Skin therapeutics/ topical therapy

Question 1

What are the advantages and disadvantages of topical treatments ?

Answer 1

Advantages:

• Direct application
• Reduced systemic effects

Disadvantages:

• Time consuming
• Correct dosage can be difficult
• Messy to use

Question 2

Describe some of the features of creams

Answer 2

• Semisolid emulsion of oil in water
• Contain emulsifier & preservative
• High water content
• Cool & moisturise
• Non greasy
• Easy to apply
• Cosmetically acceptable

Question 3

Describe some of the features of ointments

Answer 3

• Semisolid grease/oil (soft paraffin)
• No preservative
• Occlusive and emollient
• Restrict transepidermal water loss
• Greasy - less cosmetically attractive

Question 4

Describe some of the features of lotions and the areas of skin they are used to treat

Answer 4

• Liquid formulation - Suspension or solution of medication in water, alcohol or other liquids
• Treat scalp, hair-bearing areas

Question 5

Describe some of the features of gels and the areas of skin they are used to treat

Answer 5

• Thickened aqueous lotions (semi-solid)
• Treat scalp, hair bearing areas, face

Question 6

Describe some of the features of pastes and what some of the treatments they are often used in

Answer 6

• Semisolids
• Contain finely powdered material eg ZNO
• Stiff, greasy,difficult to apply
• Protective,occlusive,hydrating
• Often used in cooling, drying, soothing bandages

Question 7

Give some examples of bases/vehicles drugs used on the skin are often dissolved in

Answer 7

• Gels
• Creams
• Ointments
• Pastes
• Lotions

Question 8

Give some examples of the different types of topical therapies

Answer 8

• Emollients
• Topical steroids
• Antinfective agents - antiseptics, antibiotics, antivirals, antifungals
• Antipruritics
• Keratolytics
• Psoriasis therapies

Question 9

What are the features/function of emollients and what type of skin diseases are they mainly used in ?

Answer 9

• They Enhance rehydration of epidermis
• Require frequent application
• Used for all dry/scaly conditions esp. eczema

Question 10

What are the two main types of emollients and what differs the two from each other

Answer 10

Two main types are proprietary and non-proprietary

Proprietary costs more but is more cosmetically acceptbale hence better complicance

Examples of non-proprietary is soft paraffin, emulsifying ointment (can be used as a replacement for soap)

Question 11

What are wet wraps used to treat?

Answer 11

They are used for very dry (xerotic) skin

e.g. xerotic eczema - a form of eczema that is characterized by changes that occur when skin becomes abnormally dry, itchy, and cracked

Question 12

Are wet wraps effective to use for xerotic skin ?

Answer 12

Very effective but also very time consuming to put on

Question 13

What are the 3 main modes of action of corticosteroids ?

Answer 13

• Vasoconstrictive
• Anti-proliferative
• Anti-inflammatory

Question 14

Put the following topical steroids in order of increasing potency:

• Hydrocortisone
• Clobetasol, Proprionate
• Modrasone, Clobetasone, Butyrate
• Mometasone, Betamethasone, Valerate

Answer 14

• Mild - Hydrocortisone
• Moderate - Modrasone, Clobetasone, Butyrate
• Potent - Mometasone, Betamethasone, Valerate
• Very Potent - Clobetasol, Proprionate

Question 15

List some of the skin diseases topical steroids are used in

Answer 15

• Eczema (dermatitis)
• Psoriasis
• Other non-infective inflammatory dermatoses e.g. lichen planus
• Keloid scars (a tough heaped-up scar that rises quite abruptly above the rest of the skin. It usually has a smooth top and a pink or purple color.)

Question 16

What are some of the side effects of topical steroids ?

Answer 16

Thinning of the skin, purpura and stetch marks

Also steroid rosacea, fixed telangectasia, Perioral dermatitis

Question 17

The pic below shows some of the other side effects of steroids:

Answer 17

1. Steroid rosacea (a condition in which certain facial blood vessels enlarge, giving the cheeks and nose a flushed appearance.)
2. Fixed telangectasia
3. Perioral dermaitis

Question 18

What is the action of antiseptics and give some examples of antiseptics

Answer 18

They either have bacteriostatic or bacteriocidal effects

some examples:

• Povidone iodine (Betadine) skin cleanser
• Chlorhexidine (Hibitane, Savlon)
• Triclosan (Aquasept, Sterzac)
• Hydrogen peroxide (Crystacide)

Question 19

What are some of the clinical uses of antiseptics ?

Answer 19

• Recurrent infections
• Antibiotic resisistance
• Wound irrigation

Question 20

What is the topical antibiotic used to treat rosacea ?

Answer 20

Metronidazole

Question 21

What are some of the topical antibiotics used in the treatment of acne ?

Answer 21

clindamycin, erythromycin, tetracycline

Question 22

What are some of the topical antibiotics used in the treatment of impetigo ?

Answer 22

mupirocin, fusidic acid

Question 23

What is the topical antibiotic treatment of infected eczema ?

Answer 23

combined corticosteroid/ antibacterial (short-term)

Question 24

What are anti-puritics used to relieve ?

Answer 24

Itching

Question 25

Give some examples of anti-puritics

Answer 25

* Menthol: added to calamine & other lotions & creams to impart cooling sensation. (Dermacool) * Capsaicin: from red chilli peppers - depletes substance P at nerve endings and reduces neurotransmission, effect gradually builds * Camphor / phenol – for pruritus ani * Crotamiton: e.g Eurax cream

Question 26

What is the aim of treatment with keratolytics ?

Answer 26

Keratolytic therapy is treatment to remove warts and other lesions in which the epidermis produces excess skin.

Question 27

List some of the different conditions keratolytics are used to help treat and give and example of a keratolytic drug

Answer 27

* Viral warts * Hyperkeratotic eczema & psoriasis * Corns and calluses * To remove keratin plaques in scalp e.g. Salcylic acid

Question 28

What are the different treatment options for warts ?

Answer 28

* Keratolytics e.g.Salicylic acid * Formaldehyde * Glutaraldehyde * Silver nitrate * Cryotherapy (usually liquid nitrogen) * Podophyllin (genital warts)

Question 29

What are the different treatment options for psoriasis ?

Answer 29

Emollients and choice of: * Coal tar * Vitamin D analogue * Keratolytic * Topical steroid * Dithranol

Question 30

What is the disadvantage of using coal tar ?

Answer 30

Messy and smelly

Question 31

What are the advantages and disadvantages of using vitamin D analogue ?

Answer 31

* Clean, no smell * Easy to apply * BUT can be irritant

Question 32

What are the advantages and disadvantages of using dithranol?

Answer 32

Its effective but difficult to use and irrtiates/stains nromal skin

Question 33

What is imiquimod and what is it lincensed to treat?

Answer 33

* Immune response modulator * Enhances innate & cell-mediated immunity * Anti-viral, anti-tumour effects * Licensed for use in genital warts,superficial BCC (basal cell carcinoma)

Question 34

What is the slightly different treatment options for scalp psoriasis ?

Answer 34

* Greasy ointments to soften scale * Tar shampoo * Steroids in alcohol base or shampoo * Vitamin D analogues

Question 35

What is the action of Calicneurin Inhibitors?

Answer 35

The block lymphocyte activation - e.g. T cells aren't activated

Question 36

Give a couple examples of Calicneurin Inhibitors and what they are used to treat along with the potential side effects they may cause

Answer 36

* Tacrolimus, pimecrolimus * Topical treatment of atopic eczema (esp face,children) * May cause burning sensation on application * ?risk of cutaneous infections,??risk of skin cancer

Question 37

What is cosmetic camouflage and give an example of a disease it is used to help treat

Answer 37

Make up used to cover up skin disease e.g. vitiligo