Derm 2 Flashcards
Corticosteroid - inceases in concentration
Increases in concentration of a particular corticosteroid within a finite range in a defined vehicle enhance potency
Corticosteroid - Occlusive dressings
Occlusive dressings promote cutaneous hydration and significantly increase absorption and potency.
Corticosteroid - Occlusion can enhance
Occlusion can enhance topical corticosteroid potency by as much as 100-fold.
Corticosteroid ointment preperations
preparations generally allow better percutaneous drug absorption and are therefore more potent than creams and lotions. One exception is the super-potent topical corticosteroid (e.g.,betamethasonedipropionate) that may be packaged in “optimized” cream vehicles.
Daily use of super high potency topical corticosteroids – do not exceed
3 weeks (persistent lesions on small areas could be treated longer)
Corticosteroids - High potency and medium strengths – rarely cause cutaneous side
effects if used for less than 6 to 8 weeks; could occur with shorter courses, especially on the face and intertriginous areas
Corticosteroids - Intermittent therapy
Intermittent therapy – maintaining long-term control
Corticosteroids - Discontinue when
Discontinue when skin condition has resolved
Corticosteroids Rebound
Rebound flares – avoid by tapering topical therapy with a gradual reduction in both potency and dosing frequency at two-weeks intervals
Topical Glucocorticoids - SE
SE are rate with low potency
Topical Glucocorticoids facial
Facial, intertriginous, genital dermatoses – treat short 1 to 2 weeks intervals – most susceptible to corticoids-induced atrophy, telangiectasia, and acneiform eruption
Topical Glucocorticoids ADR
Local reactions Thinning of the skin Stretch marks Purpura Telangiectasia Hypertrichosis Atrophy
Topical Glucocorticoids - Saver than
Safer than systemic glucocorticoids
Topical Glucocorticoids - Tachy
Tachyphylasix
Topical Glucocorticoids - ADR Systemic
Systemic toxicity
More likely with higher doses and long-term therapy
Growth retardation in children
Adrenal suppression
Topical Glucocorticoids - Administration
Apply in a thin film and gently rub into the skin
Do not use occlusive bandages (or tight-fitting diapers and plastic pants)
Pediatrics - Safe
use of lower potency (groups 4 to 7) – short durations, appropriate inflammatory conditions
Pediatrics - require
Require less - infants be given one-fifth of the adult dose, children be given two-fifths of the adult dose, and adolescents be given two-thirds of adult doses
Pregnant women - mild or moderate
Pregnant women - mild or moderate
pregnancy if potent or
potent or super potent topical corticosteroids are needed, the amount used should be kept to a minimum; monitor fetal growth.
Pregnancy it is not known
whether topical corticosteroids are secreted in breast milk; no adverse effects have been noted in lactating women.
How much to dispense?
Considering the amount used per application
The number of applications to be given daily,
The duration of therapy
The Fingertip Unit (FTU)
The Fingertip Unit (FTU)
Approximately equivalent to 0.5 and 0.4 grams of ointment in men and women,respectively.
Head and neck = 4.5; trunk (front or back) = 7; one arm = 3; one hand = 1; one leg = 6; and one foot = 2.
For 3 times daily applications – 9 grams of cream covers
9% of skin area daily
Quantity of cream to dispense for complete coverage of area for 3x daily applications for 10 days
Face: 45g Chest or back: 180g 1 arm: 90g 1 forearm: 45g 1 hand or foot: 45g 1 leg: 180g
Avoiding under and
over dispensing.
Consider the amount used per
application, the number of applications to be given daily, and the duration of therapy.
For a three times a day application, 9 grams of cream will cover
9% of the skin area daily.
Example OF RULE OF NINE
Entire right leg, you take 9 (front of leg) and 9 (back of leg) which equal 18. Take 18 x 10 = 180grams. This is for a three times a day application to the entire right leg for 10 days.
Front of the forearm – it would be half of 9 = 4.5 x 10 = dispense a 45 grams tube.
Pediatrics: greater surface
greater surface area-to-weight ratio, permeability of skin increased in very young, avoid high potency corticosteroids, and avoid occlusive dressings.
Pregnant – alterations in hormonal
alterations in hormonal balance result in skin changes. Many dermatological products are not recommended in pregnancy.
Geriatrics – skin is less
permeable to drugs due to an altered lipid content and loss of subcutaneous tissues; changes in CNS alter perception of itching and pain; atrophy of the reticuloendothelial system may impair the immune system; progressive impairment of peripheral vascular symptom decreases sensation.
Combination anti-fungal/topical corticosteroid products – consider
doing a KOH scraping to help determine if its is fungal
Topical Corticosteroids - Other SE
Other side effects that can occur with topical corticosteroid use include acneiform eruptions, purpura, hypopigmentation, glaucoma, and suppression of the hypothalamic-pituitary axis
Topical Corticosteroids - Intermitent therpay
Intermittent therapy with topical corticosteroids can be effective for long-term maintenance therapy in some conditions (e.g., twice-weekly application in well-controlled atopic dermatitis to reduce risk of relapse).
Topical Corticosteroids Pulse therapy
Pulse therapy – 2 weeks on and 2 weeks off.
Topical Corticosteroids facial
intertriginous, and genital dermatoses should be treated for short one to two-week intervals. These areas are more susceptible to corticosteroid-induced atrophy, telangiectasia, and acneiform eruption.
