ABD - American Board of Dermatology Dermatologic Pharmacology Questions and Answers

Question 1

A 58-year-old male with extensive plaque psoriasis is being managed with weekly low-dose methotrexate.
To mitigate the risk of hepatotoxicity, which of the following is the most crucial long-term monitoring strategy according to consensus guidelines?

Accepted Answer

Monthly assessment of serum aminotransferases and periodic procollagen III aminopeptide (PІІІNP) levels

Answer

Annual liver biopsy regardless of other findings

Answer

Bi-annual abdominal ultrasound to assess for hepatic steatosis

Answer

Weekly complete blood count with differential

Question 2

A 45-year-old patient with onychomycosis is prescribed a course of oral itraconazole. The patient also takes atorvastatin for hyperlipidemia. This drug combination significantly increases the risk for which of the following adverse events?

Accepted Answer

Rhabdomyolysis

Answer

Serotonin syndrome

Answer

QT prolongation and Torsades de Pointes

Answer

Aplastic anemia

Question 3

A 66-year-old male with dermatitis herpetiformis is started on dapsone. Before initiating therapy, which laboratory test is mandatory to prevent a severe, dose-related adverse reaction?

Accepted Answer

Glucose-6-phosphate dehydrogenase (G6PD) level

Answer

HLA-B*57:01 allele testing

Answer

Thiopurine methyltransferase (TPMT) activity

Answer

Serum creatinine and BUN

Question 4

Tazarotene is a third-generation topical retinoid used for acne and psoriasis. Its therapeutic effect is primarily mediated through selective binding to which of the following receptors?

Accepted Answer

Retinoic acid receptors (RAR-β and RAR-γ)

Answer

Retinoid X receptors (RXR-α and RXR-γ)

Answer

Peroxisome proliferator-activated receptor gamma (PPAR-γ)

Answer

Vitamin D receptor (VDR)

Question 5

A dermatologist prescribes topical 5-fluorouracil (5-FU) cream for a patient with multiple actinic keratoses on the face. What is the primary mechanism of action of this agent?

Accepted Answer

It functions as a pyrimidine analog that inhibits thymidylate synthase, disrupting DNA synthesis.

Answer

It acts as a Toll-like receptor 7 (TLR7) agonist, inducing a local immune response.

Answer

It inhibits dihydrofolate reductase, blocking the synthesis of purines.

Answer

It binds to tubulin, preventing microtubule formation and arresting cells in metaphase.

Question 6

The FDA has issued a boxed warning for topical calcineurin inhibitors, such as tacrolimus and pimecrolimus. What is the primary concern cited in this warning?

Accepted Answer

A theoretical risk of malignancy, including skin cancer and lymphoma, although a causal link has not been established.

Answer

A high risk of systemic absorption leading to acute renal failure.

Answer

The potential for severe cutaneous atrophy and striae formation with long-term use.

Answer

The development of tachyphylaxis, rendering the medication ineffective after several months of use.