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Derm Pharm 2020 > 1 - TOPICAL CORTICOSTEROIDS > Flashcards

1 - TOPICAL CORTICOSTEROIDS Flashcards

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1
Q

Topical corticosteroid potency relates to the intensity of the topical corticosteroid clinical effect

A

True

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2
Q

The Stoughton Vasoconstriction Assay correlates topical corticosteroid potency well with clinical efficacy and is reproducible

A

True (although it only measures one aspect of topical corticosteroid effects - vasoconstriction)

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3
Q

The resultant clinical potency of a TCS preparation depends on 4 interrelated factors:

(1) structure of the corticosteroid molecule
(2) the vehicle
(3) concentration of the corticosteroid molecule
(4) characteristics of the skin onto which the TCS is applied

A

True

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4
Q

Hydrocortisone (cortisol) is the backbone of most TCS molecules

A

True

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5
Q

The removal, replacement, or masking of hydroxyl groups changes a given molecule’s lipophilicity, solubility, percutaneous absorption and glucocorticoid receptor binding activity

A

True

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6
Q

Clobetasol propionate is a superpotent topical corticosteroid

A

True (clobetasol binds more tightly to the glucocorticoid receptor)

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7
Q

Moisturisers are incorporated into the vehicle to retard transepidermal water loss

A

True

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8
Q

Moisturisers are incorporated into the vehicle to occlude the corticosteroid molecule

A

True

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9
Q

Moisturisers are incorporated into the vehicle to increase the flexibility of the skin

A

True

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10
Q

Emulsifying agents in the vehicle are required to create oil-in-water preparations such as creams and lotions

A

True (help to distribute the TCS molecule evenly on the skin surface)

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11
Q

Solvents in the vehicle in lotions, solutions, gels, and sprays create a less viscous product

A

True

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12
Q

Humectants are necessary in oil-in-water preparations (vehicle) to maintain the required water content

A

True

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13
Q

Solvents such as propylene glycol and ethanol affect the TCS molecule’s solubility in the vehicle and skin by affecting its percutaneous absorption

A

True (the net effect of propylene glycol is to enhance potency through increasing the percutaneous absorption)

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14
Q

Very occlusive vehicles enhance a TCS’s molecule’s percutaneous absorption probably by increasing the hydration of the stratum corneum

A

True (thus a TCS molecule in an ointment vehicle tends to be more potent than the same concentration of the molecule in a cream or lotion)

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15
Q

Penetration of the applied TCS correlates inversely with the thickness of the stratum corneum

A

True (condition of the skin affects bioavailability)

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16
Q

Penetration of TCS increases with inflamed or diseased skin

A

True

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17
Q

Penetration of TCS increases with increased hydration of the stratum corneum

A

True

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18
Q

Penetration of TCS increases with relative humidity

A

True (hence WET dressings)

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19
Q

Penetration of TCS increases with temperature

A

True (hence wet dressings are soaked in LUKEWARM water)

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20
Q

The stratum corneum may act as a reservoir for TCS for up to 5 days

A

True (this retention is TCS concentration and formulation dependent)

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21
Q

The vehicle is a highly engineered balance of numerous chemicals (1) emollients, (2) emulsifying agents, (3) humectants, (4) emulsion stabilisers and viscosity builders, (5) thickening, stiffening and suspending agents, (6) solvents, (7) preservatives, antioxidants and chemical stabilisers

A

True

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22
Q

Petrolatum is an occlusive moisturiser

A

True

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23
Q

Glycerin is a humectant moisturiser and solvent

A

True

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24
Q

Propylene glycol is a humectant moisturiser, solvent, and functions as a preservative, antioxidant and chemical stabiliser

A

True

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25
Q

Lanolin is an occlusive moisturiser and emulsifying agent

A

True

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26
Q

TCS have anti-inflammatory effects

A

True

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27
Q

TCS have anti-proliferative actions

A

True

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28
Q

TCS affects polymorphonuclear leukocytes (neutrophils) thus reducing their antibacterial capabilities

A

True

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29
Q

TCS affects monocytes and thus their fungicidal activity are diminished

A

True

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30
Q

TCS affects lymphocytes and the local skin immune system

A

True

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31
Q

TCS affects mast cell sensitisation and mediator release induced by IgE are inhibited

A

True

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32
Q

The anti-inflammatory properties of TCS are useful for dermatoses in which inflammation is a problem (atopic dermatitis and contact dermatitis), but can be deleterious for dermatoses in which inflammation is a useful host response (dermatophyte infection)

A

True

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33
Q

TCS reduce mitotic activity (anti-proliferative) in the epidermis, leading to flattening of the basal cell layer and thinning of the stratum corneum and stratum granulosum

A

True

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34
Q

TCS does not affect keratinocyte ultrastructure and the basement membrane

A

True

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35
Q

TCS promote atrophy of the dermis through inhibition of fibroblast proliferation and inhibits synthesis of both glycosaminoglycans and collagen

A

True

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36
Q

Loss of dermal glycosaminoglycans and TCS-induced vasoconstriction leads to reduced dermal volume

A

True

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37
Q

The antiproliferative and atrophogenic effects of TCS are helpful in proliferative dermatoses (psoriasis)

A

True (though these effects are injurious when TCS are used in the wrong disease, location, potency, or in excessive quantities)

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38
Q

The antiproliferative effects of TCS are both direct and glucocorticoid receptor mediated effects

A

True

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39
Q

TCS inhibits melanocytes pigment production

A

True (inflammation causes hyperpigmentation I.e. Post-inflammatory hyperpigmentation)

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40
Q

High-potency and Superpotent TCS can be used in scalp psoriasis and alopecia areata Twice daily for 2 weeks on, 1 week off

A

True

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41
Q

The adverse effects from TCS preparations are mostly from the TCS molecule

A

True (the vehicle can potentiate these adverse effects and cause additional problems)

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42
Q

The systemic effects of absorbed TCS include (1) suppression of HPA-axis, (2) iatrogenic Cushings’s syndrome, (3) growth retardation in infants and children

A

True (TCS molecules can be absorbed percutaneously in significant quantities and seems to involve gross misuse)

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43
Q

Epidermal atrophy (shiny, wrinkled, fragile skin with hypopigmentation, prominent vasculature, stellate pseudoscars, striae or purpura) is the most common local adverse effect of TCS

A

True (may be seen within the 1st 7 days of daily superpotent TCS application under occlusion, and is a risk factor for local atrophy from TCS within 2 weeks of daily use of less potent TCS or superpotent TCS without occlusion)

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44
Q

Steroid addiction/rebound syndrome is a local adverse effect of TCS and is characterised by initial improvement with a TCS, followed by lack of response after continued application, followed by a flare after TCS withdrawal

A

True (treated skin might appear atrophic and erythematous, and the patient reports burning sensation; frequently involves facial, genital or perianal skin)

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45
Q

Glaucoma/cataracts is a local adverse effect of TCS in ophthalmic preparations, but are rare from TCS applied to the eyelid skin

A

True

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46
Q

Allergic or irritant contact dermatitis can be a local adverse effect of TCS

A

True

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47
Q

Tachyphylaxis can be a local adverse effect of TCS

A

True

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48
Q

Facial hypertrichosis can be a local adverse effect of TCS

A

True

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49
Q

Folliculitis and miliaria can be a local adverse effect of TCS

A

True

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50
Q

Genital ulceration can be a local adverse effect of TCS

A

True

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51
Q

Granulosum gluteale infantum is a local adverse effect of TCS

A

True

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52
Q

Crusted/Norwegian scabies can be a local adverse effect of long term TCS

A

True

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53
Q

Exacerbation or increased susceptibility to bacterial, fungal and viral infections is a local adverse effect of TCS

A

True

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54
Q

Reactivation of Kaposi’s sarcoma is a local adverse effect of TCS

A

True (developed at the site of TCS application for erosive lichen planus)

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55
Q

Perioral dermatitis, Rosacea and acne is a local adverse effect of TCS

A

True

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56
Q

Delayed wound healing is a local adverse effect of TCS

A

True

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57
Q

Young age is a risk factor for systemic effect of TCS

A

True (children and infants have a greater skin surface-to-body volume ratio and may be less able to quickly metabolise corticosteroids; catch up growth is expected when TCS is discontinued)

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58
Q

Continuous long term treatment with a TCS preparation near puberty should be avoided as growth suppression may cause premature epiphyseal closure before catch-up growth can occur

A

True

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59
Q

Liver disease is a risk factor for systemic effects of TCS

A

True (systemic corticosteroids are metabolised in the liver)

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60
Q

Kidney disease is a risk factor for systemic effects of TCS

A

True (the kidneys excrete metabolised and unmetabolised corticosteroid)

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61
Q

The amount of corticosteroid applied is a risk factor for systemic effects of TCS

A

True

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62
Q

The extent of skin surface treated is a risk factor for systemic effects of TCS

A

True

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63
Q

Hydration of the skin (affecting potency of TCS) is a risk factor for systemic effects of TCS

A

True

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64
Q

Frequency of TCS application is a risk factor for systemic effects of TCS

A

True

65
Q

Duration of TCS treatment is a risk factor for systemic effects of TCS

A

True

66
Q

Potency of the TCS is a risk factor for systemic effects of TCS

A

True

67
Q

The use of occlusion (affects potency of TCS) is a risk factor for systemic effects of TCS

A

True

68
Q

Young age (infancy/childhood) is a risk factor for local atrophy from TCS

A

True

69
Q

Potency of TCS is a risk factor for local atrophy from TCS

A

True

70
Q

Use of occlusion is a risk factor for local atrophy from TCS

A

True

71
Q

Location on the face, neck, axilla, groin, and upper inner thighs and pretibial locations is a risk factor for local atrophy from TCS

A

True

72
Q

Daivobet (calcipotriene/betamethasone dipropionate) does not suppress HPA-axis function

A

True

73
Q

Mild or moderate TCS are preferred to potent or very potent TCS in pregnancy

A

True (association of fetal growth retardation with potent/very potent TCS use)

74
Q

TCS products should not be applied to the nipples before nursing

A

True

75
Q

Local adverse effects to TCS occur more frequently than systemic adverse effects, but are generally uncommon

A

True

76
Q

It has been reported that the incidence of local adverse effects from unoccluded TCS is low and roughly equal to that with vehicle alone

A

True

77
Q

Significant atrophy and striae are generally seen many weeks or months of application

A

True

78
Q

Most signs of cutaneous atrophy resolve by 1-4 weeks after discontinuation of the TCS, however striae are permanent

A

True

79
Q

Perioral dermatitis is a classic example of addiction/rebound syndrome and usually occurs after chronic or potent TCS exposure on the face

A

True (the dermatitis is characterised by both eczema and acne in a perioral, and sometimes periocular distribution)

80
Q

Treatment of perioral dermatitis involves tetracycline 500-1000mg daily followed by slow taper to 250mg daily for several weeks, and the TCS can be tapered using a non-fluorinated TCS such as 1% hydrocortisone acetate cream

A

True

81
Q

TCS initially improve, but eventually exacerbate inflammatory conditions (acne, Rosacea) and infections (scabies and dermatophytoses I.e. Tinea incognito)

A

True

82
Q

Steroid acne rebound phenomenon does not seem to happen when hydrocortisone 0.75% is compounded with 0.5% Sulfur

A

True

83
Q

Allergic contact dermatitis to a TCS product should always be considered when a corticosteroid-sensitive dermatitis fails to respond or worsens after TCS therapy

A

True (the allergy may involve the vehicle or the TCS molecule)

84
Q

Allergic contact dermatitis to a TCS product may involve the vehicle or the TCS molecule

A

True (confirmation requires patch testing and occasionally prick and intradermal testing)

85
Q

Corticosteroids are currently divided into 5 groups based on cross-reactivity defined by patch testing:
Group A - Hydrocortisone type
Group B - Triamcinolone Acetonide type (Aristocort/Tricortone)
Group C - Betamethasone type
Group D1 - Betamethasone Dipropionate type (Diprosone)
Group D2 - Methylprednisolone Aceponate type (Advantan)

A

True (TCS can cross react within each group, but only rarely between groups)

86
Q

Treatment of a TCS-induced allergic contact dermatitis involves choosing a TCS from a different cross-reactivity group

A

True

87
Q

A patient with a delayed-type hypersensitivity to a TCS should be warned that there is a small but definite risk of a generalised reaction to systemic administration of that corticosteroid

A

True

88
Q

The common screening TCS for Group A (Hydrocortisone type) on patch testing is Tixocortol pivalate

A

True (hydrocortisone acetate, methylprednisolone, prednisolone and prednisone are part of Group A)

89
Q

The common screening TCS for Group B (Triamcinolone Acetonide type) on patch testing is Budesonide

A

True

90
Q

The common screening TCS for Group C (Betamethasone type) on patch testing is Betamethasone

A

True (dexamethasone is part of Group C)

91
Q

The common screening TCS for group D1 (Betamethasone Dipropionate type) on patch testing is Clobetasol propionate

A

True (Betamethasone valerate and Mometasone furoate are part of Group D1)

92
Q

The TCS prototype and common screening TCS on patch testing for Group D2 (Methylprednisolone Aceponate type) is Hydrocortisone-17-butyrate

A

True

93
Q

A proven regimen to prevent tachyphylaxis does not exist although BD application for 2 weeks on, then 1 week off is recommended because it seems easier for patients to remember

A

True

94
Q

TCS may cause facial hypertrichosis

A

True

95
Q

TCS may cause folliculitis

A

True

96
Q

TCS may cause miliaria

A

True

97
Q

The vehicle of a TCS preparation can potentiate the adverse effects of the TCS or cause local adverse effects of its own

A

True

98
Q

Components of a TCS vehicle can cause itching, burning, stinging, urticaria, and irritant contact dermatitis

A

True

99
Q

Benzoic acid in the vehicle can cause stinging

A

True

100
Q

Cinnamic acid compound in the vehicle can cause stinging

A

True

101
Q

Lactic acid in the vehicle can cause stinging

A

True

102
Q

Urea in the vehicle can cause stinging

A

True

103
Q

Emulsifiers in the vehicle can cause stinging

A

True

104
Q

Formaldehyde in the vehicle can cause stinging

A

True

105
Q

Sorbic acid in the vehicle can cause stinging

A

True

106
Q

Propylene glycol in the vehicle can be very irritating

A

True

107
Q

Alcohol in the vehicle can be very irritating

A

True

108
Q

Acetone in the vehicle can be very irritating

A

True

109
Q

Very occlusive vehicles can cause folliculitis, miliaria, and exacerbation of acne and rosacea

A

True

110
Q

Propylene glycol is a well-known allergen commonly used in TCS vehicles

A

True (1 of most common)

111
Q

Sorbitan sesquioleate is a well-known allergen commonly used in TCS vehicles

A

True (1 of most common)

112
Q

Formaldehyde-releasing preservatives is a well-known allergen commonly used in TCS vehicles

A

True

113
Q

Parabens is a well-known allergen commonly used in TCS vehicles

A

True

114
Q

MCI-MI is a well-known allergen commonly used in TCS vehicles

A

True

115
Q

Lanolin is a well-known allergen commonly used in TCS vehicles

A

True

116
Q

Fragrance is a well-known allergen commonly used in TCS vehicles

A

True

117
Q

Urea 10% has been shown to cause significant degradation of the TCS in certain preparations

A

True

118
Q

Superpotent TCS (class I) is used when dermatoses is resistant to intermediate of high potency TCS

A

True

119
Q

Superpotent (Class I) and high (Class II and III) potency TCS should not be used on the face, axillae, submammary area or groin

A

True

120
Q

Superpotent (Class I) and high (Class II and III) potency TCS should be avoided in infants and children under 12 years

A

True

121
Q

Avoid extensive application of Superpotent (Class I) and high (Class II and III) potency TCS

A

True

122
Q

Superpotent (Class I) and high (Class II and III) potency TCS is ideal in thick, lichenified, or hypertrophic skin

A

True (should be avoided in thin skin)

123
Q

Superpotent (Class I) and high (Class II and III) potency TCS is for short term use only, ideally 2-3 weeks at a time

A

True

124
Q

Intermediate (Class IV and V) potency TCS is used in moderately severe dermatoses

A

True

125
Q

High (Class II and III) potency TCS is used in severe dermatoses

A

True

126
Q

Intermediate (Class IV and V) potency TCS is best for short treatment of extensive dermatoses

A

True

127
Q

Avoid extended use (> 1-2 weeks) of Intermediate (Class IV and V) potency TCS in infants and children

A

True

128
Q

Intermediate (Class IV and V) potency TCS is best used on the trunk and extremities

A

True

129
Q

Intermediate (Class IV and V) potency TCS is safer for short term use on thin skin, but is less effective on thicker skin

A

True

130
Q

Low (Class VI and VII) potency TCS is used in steroid sensitive dermatoses

A

True

131
Q

Low (Class VI and VII) potency TCS is the preferred treatment of large areas

A

True

132
Q

Low (Class VI and VII) potency TCS is best if long term treatment is required

A

True

133
Q

Low (Class VI and VII) potency TCS is best choice for face, axilla, groin, and other moist occluded areas

A

True

134
Q

Low (Class VI and VII) potency TCS is ideal in infants and children

A

True

135
Q

Low (Class VI and VII) potency TCS is best for thin skin, but not effective on thicker skin

A

True

136
Q

Ointment is a water in oil emulsion vehicle

A

True

137
Q

Cream is an oil in water emulsion vehicle

A

True

138
Q

Gel is a cellulose cut with alcohol or acetone vehicle

A

True

139
Q

Lotion is an oil in water vehicle

A

True

140
Q

Solution is an alcohol-based vehicle

A

True

141
Q

Ointment provides very good skin hydration

A

True

142
Q

Cream is moderate in skin hydration potential

A

True

143
Q

Gel, lotion and solution are drying

A

True

144
Q

Ointment is best for thick, lichenified or scaly dermatoses

A

True

145
Q

Cream is best for acute, subacute or weeping dermatoses

A

True

146
Q

Gel, lotion and solution are best for scalp or dermatoses in dense hair areas

A

True

147
Q

Ointment is best for thick palmar or plantar skin, and to be avoided with naturally occluded areas

A

True

148
Q

Cream is good for moist skin and intertriginous areas

A

True

149
Q

Gel is best for naturally occluded areas, scalp and mucosa

A

True

150
Q

Lotion and solution are best for naturally occluded areas and scalp

A

True

151
Q

Ointment is very greasy

A

True

152
Q

Cream, gel, lotion and solution are cosmetically elegant

A

True (in contrast to ointment)

153
Q

Ointment has a low potential for irritation

A

True

154
Q

Cream has a variable potential for irritation and requires preservatives

A

True

155
Q

Gel, lotion and solution have higher potential for irritation

A

True

156
Q

Superpotent (Class I) TCS:

(1) Clobetasol propionate 0.05% (Clobex) ointment/cream/lotion
(2) Betamethasone dipropionate 0.05% (Diprosone) OV ointment/cream

A

True

157
Q

High (Class II and III) potency TCS:

(1) Betamethasone dipropionate 0.05% (Diprosone, Eleuphrat) ointment/cream/lotion
(2) Betamethasone valerate 0.1% (Betnovate “full strength”) ointment/cream
(3) Methylprednisolone aceponate 0.1% (Advantan) fatty ointment/ointment/cream/lotion
(4) Mometasone furoate 0.1% (Elocon, Novasone) ointment/cream/lotion

A

True

158
Q

Intermediate (Class IV and V) potency TCS:

(1) Betamethasone valerate 0.05% (Betnovate 1/2, Cortival 1/2) ointment/cream
(2) Betamethasone valerate 0.02% (Celestone M, Antroquoril) ointment/cream; (Betnovate 1/5, Cortival 1/5) cream
(3) Triamcinolone acetonide 0.02% (Aristocort, Tricortone) ointment/cream
(4) Clobetasone butyrate 0.05% (Eumovate) cream

A

True

159
Q

Low (Class VI and VII) potency TCS:

(1) Desonide 0.05% (Desowen) lotion
(2) Hydrocortisone O.5% (Dermaid) cream/soft cream
(3) Hydrocortisone 1% (Dermaid) cream/soft cream
(4) Hydrocortisone 1% and Clioquinol 1% (Hydroform) cream
(5) Hydrocortisone acetate 1% (Sigmacort, Cortic-DS) ointment/cream; (Cortef) spray

A

True

Derm Pharm 2020 (47 decks)

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