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Q. Dermatology Minocycline . Card 1 1. What is the most common question for which minocycline is the answer? 2. How does minocycline work? 3. What are the most common adverse effects of minocycline? MEDICAL
A. Dermatology Ca rd 1 1. Minocycline is the best oral antibiotic for severe acne that is not con- trolled by topical antibiotics or topical vitamin A derivatives, such as tretinoin. Other indications for minocycline include the following: Nocardia Actinomycosis Rosacea '. 2. Minocycline is a tetracycline antibiotic that inhibits protein produc- tion in bacteria. 3. Minocycline can cause bluish discoloration of the skin but does not cause a photosensitivity rash as doxycycline can cause. Minocycline can bring on vertigo by causing vestibular dysfunction. . @ 2008 KiJplan, IrIC. .
Q. Dermatology Case 1: A woman comes in with mild acne. She has a few comedones with an occasional infiamed papule or pustule. Case 2: A man has failed initial therapy for acne and has nu- merous papules and pustules with mild scarring. Case 3: Your patient is very distressed and depressed be- cause of numerous large cysts on the face, neck, and trunk. He is severely scarred. . . Card 2 1. What is the treatment for each of these cases? 2. How does each treatment work? 3. What are the adverse effects of these treatments? MEDICAL
. Dermatology Ca rd 2 Case 1: is mild comedonal acne. Mild disease is treated with topical ben- zoyl peroxide and a topical antibiotic, such as erythromycin or clin- damycin. Benzoyl peroxide is both antibacterial and comedolytic. Topical antibiotics will eliminate the causative organism Propionibacterium acnes from the comedones. Case 2: is moderate to severe acne resulting in scarring. In addition to benzoyl peroxide, the patient should be treated with a topical vitamin A derivative (tretinoin). An oral antibiotic, such as minocycline, should be used. Case 3: is severe cystic acne. An oral antibiotic and oral vitamin A (isotretinoin) are needed. Isotretinoin will decrease sebum production but is extremely teratogenic and can cause severe depression, dry skin, and hyperlipidemia. . @ 2008 Kaplan, Inc.
Q. Dermatology Case: An adolescent boy comes to see you for treat- ment of a long-standing itchy, eczematous rash on his face, hands, and feet in the fiexural areas. The skin is lichenified from scratching. He also has seasonal rhinitis and occasional urticaria. . Card 3 1. What is the best therapy to treat the itching? 2. What is the best long-term therapy? 3. What are the other indications for this therapy? MEDICAL
A. Dermatology Card 3 1. Atopic dermatitis is treated with antihistamines, such as fexofenadine, cetirizine, or loratadine. Hydroxyzine and diphenhydramine are more potent but much more sedating. Doxepine is a tricyclic with extensive antihistamine effects. 2. Atopic dermatitis sym ptoms ca n be lessened in the long term by moistur- izing the skin, avoiding harsh soaps, a nd treating skin infections. Although topical steroids are effective to control symptoms acutely, in the long term, they lead to skin atrophy. Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, can control atopic dermatitis in the long term without using steroids. 3. Antihistamines, such as fexofenadine, are also used for the following conditions: Allergic/seasonal rhinitis Angioedema Urticaria . «J 2008 Kaplan, irK.
Q. Dermatology Case: A woman comes to the office for pruritic, silvery, scaly lesions of the knees, el bows, and hands. The lesions are on the extensor surfaces. . Card 4 1. What is the best therapy for localized disease of this type? 2. What is the best therapy for extensive disease of this type? MEDICAL
. Dermatology Card 4 1. Localized psoriasis is treated with topical steroids. To prevent skin atrophy, treatment with calcipotriene, a vitamin 0 analog, should be used. Topical tazarotene, a vitamin A analog, is also used. Tacrolimus and pimecrolimus are used as well to control this disease. 2. Widespread disease is treated with ultraviolet light. The most effective systemic therapy is methotrexate, but it also has the most adverse effects. Biological agents, such as etanercerpt, alefacept, and efali- zumab, are used as alternatives to methotrexate. . @ 2008 Kdpldn, Inc.