Toxic epidermal necrolysis
-Hypersensitivity
-Sore throat, fever, or rash should be reported immediately |
|
|
Term
| Drug Interactions with Griseofulvin for use in Onychomycosis |
|
Definition
Anticoagulants
Oral Contraceptives
Cyclosporine
Salicylates
Phenobarbital will decrease Griseofulvin serum concentrations |
|
|
Term
| Ketoconazole (Nizoral) use in Onychomycosis |
|
Definition
| Not effective and risk of drug interactions and hepatoxicity |
|
|
Term
| Fluconazole (Diflucan) use in Onychomycosis |
|
Definition
| Fungistatic that inhibits the synthesis of ergosterol |
|
|
Term
| Advantages and Disadvantages of Fluconazole for use in Onychomycosis |
|
Definition
Advantages:
-Good nail bed and matrix penetration
-can be detected in toenails 6 months after discontinued use
-Good absorptions that is not influenced by gastric acid, food, actacids H2 blockers.
Disadvantages:
-Lacks indication
-has not been extensively studied for use in Onychomycosis |
|
|
Term
| Dose of Fluconazole for use in Onychomycosis |
|
Definition
150 mg every week for 3 months
Treatment duration rages from 3-12 months
80% of Fluconazole is excreted unchanged in the urine |
|
|
Term
| Adverse Drug Reactions of Fluconazole for use in Onychomycosis |
|
Definition
GI - nausau, diarrhea and abdominal pain, elevated liver enzymes
DO NOT USE in patients with active liver disease:
-can increase transaminases and cause liver damage |
|
|
Term
| Monitering parameters of Fluconazole for use in Onychomycosis |
|
Definition
| Baseline AST, ALT and CBC. Consider AST and ALT monthly if therapy is longer than 6 weeks. |
|
|
Term
| Drug interactions of Fluconazole for use in Onychomycosis |
|
Definition
Increase the effects of warfarin, cyclospoine, theophylline, phenytoin, sulfonylureas
decrease the effects of oral contraceptives |
|
|
Term
| Itraconazole (Sporanox)use for Onychomychosis |
|
Definition
Fungistatic - inhibits the synthesis of ergosterol
Better for Candida infections |
|
|
Term
| Advantages of Itraconazole for use in Onychomycosis |
|
Definition
Good concentration in nail matrix and nail bed
Achieve concentrations that are detectable for 6 months following discontinued treatment |
|
|
Term
| Dose of Itraconazole for use in Onychomycosis |
|
Definition
Toenails:
-200 mg daily for 12 weeks @ $492/month
Fingernails:
-200 mg BID for 7 days/month for 2 monthly cycles seperated by 3 weeks |
|
|
Term
| Monitor parameters of Itraconazole for use in Onychomycosis |
|
Definition
| Baseline AST, ALT and CBC. Consider AST and ALT monthly if therapy is greater than 1 month. |
|
|
Term
| Drug interations of Itraconazole for use in Onychomycosis |
|
Definition
| Warfarin, H2 blockers, PPI, DDI, Ritonavir, Indinavir, Benzodiazepines, Lovastatin, Simvastatin, Cyclosporine, Tacrolimus, Phenytoin, Phenobarbital, Carbamazepine, Rifamycin |
|
|
Term
| Adverse Drug Reaction of Itraconazole for use in Onychomycosis |
|
Definition
GI (N/V, diarrhea and abdominal pain)
Headache
Dizziness
Rash
Elevated liver enzymes |
|
|
Term
| FDA Warnings for Itraconazole for use in Onychomycosis |
|
Definition
Hepatoxicity
Congestive Heart Failure:
-contraindicated for patients with CHF, cardiac dysfuntion or a history of CHF
-Black box warning recommending discontinuing use if signs and symptoms of CHF develop |
|
|
Term
| Disadvantages of Itraconazole for use in Onychomycosis |
|
Definition
Multiple Drug Interactions
Expensive
Must be taken with full meal
Acidic Environment for absorption:
-Antacids, H2 blockers and PPI with reduce absorption
-Achlohydria - Cokes will improve absorption. |
|
|
Term
| Terbinafine (Lamisil) for use in Onychomycosis |
|
Definition
First line therapy in private practive
More effective than Itraconazole
Fungicidal with generic now available |
|
|
Term
| Dose of Terbinafine for use in Onychomycosis |
|
Definition
Fingernails:
-250 mg QD for 6 weeks
Toenails:
-250 mg QD for 12 weeks ($52.00/month) |
|
|
Term
| FDA Warnings of Terbinafine for use in Onychomycosis |
|
Definition
Hepatotoxicity
-Liver failure and death
-Not indicated in patients with chronic or active hepatic disease |
|
|
Term
| Monitoring parameters of Terbinafine for use in Onychomycosis |
|
Definition
| Baseline AST, ALT and CBC. Consider monthly AST and ALT if therapy is greater than 6 weeks. |
|
|
Term
| Drug Interactions of Terbinafine for use in Onychomycosis |
|
Definition
-Tricyclic antidepressants (SSRI - fluoxetine and paroxetine)
-Venlafaxine
-Cyclosporin |
|
|
Term
| Adverse Effects of Terbinafine for use in Onychomycosis |
|
Definition
GI - diarrhea, abdominal pain, nausea and flatulence
Rash
Taste disturbances
Elevated liver enzymes |
|
|
Term
| Advantages of Terbinafine for use in Onychomycosis |
|
Definition
Fewer drug interactions
Fewer Adverse Drug Reactions
fungicidal activity
Pregnancy category B |
|
|
Term
| Best options for treatment of Onychomycosis |
|
Definition
| Ciclopiox and Terbinafine |
|
|
Term
| Therapeutic considerations for Onychomycosis patients |
|
Definition
-Concomitant Disease States
-Drug Interactions (Fluconazoles and Itraconazole)
-Adverse Drug Reactions - Terbinafine and Fluconazole tent to be better tolerated)
-Cost |
|
|
Term
| Tinea Pedis - Interdigital |
|
Definition
Toe web infection
-most common superficial fungal infection
-Maceration appearance (soggy and wet)
-Dry scaly fissure appearance
-Most commonly involves 4th and 5th toe
-Itching is common symptom |
|
|
Term
|
Definition
Affects the soles of the feet
Appearance:
-Hyperkeratotic (thickening of soles)
-Erythema - redness
-White and Silver scales
-Entire sole is involved
May be difficult to distinguish from xerosis, psoriasis, or eczema |
|
|
Term
| Tinea Pedis - Inflammatory or Bullous |
|
Definition
Rare and resembles contact allergic dermatitis.
Starts as web infection.
Vesicles form on the soles of feet and vesicles may form into bullae.
Patient at risk of secondary infection. |
|
|
Term
| Tinea Pedis - Ulcerative Type |
|
Definition
Invasive involvement of interdigital into the dermis.
Maceration
Secondary infection |
|
|
Term
| Tinea Pedis - dermatophytid |
|
Definition
|
|
Term
| Web infection invading the skin decreases the skin's integrity leading to... |
|
Definition
| Secondary infections. Staph |
|
|
Term
| First line Topical treatment of Tinea Pedis |
|
Definition
-if maceration or wet lesions are present consider aluminum acetate foot soaks or powder (powder will not treat the infection but will help to dry out environment)
-wash the area and dry very well then apply treatment morning and night |
|
|
Term
| Oral Treatment of Tinea Pedis with Doses |
|
Definition
Give only if very invasive infection
Griseofulvin:
-Adult: 500 mg /day for 6-12 weeks
-Children: 7 mg/kg/day for 6-12 weeks
Gluconazole: 150 mg once a week for 1 month
Terbinafine: 250 mg/day for 2 weeks |
|
|
Term
| Monitoring Parameters for oral treatment for tinea pedis |
|
Definition
Re-evaluate at the end of each treatment phase
Baseline CBC and LFT
If treatment exceeds 1 month recheck LFT |
|
|
Term
|
Definition
"Ring worm" of the scalp
-involves scalp hair follicles and skin
-affects school age children
-rare in adults but they can be asymptomatic carriers
-Higher incidence in African Americans |
|
|
Term
| Presentation of Tinea Capitis |
|
Definition
-Circular scalp alopecia
-"Black dots" - broken off hair shafts
-Dandruff |
|
|
Term
| Symptoms of Tinea Capitis |
|
Definition
Hair loss
Pain and tenderness
Flaking or scaling |
|
|
Term
| Topical Treatment of Tinea Capitis |
|
Definition
Ketoconazole shampoo
Topical antifungals solution and lotions (will not be effective alone, need to be used as adjunctive treatment to oral agents)
Selenium sulfide
Topical steroids |
|
|
Term
| Oral Treatment of Tinea Capitis |
|
Definition
Griseofulvin:
-Children: 15 mg/kg for 6-8 weeks
-Adults: 330 QD for 4-6 weeks (330-500 may be appropriate)
Fluconazole
-Adults: 50 mg QD for 4-6 weeks
-Children: 6 mg/kg/day
-8 mg/kg/week for 4-16 weeks
Itraconazole:
-Adults: 100 mg QD for 4-6 weeks
-Children: 5 mg/kg/day
Terbinafine:
-Adults: 250 mg QD for 4-6 weeks
-Children: 125 mg QD for 4-6 weeks |
|
|
Term
|
Definition
| Lesions resemble tinea corporis and involves the hair follicles of beard and mustache. |
|
|
Term
|
Definition
Pruritis
Tenderness and Pain |
|
|
Term
| Oral Treatment of Tinea Barbae |
|
Definition
Griseofulvin
Fluconazole
Itraconazole
Terbinafine |
|
|
Term
|
Definition
"Ring Worm"
Circular lesions with demarcated borders found on trunk and limbs |
|
|
Term
| Triggering factors for Tinea Corporis |
|
Definition
| Humid climates, daycare settings and animal contact |
|
|
Term
| Treatment of Tinea Corporis |
|
Definition
Localized infections will respond to topical antifungal therapy.
-Apply twice a day for 2-3 weeks and advise patient to continue therapy 1 week after resolution of symptoms
May also use Aluminum acetate for wet lesions.
-apply dressings for 20-30 minutes 2-6 times/day |
|
|
Term
| Oral treatment for Tinea Corporis |
|
Definition
Griseofulvin:
-Adults: 330 or 500 mg QD for 2-4 weeks
-Children: 5-7 mg/kg/day 2-6 weeks
Fluconazole: 150 mg every week for 2-6 weeks
Ketoconazole: 200-400 mg QD for 2 weeks
Itraconazole: 100-200 mg QD for 2 weeks
Terbinafine: 250 mg QD for 1-2 weeks |
|
|
Term
| Treatment plan for Tinea Corporis |
|
Definition
Try topical first with aluminun acetate solution if wet then try oral if it is not working.
absolutely no oral anti-fungal for patients with liver disease b/c they are all hepatotoxic. |
|
|
Term
|
Definition
"Jock Itch" with highest incidence of infection in men and a high rate of relapse.
Can be triggered by warm and humid environment, tight, occlusive clothing and obesity. |
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Term
| Presentation of Tinea Cruris |
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Definition
| Demarcated scaling plaques, erythematous and bilateral on thighs and groin region that may extend to the buttocks. |
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Term
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Definition
| Pruritus and Inflammation |
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Term
| Treatment of Tinea Cruris |
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Definition
Topical treatment:
-apply twice daily for 10 days and advise patient to continue application even after lesions have disappeared.
-use powder or aluminum acetate solution to absorb moisture |
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Term
| Topical Steroid/Antifungal combination for Tinea Cruris |
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Definition
Lotrisone:
-Clotriamazole and betamethasone
Mycolog II:
-Nystatin and triamcinolone |
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Term
| Oral therapy for Tinea Cruris (if extensive involvement) |
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Definition
Griseofulvin:
-330-500 mg/day for 2-4 weeks
Ketoconazole:
-200-400 mg QD for 2 weeks
Fluconazole:
-150 mg every week for 2-4 weeks
Itraconazole:
-100-200 mg QD for 2 weeks
Terbinafine:
-250 mg QD for 2-4 weeks |
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Term
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Definition
Thickened, scaling skin on palms.
Erythema appearance.
Co-infection with Tinea pedis |
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Term
| Treatment for Tinea Manuum |
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Definition
Use oral because the skin is too thick for topical to penetrate.
Terbinafine: 250 mg QD for 14 days
Itraconazole: 200 mg QD for 7 days
Griseofulvin: 500 mg QD for 21 days |
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Term
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Definition
Caused by the yeast P. orbiculare which is a normal flora and in highest numbers in areas with increased subaceous glands.
Triggered by heat and humidity, Cushing's disease, pregnancy, malnutrition, burns, corticosteroids, immunosuppresion, oral contraceptive agents |
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Term
| Presentation of Tinea Veriscolor |
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Definition
Circular, macular patches of various color (white, pink or brown)
Asymptomatic with mild pruritus |
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Term
| Topical Treatment of Tinea Versicolor |
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Definition
Selenium Sulfide (Selsyn Blue)
-apply 10 minutes daily for 7 consecutive days
Ketoconazole, Miconazole, Clotriamizole or Econazole:
-apply 1-2 times a day for 2-4 weeks
Keratolytic soaps may help prevent reoccurence. |
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Term
| Systemic agents for Treatment of Tinea Veriscolor |
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Definition
Ketoconazole: 400 mg single dose or 200 mg every day for 5 days
Itraconazole: 200 mg daily for 5 days
Fluconazole: 300-400 mg as a single does that may be repeated in 2 weeks |
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Term
| Topical agents are indicated for... |
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Definition
| Tinea Corporis, Tinea cruris, Tinea manuum (even though there is not good penetration) and Tinea pedis |
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Term
| Oral treatments indicated for... |
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Definition
| Tinea manuum, Tinea barbae, and Tinea capitus |
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Term
| Use of different formulations of topical agents for fungal infections |
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Definition
Ointment - more moisturizing and will soften up lesions and allow drug penetration. Use for Hyperkeratotic lesions.
Lotions and Solutions - Hairy areas of body, moist or weeping lesions and to prevent maceration.
Creams - use for scaling, dry lesions.
Powders - use for prevention, adjunctive therapy and to reduce maceration and moisture. |
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Term
| Most common OTC Topical Antifungals |
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Definition
Terbinafine (Lamisil)
Clotriamizole (Lotrimin)
Tolnaftate (Tinactin) |
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Term
| Use Systemic Therapy for fungal infection if patient is: |
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Definition
Immunocompromised
Diabetic
Extensive or invasive infection
Inflammatory infection
Hyperkeratotic involvement of palms or soles
Failure of two forms of topical therapy |
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