bedside diagnostic testing and photobiology

Question 1

potency

Answer 1

The intensity of the clinical effect

Depends on the molecular structure of the corticosteroid and the vehicle that carries it

Question 2

% of active ingredient is not correlated with potency

Answer 2

yep

Question 3

MOA of glucocorticosteroids:

Glucocorticosteroids enter cells and bind to the glucocorticoid receptors in the cytoplasm. Glucocorticoid receptor complex translocates to the nucleus, forms a _____, and binds to the glucocorticoid response element of many genes
Transcription of these genes is then either _____ or _____

Answer 3

Glucocorticosteroids enter cells and bind to the glucocorticoid receptors in the cytoplasm. Glucocorticoid receptor complex translocates to the nucleus, forms a dimer, and binds to the glucocorticoid response element of many genes
Transcription of these genes is then either induced or suppressed

Question 4

Glucocorticoid receptor complex also interacts with other transcription factors
yep

Answer 4

yep

Question 5

Affect the potency of a topical steroid by affecting its absorption into the skin through the stratum corneum

Answer 5

vehicle

Question 6

A glucoroticoid molecule is more potent in an ______ than a _____ and least potent in a _____ or other vehicle

Answer 6

A glucoroticoid molecule is more potent in an ointment than a cream and least potent in a lotion or other vehicle

Question 7

• emulsions of water droplets in oil
  - most occlusive
  - improve hydration of skin
  - maximal penetration of active ingredient
  - do not require preservatives
  - best for difficult to penetrate areas, such as
  palms, soles and when trying to avoid
  possible allergic reaction to preservatives

Answer 7

ointments

Question 8

• semisolid emulsions of oil in water
  - rub into the skin completely
  - non-greasy
  - contain more ingredients than ointments,
  including preservatives
  - used when patient cannot tolerate the greasy
  feeling of an ointment or in areas of thin skin
  (face, scrotum)

Answer 8

creams

Question 9

• suspensions of powder in water
  - used to help relieve itch as evaporation of water creates a cooling
  effect

Answer 9

lotions

Question 10

• semisolid transparent emulsions
  - liquefy upon application to the skin
  - rarely used as vehicles for topical steroids

Answer 10

gels

Question 11

• based in alcohol
  - evaporate upon application to the skin, leaving the active
  ingredient
  - best for hairy areas

Answer 11

solutions, sprays and foams

Question 12

corticosteroids can lead to _______: striae, telangiectasia, hypopigmentation and wrinkled shiny skin and _____: monomorphic papues/pustules

Answer 12

skin atrophy and steroid acne

Question 13

what happens if corticosteroids are used over a long period of time near the eyes

Answer 13

glaucoma and cataracts development

Question 14

Systemic side effects are rare, but possible in prolonged extensive topical use of potent steroid

Answer 14

yep

• suppression of the HPA axis
  - iatrogenic Cushing’s syndrome
  - growth retardation in young children

Question 15

potency:

at thick skin areas such as hands and feet

Answer 15

superhigh potency and longer duration is ok

Question 16

potency:

face and groin

Answer 16

low potency with vehicle that allows less absorption

Question 17

potency:

other area-trunk, extremeties

Answer 17

medium potency

Question 18

vehicle:

dry rashes

Answer 18

most hydrating vehicle- ointment

Question 19

vehicle:

wet rashes

Answer 19

drying vehicle- lotion or gel

Question 20

Amount of time required to produce erythema in skin with sunscreen/Amount of time required to produce erythema in unprotected skin

Answer 20

SPF- sun protection factor

Question 21

Protection does not increase proportionally with increased SPF number

Answer 21

yep

Question 22

SPF primarily evaluates protection against

Answer 22

UVB