Lecture 1 - Exam of Skin-Derm Therapy FINAL MEDPEDS

7/23/2019 Lecture 1 - Exam of Skin-Derm Therapy FINAL MEDPEDS

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Examination of Skin andExamination of Skin andDermatologic TherapyDermatologic Therapy


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Module InstructionsModule Instructions

The following module contains hyperlinkedThe following module contains hyperlinked

information which serves to offer moreinformation which serves to offer moreinformation on topics you may or may not beinformation on topics you may or may not be

familiar with. We encourage that you read allfamiliar with. We encourage that you read all

the hyperlinked information.the hyperlinked information.


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Examination of SkinExamination of Skin


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Components of Dermatological EvaluationComponents of Dermatological Evaluation

History (Subjective)History (Subjective)

Physical Examination (Objective)Physical Examination (Objective)

Diagnosis (Assessment)Diagnosis (Assessment)

PlanPlan

SOAPSOAP notenote


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History ComponentsHistory Components

A dermatologic history is similar to other fields of medicine anA dermatologic history is similar to other fields of medicine anddincludes:includes:

Chief ComplaintChief Complaint

History of Present Illness: Onset and evolution, SymptomHistory of Present Illness: Onset and evolution, Symptom(itch, pain), Current Treatments(itch, pain), Current Treatments

Past Medical History (PMH)Past Medical History (PMH)

AllergiesAllergies

MedicationsMedications

Family History (especially psoriasis, atopic dermatitis, allergiFamily History (especially psoriasis, atopic dermatitis, allergiccrhinitis, asthma, and skin cancer, particularly melanoma)rhinitis, asthma, and skin cancer, particularly melanoma)

Social History: Occupation, living state (may becomeSocial History: Occupation, living state (may become

important in the case of allergic skin reactions)important in the case of allergic skin reactions) Review of SystemsReview of Systems


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Physical ExaminationPhysical Examination

Be complete, examining both places that the patientBe complete, examining both places that the patient

indicates there may be a lesion as well as places theindicates there may be a lesion as well as places thepatient may not be obvious to the patientpatient may not be obvious to the patient

For example, it is important to examine the cleft ofFor example, it is important to examine the cleft of

the buttock in a patient with psoriasisthe buttock in a patient with psoriasis

For skin cancer patients, a complete examination of allFor skin cancer patients, a complete examination of all

sun exposed areas is essential (full body skin exam)sun exposed areas is essential (full body skin exam)

Adequate illumination is essential for seeing skin lesionsAdequate illumination is essential for seeing skin lesions

Magnification may help in identifying lesionsMagnification may help in identifying lesions

Palpate lesions (with gloves)Palpate lesions (with gloves)


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Describing Skin LesionsDescribing Skin Lesions

Carefully describe ALL skin lesionsCarefully describe ALL skin lesions

Indicate the distribution of lesions (where theyIndicate the distribution of lesions (where theyare on the body)are on the body)

Indicate configuration of lesions (shape andIndicate configuration of lesions (shape andgrouping)grouping)

Indicate the color of lesionsIndicate the color of lesions


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Types of Skin LesionsTypes of Skin Lesions

Primary Lesions: these lesions represent thePrimary Lesions: these lesions represent the

early stage of the lesion, how they look whenearly stage of the lesion, how they look whenthey start, prior to evolvingthey start, prior to evolving

Secondary Lesions: these lesions represent aSecondary Lesions: these lesions represent a

later stage after the lesion has evolved or beenlater stage after the lesion has evolved or beenalteredaltered

This may help you to determine where in theThis may help you to determine where in theskin the process is occurring (epidermis, dermis,skin the process is occurring (epidermis, dermis,fat)fat)


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Types of Primary Skin LesionsTypes of Primary Skin Lesions

MaculeMacule:: 1 cm flat non--palpable lesionpalpable lesion

These lesions only represent a change in colorThese lesions only represent a change in color

The color displayed helps localize the pathologyThe color displayed helps localize the pathology

Red: from blood vessels in the dermisRed: from blood vessels in the dermis

White: from loss of melanin in the epidermisWhite: from loss of melanin in the epidermis

Brown: from melanin in the epidermis or dermisBrown: from melanin in the epidermis or dermis
http://missinglink.ucsf.edu/lm/DermatologyGlossary/patch.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/macule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/macule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/patch.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/patch.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/patch.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/patch.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/patch.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/patch.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/patch.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/patch.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/macule.html


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More Primary Skin LesionsMore Primary Skin Lesions

PapulePapule: elevated: elevated bumpbump

< 0.5 cm< 0.5 cm

NoduleNodule: elevated: elevated bumpbump

> 0.5 cm, frequently in> 0.5 cm, frequently inthe dermis or fat and deeper than a plaquethe dermis or fat and deeper than a plaque

Large nodules, >2cm are often referred to asLarge nodules, >2cm are often referred to as

tumorstumors

PlaquePlaque: Plateau: Plateau--like lesion > 0.5 cmlike lesion > 0.5 cm

WhealWheal: Special plaque composed only of fluid (a: Special plaque composed only of fluid (ahive)hive)

Cyst: Papule or nodule filled fluid or semisolidCyst: Papule or nodule filled fluid or semisolid

materialmaterial
http://missinglink.ucsf.edu/lm/DermatologyGlossary/nodule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/papule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/papule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/nodule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/nodule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/wheal.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/plaque.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/plaque.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/wheal.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/wheal.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/wheal.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/plaque.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/nodule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/papule.html


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More Primary Skin LesionsMore Primary Skin Lesions

VesicleVesicle: Fluid filled: Fluid filled blisterblister

0.5 cm

PustulePustule:: Cloudy fluid filled lesion containingCloudy fluid filled lesion containing

many inflammatory cells (pus in it!!!)many inflammatory cells (pus in it!!!)

TelangiectasiaTelangiectasia::

Dilated superficial vessels (notDilated superficial vessels (not

brokenbroken

blood vessels)blood vessels)
http://missinglink.ucsf.edu/lm/DermatologyGlossary/bulla.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/vesicle.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/vesicle.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/pustule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/bulla.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/bulla.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/pustule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/pustule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/telangectasias.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/telangectasias.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/telangectasias.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/pustule.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/bulla.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/vesicle.html


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Secondary LesionsSecondary Lesions

CrustCrust: Dried fluid and: Dried fluid and keratinocyteskeratinocytes

arisingarising

from broken vesicles andfrom broken vesicles and bullaebullae

ScaleScale::

thickened stratumthickened stratum corneumcorneum

(scale occurs(scale occurs

in the epidermis)in the epidermis)

IndurationInduration:: Increased firmness and thickeningIncreased firmness and thickeningof the dermis (need to feel to determine this)of the dermis (need to feel to determine this)
http://missinglink.ucsf.edu/lm/DermatologyGlossary/crusting.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/crusting.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/scaling.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/scaling.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/induration.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/induration.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/induration.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/scaling.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/crusting.html


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ErosionErosion: Loss of the epidermis: Loss of the epidermis

Ulcer(ation):Ulcer(ation): Loss of the epidermis and someLoss of the epidermis and someor all of the dermis and sometimes subcutaneousor all of the dermis and sometimes subcutaneous

tissuetissue

AtrophyAtrophy::

Loss of dermis or fat (sunken in) orLoss of dermis or fat (sunken in) or

thinning of the epidermis (finely wrinkledthinning of the epidermis (finely wrinkledtranslucent skin)translucent skin)
http://missinglink.ucsf.edu/lm/DermatologyGlossary/ulceration.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/erosion.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/erosion.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/ulceration.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/ulceration.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/atrophy.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/atrophy.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/atrophy.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/ulceration.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/erosion.html


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Shapes and ConfigurationsShapes and Configurations

AnnularAnnular: Making a circle, clear in the center: Making a circle, clear in the center

Round or ovalRound or oval

GroupedGrouped ((herpetiformherpetiform): occurring in crops): occurring in crops

LinearLinear: Making a line: Making a line

DermatomalDermatomal: Going along the nerves: Going along the nerves
http://missinglink.ucsf.edu/lm/DermatologyGlossary/annular.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/annular.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/grouped.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/linear.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/grouped.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/grouped.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/dermatomal.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/linear.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/linear.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/dermatomal.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/dermatomal.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/dermatomal.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/linear.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/grouped.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/annular.html


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DirectionsDirections

A series of pictures displaying variousA series of pictures displaying various

morphologies and patterns will follow, try tomorphologies and patterns will follow, try tothink about how you should describe thesethink about how you should describe these

lesions to your residents andlesions to your residents and attendingsattendings

andandthen see how these lesions are appropriatelythen see how these lesions are appropriately

described.described.


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How would you describe this lesion?How would you describe this lesion?

Which morphologies areWhich morphologies are

present?present?

a.a. maculemacule

i. bullai. bulla

b. patchb. patch

j. pustulej. pustule

c. papulec. papule

k.k. telangiectasiatelangiectasia

d. noduled. nodule

l. crustl. crust

e. plaquee. plaque m. scalem. scale

f. whealf. wheal

n.n. indurationindurationg. cystg. cyst

o. erosiono. erosion

h. vesicleh. vesicle

p. ulcerp. ulcer

q. atrophyq. atrophy


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On exam, the patient has large

white patches of depigmentationwith some surroundingdepigmented

macules

withoutoverlying scale

MACULE

PATCH


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present?present?

a.a. maculemacule

i. bullai. bulla

b. patchb. patch


c. papulec. papule


d. noduled. nodule

l. crustl. crust


f. whealf. wheal




p. ulcerp. ulcer



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Papule

Plaque

Exam: 10-20 scatteredflesh colored papulesintermixed with 5-10blue plaques


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present?present?

a.a. maculemacule

i. bullai. bulla

b. patchb. patch


c. papulec. papule


d. noduled. nodule

l. crustl. crust


f. whealf. wheal




p. ulcerp. ulcer



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Wheal


Exam: large circumscribedplaque with flesh coloredcenter and erythematous

border (wheal and flare)

Flare


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present?present?

a.a. maculemacule

i. bullai. bulla

b. patchb. patch


c. papulec. papule


d. noduled. nodule

l. crustl. crust


f. whealf. wheal




p. ulcerp. ulcer



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Bulla

Crust

Erosion

Exam: numerous scattered

bullae

with some rupturedbullae

with overlying crustas well as some erosions atsites of ruptured bullae


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present?present?

a.a. maculemacule

i. bullai. bulla

b. patchb. patch


c. papulec. papule


d. noduled. nodule

l. crustl. crust


f. whealf. wheal




p. ulcerp. ulcer



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Pustule

Papule

Exam: grouped pustules

and inflammatorypapules on theabdomen, thighs, and

genital region


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present?present?

a.a. maculemacule

i. bullai. bulla

b. patchb. patch


c. papulec. papule


d. noduled. nodule

l. crustl. crust


f. whealf. wheal




p. ulcerp. ulcer



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Telangiectasia

Nodule

Exam: diffuse telangiectasiaon the cheek as well as a

large well circumscribedtan/brown plaque at the jaw



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present?present?

a.a. maculemacule

i. bullai. bulla

b. patchb. patch


c. papulec. papule

k.k. telangiectasiatelangiectasiad. noduled. nodule

l. crustl. crust


f. whealf. wheal




p. ulcerp. ulcer



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Exam: Large

ulceration withdefined borders onthe medial ankle

Ulceration



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present?present?

a.a. maculemacule

i. bullai. bulla

b. patchb. patch


c. papulec. papule


l. crustl. crust


f. whealf. wheal




p. ulcerp. ulcer



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Epidermal Atrophy

-looks like cigarette paper

Exam: large atrophichypopigmented

patchwith interspersedtan/brown macules

anda tan/brown border

Macule


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present?present?

a.a. maculemacule

i. bullai. bulla

b. patchb. patch


c. papulec. papule


l. crustl. crust


f. whealf. wheal




p. ulcerp. ulcer



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Exam: well defined annular

plaque with erythematous

border and flesh coloredcenter


PlaqueAnnular border


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present?present?

a.a. maculemacule

i. bullai. bulla

b. patchb. patch


c. papulec. papule


l. crustl. crust


f. whealf. wheal




p. ulcerp. ulcer



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Vesicle

Exam: region ofgrouped vesicles that

coalesce into bullaeat the periphery ofthe lesion


Bulla


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DematologicDematologic

TherapyTherapy


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Principles of Dermatologic TherapyPrinciples of Dermatologic Therapy

The efficacy of any topical medication isThe efficacy of any topical medication is

related to:related to:

1. The concentration of the medication1. The concentration of the medication

2. The vehicle (the mode in which it is2. The vehicle (the mode in which it istransported)transported)

3. The active ingredient (inherent strength)3. The active ingredient (inherent strength)

4. Anatomic location4. Anatomic location


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Drug CostsDrug Costs

Topical Medications can be very expensiveTopical Medications can be very expensive

They are not all covered by insuranceThey are not all covered by insurance

Over the counter (Over the counter (OTC)OTC)ss

are generally cheaperare generally cheaper

than name brandsthan name brands

Know the costs of the medications youKnow the costs of the medications you

prescribe and tell the patient in advance whatprescribe and tell the patient in advance what

they should expect to paythey should expect to pay


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VehiclesVehicles

Ointment (like Vaseline): Greasy, moisturizing,Ointment (like Vaseline): Greasy, moisturizing,

messy,messy, most effective in penetrating the skinmost effective in penetrating the skin..

Creams (vanish when rubbed in): Less greasy,Creams (vanish when rubbed in): Less greasy,

can sting, more likely to cause allergycan sting, more likely to cause allergy(preservatives/fragrances).(preservatives/fragrances).

Lotions (liquid): Cooling, liquids that pourLotions (liquid): Cooling, liquids that pour


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VehiclesVehicles

Solutions (liquids that are greasy or alcoholic):Solutions (liquids that are greasy or alcoholic):

Can sting, good for hairy areasCan sting, good for hairy areas

Gels (semi solid alcoholGels (semi solid alcohol--based): Can sting, goodbased): Can sting, good

for hairy areas or wet lesionsfor hairy areas or wet lesions

Foams (cosmetically elegant): Good for hairyFoams (cosmetically elegant): Good for hairy

areasareas

Sprays: Aerosols (rarely used)Sprays: Aerosols (rarely used)


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Amount of Medication to PrescribeAmount of Medication to Prescribe

Rule of 9Rule of 9ss: Each whole leg is 18% of the Body Surface: Each whole leg is 18% of the Body Surface

Area.Area.

It takes 30 grams of medication to covers the wholeIt takes 30 grams of medication to covers the whole

body. A large tube of topical medication is 60 grams.body. A large tube of topical medication is 60 grams.

Whole body x percentage needing medication =Whole body x percentage needing medication =

amount necessary per applicationamount necessary per application

Ex. For one legEx. For one leg30g x 0.18 = 5.4g30g x 0.18 = 5.4g

The sole is 1% of body surface area (BSA), requiringThe sole is 1% of body surface area (BSA), requiring

0.3 grams (30g x 0.01) per treatment.0.3 grams (30g x 0.01) per treatment.
http://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdf


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A patient comes in with a large rash on her leftA patient comes in with a large rash on her left

calf. If she must apply her topical medicationcalf. If she must apply her topical medicationBID how much should you prescribe for theBID how much should you prescribe for the

month?month?Refer to BSA diagramRefer to BSA diagramfor assistance.for assistance.

ANSWER: 30 days/month x 2 times/day xANSWER: 30 days/month x 2 times/day x

30g/body x 0.065 = 120 grams (4 oz)30g/body x 0.065 = 120 grams (4 oz)

http://burns%20for%20erythroderma.pdf/http://burns%20for%20erythroderma.pdf/http://burns%20for%20erythroderma.pdf/http://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://burns%20for%20erythroderma.pdf/http://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://burns%20for%20erythroderma.pdf/http://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdf


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How much would you prescribe for the monthHow much would you prescribe for the month

if someone needed to medicate both soles onceif someone needed to medicate both soles oncea day?a day?Refer to BSA diagramRefer to BSA diagramforfor assisanceassisance..

a. 1.8ga. 1.8gb. 18gb. 18g

c. 180gc. 180g

d. 1800gd. 1800g
http://burns%20for%20erythroderma.pdf/http://burns%20for%20erythroderma.pdf/http://burns%20for%20erythroderma.pdf/http://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://burns%20for%20erythroderma.pdf/http://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://burns%20for%20erythroderma.pdf/http://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdfhttp://../Documents%20and%20Settings/Eric%20Meinhardt.ERICMEIN/Desktop/Burns%20for%20erythroderma.pdf


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Answer: bAnswer: b

How much would you prescribe for the month ifHow much would you prescribe for the month ifsomeone needed to medicate both soles once a day?someone needed to medicate both soles once a day?

a. 1.8ga. 1.8g

b. 18gb. 18g

c. 180gc. 180g

d. 1800gd. 1800gExplanation: 30 days/month x 1 time/day x 30g xExplanation: 30 days/month x 1 time/day x 30g x

0.01/sole x 2 soles = 18g (1/2 oz)0.01/sole x 2 soles = 18g (1/2 oz)


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Topical CorticosteroidsTopical Corticosteroids

Topical steroids are classified based on potency.Topical steroids are classified based on potency.

Potency is inherent to the molecule, not thePotency is inherent to the molecule, not theconcentrationconcentration

The CLASS of the steroid is the strength.The CLASS of the steroid is the strength.

Steroids within any class are equivalent inSteroids within any class are equivalent in

strengthstrength

In practice, it is important to know one steroidIn practice, it is important to know one steroid

from each classfrom each class


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Topical CorticosteroidsTopical Corticosteroids

SuperSuper--High Potency:High Potency: ClobetasolClobetasol

((TemovateTemovate) 0.05% cream,) 0.05% cream,ointment, solution, foamointment, solution, foam

High Potency:High Potency: FluocinonideFluocinonide

((LidexLidex) 0.05% cream, gel,) 0.05% cream, gel,ointment, solutionointment, solution

Medium Potency:Medium Potency:TriamcinoloneTriamcinolone

(TAC) 0.1% cream,(TAC) 0.1% cream,

ointment, solutionointment, solution

MidMid--Low:Low:Aclometasone(AclovateAclometasone(Aclovate) 0.05% cream or) 0.05% cream orointment,ointment, DesonideDesonide

0.05% cream or ointment0.05% cream or ointment

Lowest Potency: Hydrocortisone 1% or 2.5% cream orLowest Potency: Hydrocortisone 1% or 2.5% cream orointmentointment

NOTE:NOTE: ClobetasolClobetasol

0.05% is STRONGER than0.05% is STRONGER than

hydrocortisone 1%. Look at class not percentage.hydrocortisone 1%. Look at class not percentage.


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Applying CorticosteroidsApplying Corticosteroids

There are many ways that corticosteroids are applied.There are many ways that corticosteroids are applied.

The topical steroid can also be applied to spot lesionsThe topical steroid can also be applied to spot lesions

Soak and smearSoak and smear: this involves the patient soaking in a: this involves the patient soaking in atub for 15 min (to open pores) and thentub for 15 min (to open pores) and then smearingsmearing

thethe

topical steroid on the skintopical steroid on the skin

Sometimes, occlusion is used which is the placing ofSometimes, occlusion is used which is the placing ofsaran wrap or vinyl suit over the topical steroid tosaran wrap or vinyl suit over the topical steroid to

increase penetrationincrease penetration

Typically midTypically mid--low/lowest potency topical steroids arelow/lowest potency topical steroids areused on the face with a stronger one for the body as aused on the face with a stronger one for the body as a

stronger steroid on the face may cause atrophy as astronger steroid on the face may cause atrophy as aresult of thin skin and strong steroid!result of thin skin and strong steroid!


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Side Effects of Topical Steroid TreatmentSide Effects of Topical Steroid Treatment

Acne (Acne (perioralperioral

dermatitis/dermatitis/rosacearosacea) can result when a) can result when agreater than low potency steroid is applied to the facegreater than low potency steroid is applied to the face

Atrophy andAtrophy and striaestriae

(stretch marks) can result when steroid(stretch marks) can result when steroidis used in the groin or arm pitsis used in the groin or arm pits

PetechiaePetechiae

andand telangiectasiatelangiectasia

is possible from skin atrophyis possible from skin atrophy

Increased Fungal infections: For example,Increased Fungal infections: For example, LotrisoneLotrisoness

((betamethasonebetamethasone

andand clotrimazoleclotrimazole) does not kill fungus as) does not kill fungus asthethe betamethasonebetamethasone

is too strong and suppresses theis too strong and suppresses theimmune response from killing the fungus.immune response from killing the fungus.

Systemic side effects are rare due to low absorption,Systemic side effects are rare due to low absorption,however with full body high potency steroid it is possiblehowever with full body high potency steroid it is possible

NOTE: THE HIGHER THE POTENCY THENOTE: THE HIGHER THE POTENCY THEMORE LIKELY SIDE EFFECTS ARE TOMORE LIKELY SIDE EFFECTS ARE TOOCCUR!OCCUR!


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TopicalTopicalAntifungalsAntifungals

There are several classes of topical antifungalThere are several classes of topical antifungal

medicationsmedications

Some classes areSome classes are FungistaticFungistatic

(stop fungi from(stop fungi fromgrowing), others are Fungicidal (they kill thegrowing), others are Fungicidal (they kill the

fungi)fungi)

Not all conditions are treatable with topical antiNot all conditions are treatable with topical anti--

fungalsfungals

(hair infections and nail infections do(hair infections and nail infections donot respond to topical treatment and requirenot respond to topical treatment and requiresystemic treatment)systemic treatment)


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TopicalTopicalAntifungalsAntifungals

The following are some examples of topicalThe following are some examples of topical antifungalsantifungals::

ImidazolesImidazoles

((fungistaticfungistatic):): KetoconazoleKetoconazole,, EconazoleEconazole,,

OxiconazoleOxiconazole,, SulconazoleSulconazole,, ClotrimazoleClotrimazole

(OTC),(OTC),

MiconazoleMiconazole

(OTC)(OTC)

AllylaminesAllylamines

(fungicidal):(fungicidal): NaftifineNaftifine,,TerbinafineTerbinafine

(OTC),(OTC),

ButenifineButenifine

CiclopiroxCiclopirox

(may have both(may have both fungistaticfungistatic

and fungicidaland fungicidalproperties)properties)

KetoconazoleKetoconazole

((NizoralNizoral) shampoo is often used in) shampoo is often used inseborrheicseborrheic

dermatitisdermatitis

NOTE: most frequently prescribed antiNOTE: most frequently prescribed anti--fungalsfungals

are inare inyellowyellow


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Review InstructionsReview Instructions

This module contains key morphology and descriptionsThis module contains key morphology and descriptions

used in dermatology. Please review this information asused in dermatology. Please review this information asit is fundamental to dermatologic diseases. Theit is fundamental to dermatologic diseases. The

following links will help you.following links will help you.

DistributionDistribution

Primary LesionsPrimary Lesions


Shape and arrangement of lesionsShape and arrangement of lesions

Dermatology lexiconDermatology lexicon
http://missinglink.ucsf.edu/lm/DermatologyGlossary/primarylesions1a.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/distribution1.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/distribution1.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/secondarylesions1a.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/primarylesions1a.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/primarylesions1a.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/distribution.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/secondarylesions1a.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/secondarylesions1a.htmlhttp://www.dermatologylexicon.org/http://missinglink.ucsf.edu/lm/DermatologyGlossary/distribution.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/distribution.htmlhttp://www.dermatologylexicon.org/http://www.dermatologylexicon.org/http://www.dermatologylexicon.org/http://missinglink.ucsf.edu/lm/DermatologyGlossary/distribution.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/secondarylesions1a.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/primarylesions1a.htmlhttp://missinglink.ucsf.edu/lm/DermatologyGlossary/distribution1.html


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END OF MODULEEND OF MODULE