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Senior - Derm 1 > 2 - Topical Therapy > Flashcards

2 - Topical Therapy Flashcards

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Dermatology Board Prep flashcards
1
Q

Purpose of topical therapy?

A

Restore normal skin function after an insult removes water, lipids, or protein from epidermis

This alters integrity of skin barrier and compromise function

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2
Q

How is restoration of normal skin function accomplished?

A

Through the use of mild soaps, emollient creams and lotions

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3
Q

If you’ve got a patient with dry cutaneous lesions or dry skin, they’ve lost:

A

Water

In most instances, they’ve lost epidermal lipids and proteins which help contain moisture

Replace moisture with emollient creams and lotions

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4
Q

What is xerosis?

A

Severe dry skin

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5
Q

When is xerosis worse?

A

In the dry winter months (“winter itch)

MC’ly affects the hands and lower legs

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6
Q

Describe xerosis

A

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

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7
Q

Txt of xerosis?

A

Emolloients

12% lactate lotion (Lac-Hydrin, AmLactin)

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8
Q

Describe wet diseases

A

Exudative inflammatory diseases pour out serum

Leaches complex lipids and proteins from epidermis

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9
Q

How are wet diseases managed?

A

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

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10
Q

Why use emollient creams with urea and lactic acid?

A

Special lubricating properties - very effective

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11
Q

Creams

A

Are thicker and more lubricating than lotions

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12
Q

Emollient creams and lotions are most effective when applied to:

A

Damp skin

After shower, pat dry and immediately apply moisturizer

Apply as frequently as necessary to keep skin soft

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13
Q

What can be added to emollients to reduce pruritis?

A

Menthol and phenol

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14
Q

Wet dressing good for:

A 
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
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15
Q

Benefits of wet dressings?

A

Inflammation suppression and evaporative cooling -> constriction of superficial vessels which decreases erythema and production of serum (works faster than topical or oral steroids)

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16
Q

You can get an antibacterial action with wet dressings by adding:

A

Aluminum acetate, acetic acid, or silver nitrate

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17
Q

Types of wet dressings

A
  1. Water - doesn’t need to be sterile - poison ivy, sunburn, non-infective process
  2. Burow’s Sol’n (aluminum acetate) - 1-3 packets in 16oz water - mildly antiseptic - acute inflammation, poison ivy, insect bites, athletes foot
  3. Silver nitrate 0.5% - stains skin - bactericidal; for exudative infected lesions (stasis ulcers / dermatitis)
  4. Acetic acid - dilute vinegar - bactericidal, good for some gram neg (pseudomonas)
18
Q

Technique for wet dressings:

A

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

19
Q

Effects of topical steroids:

A

Anti-inflammatory

Vasoconstriction

Anti-mitotic (decreased proliferation of cells)

20
Q

Which groups of meds should we (PA’s) be using?

A

Groups V through VII

The lower numbers are really in derm’s wheelhouse

21
Q

What is the vehicle?

A

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

22
Q

Cream

A

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
23
Q

Ointments

A

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

24
Q

Gels

A

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)

25
Q

Solutions and lotions

A

Clear or milky

LEAST lipophilic - can be very drying

Solutions (alcohol) and lotions (water) most useful in scalp

Stinging and drying may result when applied to intertriginous areas

26
Q

Foams

A

Good for scalp dermatoses, acute eczematous inflammation (i.e. poison ivy, plaque psoriasis)

High potency preparations: do not use for more than 2 weeks - suppresses HPA - do not use in kids under 12yrs

27
Q

Things that can decrease absorption of topical steroid?

A

Thick scale

Lichenification

Use on soles / palms (thicker skin)

28
Q

Things that can increase absorption of topical steroids?

A

Abrasion

Cracking

Fissuring

Atrophy

Keratolytic agents

propylene glycol can irritate already inflamed skin

29
Q

Occlusion

A

Can increase steroids potency up to 100x

Can happen naturally (i.e. skin folds) or we can do it intentionally

30
Q

Want better absorption?

A

Apply right after you get out of the shower (only lightly pat to dry off, then apply medicine)

31
Q

Areas to watch out for that have thin stratum corneum and increased blood flow?

A

Face/eyelids

32
Q

Local side effects of topical steroids:

A 
Burning and itching
• Hypopigmentation
• Atrophy
• Easy bruising
• Striae
• Hypertrichosis (face)
• Steroid acne/folliculitis
• Steroid rosacea
• Dryness of skin - creams, lotions
• Worsening infection
• Rebound phenomenon
33
Q

How will local allergic reaction commonly present?

A

Chronic dermatitis that is not exacerbated by, but “fails to respond to” corticosteroid therapy…..they’re allergic to the corticosteroid itself

Occasionally exanthem, purpura, or urticaria

If suspected, need skin test *patch testing

34
Q

Systemic side effects of topical steroid therapy

A

Adrenal axis suppression
• children <2
• teens in active puberty

Cushing Syndrome
• unmonitored chronic use of high potency steroid or
occlusion
• Use of mid potency in large areas

Failure to thrive
Stunted growth
Cataracts
Glaucoma (if used near eyes)

35
Q

Intralesional?

A

Injected steroid (typically triamcinolone)

Injected into the lesions, not surrounding skin

36
Q

IM steroids?

A

Longer lasting
Easier than topical and oral

Local atrophy at the site possible

37
Q

Diabetic and topical steroids?

A

Can cause their sugars to go up

38
Q

Pregnancy and topical steroids?

A

Avoid in 1st tri

Use only when benefit outweighs risk

39
Q

Top 5 common mistakes in topical steroid therapy

A
  1. Steroid too weak for process and area
  2. Not enough rx given (tube size)
  3. Failure to follow up on txt
  4. Too strong used on kids
  5. Too strong used on face
40
Q

What is a finger tip unit?

A

5mm diameter nozzle

1 FTU = 0.5gm

41
Q

How much steroids for how much body area?

A

Slides 48 to 51

42
Q

Smiling gives you wrinkles

A

Resting bitch face keeps you flawless

Senior - Derm 1 (7 decks)

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