Dermatology Flashcards
What is Topical corticosteroids and how do they work?
Topical corticosteroids are drugs to help reduce inflammation on irritated skin.
Drug examples:
Hydrocortisone, betamethasone
MOA:
Corticosteroids have immunosuppressive, metabolic, glucocorticoid and mineralocorticoid effects.
- Prescribed to modify immune response, upregulate antiinflamatory disease and down regulate proinflammatory genes (Cytokines) These help supress monocytes and esonophils
- They also have metabolic effect and mineral corticosteroid effect.
Indications:
- Inflammatory skin conditions such as eczema
- Treat disease flares and control chronic disease when emmolients are insufficient
Adverse effects:
- Skin thinning
- Striae
- Telangiectasia (Spidery veins)
- Contact dermatitis
- Perioral dermatitis
- Exacerbate acne
- Rebound worsening of skin conditions
- Adrenal suppresion
Warning/caution:
- Prolonged use especially on the face
- Avoid potent use of face and skin flexures
- Caution use in periocular area
- When infection is present
- Facial lesions
Contraindication:
- Bacterial, viral or fungal infection
- Rosacea
- Perioral dermatitis
- Acne vulgaris
- Anogenital pruritus
- Facial lesions
Interactions:
No interactions however, if several topical agents are being used on the same area of skin, applications should be spaced out
Monitoring:
Providing inflammation relief and help improve skin problem. Duration is 2 weeks maximum
Corticosteroids should be applied very thinly and only to the area of skin where disease is active. Should be applied using finger tip measurement
DISCUSS benzoyl peroxide CLINICAL PHARM ?
Benzoyl peroxide is used to treat acne. It works as an antiseptic to reduce the number of germs (bacteria) on the surface of your skin.
MOA: Benzoyl peroxide is metabolized in the skin to benzoic acid and free oxygen radicals interfering with their function, and survival of the bacteria, leading to decreased keratin and sebum of the skin.
Indications:
- Acne vulgaris
Adverse effects:
- Skin irritation: Dryness, Erethyma, Bleeding, Blistering, Peeling,
- Allergic contact dermatitis
- Increased risk of sun burn
- May bleach fabric and hair
Caution/warning:
- Avoid broken skin, eyes, mouth, mucus membranes
Contraindication:
- Hypersensitivity to the active substance
Interactions:
- usually with other antibiotics
- combined with topical retinoids
Monitoring: -
Benzoyl peroxide is frequently combined with a topical antibiotic. Monitor symptoms
If sun exposure is unavoidable, an appropriate sunscreen or protective clothing should be used.
Patients and carers should be warned that some redness and skin peeling can occur initially but settles with time.
DISCUSS Topical retinoids CLINICAL PHARM?
They help unclog pores by boosting the production of new skin cells.
MOA: Topical retinoids promote the exfoliation of dead skin cells and boost the production of new skin cells. The new cells push dead cells and excess oil out of blocked pores. Retinoids also have anti-inflammatory properties.
Indications:
- Adapalene and tretinoin
Adverse effects:
- Skin irritation, blistering, peeling, crusting, dryness, erythema, oedema, puritus, stinging, contact dermatitis, temporary change to skin pigmentation
- Eye irritation
- Increased sensititivty to UV light
Warnings/caution:
- Use with caution during breastfeeding.
- Hypersensitivity to active substances
Contraindications:
- Avoid in people with severe acne, perioral dermatitis, rosacea or a personal or family history of non-melanoma skin cancer.
- Avoid accumulation in angles of the nose and contact with eyes, nostrils, mouth and mucous membranes, eczematous, broken or sunburned skin.
- Avoid exposure to excess UV light.
Interactions:
- Systemic absorption may follow topical application of isotretinoin and prescribers should be aware of the possibility of interactions
- Other retinoids or drugs with a similar mode of action should not be used concurrently.
- Avoid use of topical retinoids with abrasive cleaners, comedogenic or astringent cosmetics.
Monitoring:
- Effect of retinoid and monitoring of progression of skin healing
Usually follow up is 12 weeks as the retinoids take time to work on the skin
- Apply the products once daily, 12 hours apart (for example the topical retinoid at night and benzoyl peroxide in the morning). Also same with antibiotics
DISCUSS AZAELIC ACID CLINICAL PHARM
MOA: Its antibacterial effects by inhibiting the synthesis of cellular protein in anaerobic and aerobic bacteria, especially Staphylococcus epidermidis and Propionibacterium acnes.
Indications:
- Papulopustular rosacea
- Acne vulgaris
Adverse effects:
- Skin reactions
- Asthma exacerbated; cheilitis
- Angioedema; eye swelling
Caution/warnings:
- Avoid contact with eyes; avoid contact with mouth; avoid contact with mucous membranes
Monitoring:
- If severe skin irritation occurs, the amount of preparation applied or frequency of application should be reduced, or treatment temporarily discontinued. In patients with sensitive skin, treatment may be started with once-daily application (in the evening) and progressed to twice-daily application if tolerated.
