Ch 26, 27 Treatment

Question 1

Principles of Topical Tx

Answer 1

• Horny layer is biggest barrier, diffusion a function of concentration and premeiability
• Nonpolar, small MW, with increased hydration and increased temperature absorbed more rapidly

Question 2

Areas with rapid transformatino

Answer 2

-Face, folds, and scrotum are more easily absorbed

Question 3

Factors effecting absorption

Answer 3

Molecular Weight
Polarity
Concentration
Base
Partition Coefficient
Diffusion constant
Horny layer thickness
State of horny layer (Temp, hydration, integrity)
Temperature

Question 4

Steroid Actions

Answer 4

• Vasoconstrict
• Decrease phagocyte activation and migration
• Decrease Fibrin and Kinin Formation
• Inhibit PLA2
• Decrease Fibroblast activity
• Stabalize Lysosomal Membrane
• Decrease epidermal proliferaion
• Lympholytic and decrease cytokine expression

Question 5

SE

Answer 5

Skin thinning, atrophy, stretch marks

• Telangectasia, bruising, hirsuitism, folliculitis, disguise infections
• Tachyphylaxis
• Rebound

Question 6

Vehicles

Answer 6

Powders
Alchohl based (tinctures)
-Cream
-Ointment
-Gel
Paste
Spray
Mousse
-Lotions

Question 7

Powders

Answer 7

-Flexures

Question 8

Alchohol based

Answer 8

Hair

Question 9

Lotions

Answer 9

• More watery

- drying skin, smoothing, cooling

Question 10

Creams

Answer 10

-Cooling emolient and moisturizer

Question 11

Ointments

Answer 11

Occlusive emolient

-Allows better absorption

Question 12

Pastes

Answer 12

Protective emolient

Question 13

Sprays

Answer 13

Drying and non-occlusive

Question 14

Gels

Answer 14

Face/scalp

Question 15

Mouse

Answer 15

Scalp

Question 16

Preservatives

Answer 16

May cause allergy, especially parabens

Question 17

Principles

Answer 17

-Use the least potent and monitor closely for side effects

Question 18

Excision

Answer 18

• Used for biopsy
• Shave for exophytic likely benign tumors
• Saucerization for deeper tissues and to get subq fat

Question 19

Curretage

Answer 19

• Destroys underlying tissue

- Healthy dermis is more resistant to curretage

Question 20

Mohs indications

Answer 20

• Large basal cell carcinoma
• Scaring/cicatricial BCC
• BCC in sensitive area
• Recurrent BCC
• BCC with risk of recurrence (nose, glabella, nasolabial folds)
• Sometimes for SCC that is aggresive appearing

Question 21

Cryotherapy

Answer 21

• Cellular components are more responsive to damage than stromal components
• Generally liquid nitrogen

Question 22

Phototherapy

Answer 22

• UVB Narrowband: May be less carcinogenic, no need to protect skin peri-treatment from photosensitivity
• PUVA: Psoralen sensitizes, may be more effective and delivered in fewer sessions, penetrates deeper

Question 23

PDT

Answer 23

• Apply sensitizer to skin that is absorbed over ~4 hours
• Leads to sensitivity of tissues to damage
• Blister and destruction of superficial skin (mostly oxygen radical induced)

Question 24

IPL

Answer 24

-Noncoherent light on skin that causes absorption by a number of chromophores leading to photothermal damage relatively non-specifically