L18: Drugs & Cosmetics Flashcards
What is Minoxidil?
First cosmeceutical to treat male pattern baldness.
What is fluoride?
In toothpaste, drug to prevent tooth decay and gum disease by getting rid of microorganisms. It’s also a cosmetic to keep your teeth looking nice.
What is the largest organ of the body? Why is this dangerous for children?
The skin. Babies have a high surface to volume ratio of skin therefore we must be careful about the compounds we put on babies.
What is the structure of the skin?
The skin has three layers:
- The epidermis – the outermost layer of the skin, it’s a superficial layer, vasculature does not go there. Hair that is above the epidermis does not contain alive cells anymore.
- The dermis – contains blood vessels, hair follicles, various glands like sweat glands and sebaceous glands, muscles that pull hair shafts straight when we are afraid or cold and makes us shiver, and nerve endings.
- The sebaceous gland is located beside hair follicles and it secretes sebum which lubricates the surface of the skin. Nerve ending is connected to sensory receptors to sense touch, pain, and temperature. - Hypodermis: fat and connective tissue
What is the main difference between different peoples’s skin?
The chemical structure of melanin in the skin is different.
What do melanocytes do?
Melanocytes produce melanin and insert them into keratinocytes (primary cell in the epidermis to form. protective barrier).
How does UV exposure change the skin?
- Sunburns (excessive exposure to UV light) cause melanocytes to increase production and insertion of melanin (pigment granules) into keratinocytes. This causes a darker skin colour because of increased pigment in an attempt to block UV light which is damaging and carcinogenic.
- Sunburn is the reaction to UV injury.
- Causes premature wrinkling, broken blood vessels, pigmental changes and blotches in the skin, and skin cancer.
What are the receptors in the skin? What’s the turnover rate of skin cells?
There are receptors in the skin for cold, heat, pain, touch, and pressure. The skin cells have a fast turnover rate so it can continually repair itself and replace deficits.
Give an examples of how skin structure is adapted to location.
Skin behind the ear is thin while skin on the palm of the hand and soles of the feet is thick. The number and types of glands also vary (ex: on scalp, different oils are secreted and the amounts secreted are different in different locations).
Normally, the skin is a barrier that does not absorb compounds, however, behind the ear is a good place to apply patches to prevent motion sickness (abdomen is another). It allows fast absorption so the drug can be distributed systemically.
What is psoriasis?
Psoriasis is characterized by patches of abnormal skin. Psoriasis is a second layer of keratinocytes with plaque. Skin turnover is very rapid, so many more skin cells are made, and the skin becomes thicker, and sells rise to the surface and flake off.
What can be used to treat psoriasis and acne?
- Topical (preferred) ex: corticosteroids, Vitamin D3
- Systemic methods ex: retinoids (for more serious cases)
- Phototherapy ex: UV light or other light sources
- Biologic ways ex: monoclonal antibodies (last set of choices)
What is photosensitivity and what can cause it?
- Photosensitivity is caused by an allergic reaction to certain drugs. Being out in the sun without sunscreen can cause skin damage (sun burn) at very low exposure which normally does not happen.
- Antibiotics, diuretics, antipsychotics, NSAIDs, and many plants and herbal mixtures can elicit photosensitivity.
What is tanning? What are the side effects? Why are tanning machines banned in certain areas?
The skin’s reaction to UV injury. It is never safe.
It increases the risk of cancer and causes wrinkles earlier.
Tanning beds have been banned because they increase the risk of melanoma (deadliest skin cancer) by 59%.
What makes up UV light?
UVB & UVA rays in the 290-400nm range.
UVB and UVA have different wavelengths that can damage the skin and cause injury. This causes them to penetrate the skin to different extents. UVA penetrates deeper into the skin, UVB cannot penetrate as deep but its exposure is greater.
- It’s also important to wear sunglasses in the Sun as you can damage your eyes and cause cataracts
Who is particularly vulnerable to sun?
- Children are the most vulnerable, especially the ones with light skin. Every sunburn increases the risk of cancer in children.
- People with freckles because there’s very little pigment in between freckles, and pigments are the ones protecting against skin damage.
What is photoaging? What is a vulnerable area?
Skin damage caused. by prolonged sun exposure.
- The back of the neck
What is the biggest risk of sunburn?
Skin cancer:
- Basal cell carcinoma: can be removed before the carcinoma becomes large
- Melanoma: can lead to death
What is sunscreen? What is SPF?
- Sunscreens are creams that protect skin from UV light damages and contain SPF (sun protective factors).
- SPF is a measure of efficacy and is used to compare potency of different sun blocks. It determines how long you can stay in the sun vs if you have no protection.
What is broad spectrum sunscreen?
Blocks both UVA and UVB rays.
Why do you need to wear higher SPF when skiing or swimming?
Because water and snow can reflect light back. Snow can reflect up to 85% of UV radiation. Therefore, you will experience greater UV exposure when swimming and skiing so you need to wear higher SPF.
What can cause acne?
- Occlusion of the pilosebaceous duct where hair follicles normally come out.
- Bacterial colonization in the duct, releasing inflammatory mediators.
- Increase sebum secretion as often occurs during adolescence. Sebum is a lubricant that lubricates the hair shaft and the hair to keep it shiny, some comes out and lubricate the skin and the scalp.
- Inflamed sebaceous glands. In severe cases, the comedo (excessive accumulation of sebum filling the pore of the skin) may rupture and release contents into the dermis.
What are the stages of acne? Describe them.
Acne- abnormal keratinocytes
- Normal hair follicle
- Oxidized sebum: When duct is blocked, sebum accumulates at the surface of the open pore and becomes oxidized to form blackheads. Blackheads are not dirt, but they’re an open follicle with oxidized sebum which blocks the opening of the pore.
- Trapped sebum: When sebum is trapped below the surface of the skin, they form of whiteheads. Contains bacteria and leukocytes. Closed comedo.
- Bacteria & leukocytes: Bacteria accumulates in the sebum which attracts the white blood cells therefore, there is a mixture of bacteria, leukocytes, and sebum. In more severe cases, the comedo will rupture and spread to become larger which forms and inflamed red circle around the original site and a bump on the surface of the skin. Both blackheads (open) and whiteheads (closed) comedo can accumulate bacteria and increase sebum accumulation.
What is Hyperkeratosis?
accumulation of keratin and sebum which causes bacteria to proliferate, causes inflammation, and rupture.
What is mild acne? severe acne? cystic acne?
Mild acne: dead skin cell, trapped sebum, blackheads (sometimes white heads).
Severe acne: pus (bacteria + WBCs), inflamed tissue, and rupture.
Cystic acne: most serious type of acne
How did we learn to treat acne.
We learned how to treat acne on humans through trial and error because no animal model is known to get acne.
Who is more vulnerable to acne?
Males are more vulnerable than women because acne is caused by androgens, especially testosterone, which causes increased sebum during puberty. Males have more testosterone.
What are the 4 hallmarks of acne?
Increase sebum, increase keratin, increased bacteria, and inflammation.
What are the 4 targets to reduce acne?
- Normalize follicular keratinization
- Reduce bacteria
- Inhibit sebaceous glands
- Decrease inflammation
What can be used to normalize follicular keratinization in acne?
- During acne, there is too much keratinocyte turnover (comedogenesis)
- Topical retinoids like acutane can allow the follicles to stop being plugged.
- Systemic retinoids an be used if acne is more severe
- Benzoyl peroxide
- Sulfur
- Azelaic acid
What can be used to reduce bacteria in acne?
Without bacteria, there is no infection and no inflammation.
- Benzoyl peroxide can be topical to reduce bacteria around the follicle (local)
- Antibiotics (topical and oral)
- Retinoids (ex: isotretinoin) have indirect antibacterial effects.
What can be used to Inhibit sebaceous glands in acne?
Sebum is the medium for bacterial growth and it also plugs the duct. By inhibiting the sebaceous gland, sebum excretion can be reduced.
- Accutane
- Hormonal therapy: corticosteroids in low doses, anti-androgens (Spironolactone)
- Estrogen in oral contraceptives ex: low dose birth control pills
- Retinoids: isoretinoin