Pharm: Topical Corticosteroids Flashcards
Ointments
-water in oil -good lubricant -facilitate heat retention (never put on burns) -decreased water loss -semi-occlusive (enhances drug penetration and absorption) -most potent** vehicle (b/c its occlusive) -best for dry/thick, hyperkeratotic lesions -avoid hairy and intertriginous areas -greasy
Cream
-oil in water -can be washed off w/ water -good lubricating qualities -vanish into skin -less potent than ointment but more than lotions -good for exudative inflammation and intertriginous areas -no occlusive properties
lotions/aerosols/solutions
-least greasy and occlusive -good for hairy and large areas -penetrate easy and leave little residue
foams
-pressurized collections of gaseous bubbles in liquid film -spread readily and easy to apply -good for inflammed skin and scalp dermatoses -cosmetically acceptable -depend on vehicle delivery (expensive)
gels
-oil in water with alcohol in the base (evaporate quickly) -they dry in a thin, greaseless, nonstaining film -efficient for hairy areas and acne -dry quickly and can be applied to scalp -best for exudative inflammation -helpful for drying of oozing lesions (as long as not broken skin)
purpose of an occlusive dressing
increase steroid absorption
Know this chart
contraindications to topical steroids
- acne vulgaris
- scabies
- warts
- fungal infections
- viral infections
factors that effect the degree of absorption of topical steroids
- skin integrity: absorbed more at areas of inflammation and desquamation
- pts age: more readily through infants skin
- vehicle used
- use of occlusive dressing
- the area of body on which it is applied: thin skin more permeable than thick
Which group of steroids is the most potent and the least potent?
- group 1 = most potent
- group 7 = least potent
super high potent topical steroids
clobestasol
high potency (group 2) steroids
halcinonide (halog 0.1%)
high potentcy (group 3) steroid
triamcinolone acetonide 0.5% cream or ointment
medium potentcy (group 4) steroid
triamcinolone acetonide 0.1% cream or ointment
low potency (group 5) steroid
flucocinolone acetonide 0.01% solution
what is the least potent topical steroid?
hydrocortisone
when is the best time to apply topical steroids?
to moist skin
what is the appropriate frequency of application of topical steroid?
no more than twice daily (using it more often doesn’t increase effectiveness, just risk of toxicity)
areas of the body that are most susceptible to steroid ADRs
- occluded areas
- thin skinned areas (face and flexures)
vulnerable populations to steroid ADRs
- children
- eldery
- pts w/ liver failure
- pts who use the highest potency preps for longer than 2 weeks
treatment duration w/ a topical steroid
- super high potentcy: should not exceed 3 weeks if possible
- high/med potentcy: rarely cause ADRs if used < 6-8 weeks
- facial, intertriginous, and genital dermatoses should be treated for 1-2 week intervals
explain intermittent topical steroid therapy
- twice weekly
- may be effective for maintaining long term dz control
tapering after short course of steroids
- dc topical steroids when skin condition resolves
- avoid rebound skin condition by tapering topical tx w/ gradual reduction of potency and frequency at 2-week intervals
use of topical steroids in children
- lower potency (groupe 4-7) for short durations
- avoid using potent or super potent topical steroids in children < 12 except for very severe inflammatory dermatoses
- avoid use on face, intertriginous or other thin skinned areas
- use only once daily
- do not use longer than 2 weeks
use during pregnancy and lactation
- mild or moderate instead of potent/super potent for pregnant women
- if potent are needed, keep at min. dose and monitor fetal growth
- unknown if steroid are secreted in breast milk; don’t apply to nipples
epidermal / dermal atrophy
- usually reversible
- thin skin areas most vulnerable
telangiectasia
striae
- occur MC in cubital and popliteal fossa, groin, axillary and inner thigh
- usually permanent
purpura
-red or purple discolored spots that don’t blanch
hypopigmentation
- primarily a problem of dark skinned pts
- generally reversible
acneiform eruption
-may be induced by prolonged use of topical steroids
factors associated w/ systemic absoprtion and ADR w/ topical steroid use
- significant hypothalamic pituitary axis suppression
- systemic absorption –> adrenal suppression
- cushingoid features (rarely)
nonpharmacologic interventions to decrease pruritus
- skin moisturiation
- gentle cleansers during bathing: dove, olay, cetaphil
- apply emollients to skin daily
- avoidance of excessive and agressive skin washing
- use a humidifier
topical products that can be used to decrease puritis
- corticosteroids
- topical capsaicin
- calcineurin inhibitors
- anesthetics
- astringents
- calamine
- colloidal oatmeal
CIs to self tx of a corn or callus
- DM
- peropheral circulatory dz or other medical conditions that contraindicates use of foot care products
- lesions that are oozing or bleeding
- anatomic defect or fault in body weight distribution
- extensive or painful, debilitating corn or calluses
- proper but unsuccessful self-tx attempt
- hx of RA and complaint of painful metatarsal heads or deviation of great toe
CIs to the use of salicyclic acid in treating corns and calluses
- irritated, infected, reddened, or broken skin
- moles, birthmarks, warts w/ hair
- DM or poor blood circulation
- warts on face, mucous membranes or genital warts
- avoid in pregant / breastfeeding women
patient education needed to decrease or prevent the spread of HPV virus for warts
- avoid cutting, shaving or picking at warts
- wash hands before and after treating or touching them
- use designated towel to dry warts (a wart towel, if you will)
- avoid transmissions to other: avoid sharing towels, razors, socks, shoes
- keep wart covered and don’t go barefoot
tx duration w/ salicylic acid in the tx of warts
should not exceed 12 weeks
mechanism of cryotherapy for warts
- freezing causes intracellular ice crystals, microthrombi formation leading to ischemic necrosis and destruction of the HPV infected keratinocytes
- also causes local inflammation that may clear the wart through a cell-mediated process
- a blister forms under wart and will fall off after 10 days
