2 - Topical Therapy Flashcards
Purpose of topical therapy?
Restore normal skin function after an insult removes water, lipids, or protein from epidermis
This alters integrity of skin barrier and compromise function
How is restoration of normal skin function accomplished?
Through the use of mild soaps, emollient creams and lotions
If you’ve got a patient with dry cutaneous lesions or dry skin, they’ve lost:
Water
In most instances, they’ve lost epidermal lipids and proteins which help contain moisture
Replace moisture with emollient creams and lotions
What is xerosis?
Severe dry skin
When is xerosis worse?
In the dry winter months (“winter itch)
MC’ly affects the hands and lower legs
Describe xerosis
Skin is rough, covered with fine white scales, progresses to thicker tan or brown scales
If severe, criss-crossed and fissured
Itching, burning sensation can happen if more severe form
Txt of xerosis?
Emolloients
12% lactate lotion (Lac-Hydrin, AmLactin)
Describe wet diseases
Exudative inflammatory diseases pour out serum
Leaches complex lipids and proteins from epidermis
How are wet diseases managed?
Wet compresses
Suppresses inflammation
Debrides crust and serum
Repeated cycles of wet and dry eventually dry the lesion
Once wet phase is controlled, restore lipids and proteins with emollient creams and lotions - DISCONTINUE WET DRESSINGS
Why use emollient creams with urea and lactic acid?
Special lubricating properties - very effective
Creams
Are thicker and more lubricating than lotions
Emollient creams and lotions are most effective when applied to:
Damp skin
After shower, pat dry and immediately apply moisturizer
Apply as frequently as necessary to keep skin soft
What can be added to emollients to reduce pruritis?
Menthol and phenol
Wet dressing good for:
Poison ivy • Bullous impetigo • Eczematous skin with secondary infx • Herpes simplex/zoster • Insect bites • Intertrigo • Nummular eczema • Stasis dermatitis/ulcers • Sunburn (blistering) • Tinea pedis—vesicular
Benefits of wet dressings?
Inflammation suppression and evaporative cooling -> constriction of superficial vessels which decreases erythema and production of serum (works faster than topical or oral steroids)
You can get an antibacterial action with wet dressings by adding:
Aluminum acetate, acetic acid, or silver nitrate
Types of wet dressings
- Water - doesn’t need to be sterile - poison ivy, sunburn, non-infective process
- Burow’s Sol’n (aluminum acetate) - 1-3 packets in 16oz water - mildly antiseptic - acute inflammation, poison ivy, insect bites, athletes foot
- Silver nitrate 0.5% - stains skin - bactericidal; for exudative infected lesions (stasis ulcers / dermatitis)
- Acetic acid - dilute vinegar - bactericidal, good for some gram neg (pseudomonas)
Technique for wet dressings:
4-8 layers of clean, soft material
Soak in solution then wring out
Place on skin
Leave in place 30-60 mins
Use 2 to 4x per day
D/C once skin is dried out
Effects of topical steroids:
Anti-inflammatory
Vasoconstriction
Anti-mitotic (decreased proliferation of cells)
Which groups of meds should we (PA’s) be using?
Groups V through VII
The lower numbers are really in derm’s wheelhouse
What is the vehicle?
AKA the base
The substance in which the active ingredient is dispersed and determines RATE of absorption
Ex. creams, ointments, gels, solutions and lotions, foams
Cream
Mix of organic chemicals/oils, water and preservative
- White color, slightly greasy texture
- Can use almost anywhere
- cosmetically acceptable
- drying effect with prolonged use (best for acute exudative inflammation)
- most useful for intertriginous areas
Ointments
Primarily grease with little to no water
- usually preservative-free
- translucent, greasy feeling on skin
- most LIPOPHILIC, moisturizing, and occlusive
- greater penetration -> increased potency
TOO OCCLUSIVE for acute exudative eczematous inflammation or intertriginous areas
Gels
Mix of propylene glycol and water, sometimes alcohol
Greaseless, clear, jelly-like consistency
Good for acute exudative inflammation (i.e. poison ivy) due to drying effect
Useful in the scalp (does not mat the hair)
