Module 11: Derm (b) Flashcards
1
Q
Topical Corticosteroids
-Indications in Primary care?
A
- Contact Dermatitis
- Atopic Dermatitis/Eczema
- Psoriasis
2
Q
Topical Corticosteroids
-MOA
A
- Induce cutaneous vasoconstriction commensurate w/ their potency TEST
3
Q
Topical Corticosteroids
-Components of Successful Use
A
- Correct Dx
- Lesion type and location being treated
- Potency
- Vehicle (base the active med is delivered
- Application methods
- Consider absorption
- Inflamed skin- higher systemic absorption
- For optimal absorption of most topical drugs, apply to moist skin after bathing/wet soak
- Occlusion enhances drug absorption & Potency
4
Q
Pitfalls of Topical Corticosteroid Treatment
A
- Improper Dx
- Suboptimal Med use — Inaccurate med strength, improper vehicle
- Poor patient adherence/ incorrect use
- Inadequate Pt education
- A/E drug events - Use of combination steroid/antifungals formulations — NOT recommended
- Drug interactions
- Disregard for medication costs
5
Q
Vehicles for Topical Medications?
-How to choose?
A
- Is lesion moist or dry? — Moist = poison ivy — Dry = Psoriasis
- Ex: Gel on fissured hand eczema stings
- Ointment on moist lesion can cause folliculities
6
Q
Classifications of Topical Corticosteroids
-Potency Principles
A
- Topical Corticosteroids induce cutaneous vasoconstriction commensurate w/ their potency
- Potency measurements correlate well w/ clinical anti inflammatory efficacy
- Occlusion can enhance topical corticosteroids potency by as much as 100-fold — Ointments are occlusive
- USA classification system divides into 7 potency groups
7
Q
Classifications of Topical Corticosteroids
-Ointments
A
- For the same med, potency of Ointments is greater than creams which are greater than lotions
- Semi-occlusive
- ENHANCED medication absorption
- Increased POTENCY TEST
8
Q
Potency Classification system
-Class 1
A
- Class 1 Clobetasol propionate ointment is approximately 1000x more potent than 1% hydrocortisone (Class VII)
9
Q
General Potency Considerations
A
- Super high Potency Corticosteroids — Possible use on Palms and soles of feet
- Medium to high potency — no facial/nonintertriginous dermatoses
- Low potency — face, eyelid, intertriginous, and genital dermatoses
- Large areas (low-medium strength) — consider likelihood for systemic absorption
10
Q
High Risk areas for Absoption
A
- Face, Groin, intertriginous, axillae
2. A/Es — Thinnin/atrophy of skin, systemic effects
11
Q
Factors Affecting Tx
-Dosing and DUration
A
- Goal — SHORTEST duration required to achieve desired effect
- High potency - MAX 3-4 wks
- Medium potency 9Not on face/intertriginous areas) <6 wks
- Facial, intertriginous, genital dermatoses shorter — Max 1-2 wks - Peds — max 2 wks
12
Q
A/E of Topical Corticosteroids
A
- Burning, pruritus, Erythema
- Skin Changes
- Skin atrophy **TEST, Telangiectasias, DC med immediately to reverse damage.
- Ecchymosis and Purpura, striae, Aceneiform eruption, Hypo/Hyperpigmentation
- Hypertrichosis (Excessive hair growth)
- Hypersensitivity to vehicle or drug - Photo sensitization
- Promotion of fungal growth
- INCREASED risk of AE when topical corticosteroids are used >3 weeks**
13
Q
Systemic Effects of Topical Corticosteroids
A
- Immunosuppression
- Impaired wound healing
- Hyperglycemia, unmask DM
- Other Sx’s — Glaucoma, cataracts, HTN, necrosis of femoral head **
14
Q
Potential Systemic Effects of Topical Corticosteroids
-Hypothalamic-Pituatary-adrenal (HPA) axis suppression
A
- Can occur w/ oral or topical steroids w/ as little as 2 wks of use
- Adrenal atrophy, loss of cortisol secretory capability
- Risks for HPA suppression
- High-potency
- Chronic/long duration of use
- Children
- Application to highly permeable areas
- Tx of large areas
- Occlusion and poor skin integrity
- Liver failure
15
Q
Chronic Use of Corticosteroids
-Considerations
A
- May induce eruptions — sensitivity reactions, Acneiform eruptions, dry, scaly eruption w/ scattered follicular pustules around the mouth (perioral dermatitis) facial eruptions similar to rosacea
- Increased risk of tolerance to therapy
- To includes discontinuation of steroid therapy w/ a GRADUAL taper ** - Consider intermittent use (1-2x weekly) for chronic conditions
- Consider intermittent use
REFER to DERM
