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Dermatology > Skin therapeutics & topicals > Flashcards

Skin therapeutics & topicals Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the advantages and disadvantages of topical therapies?

A 
Advantages:
- direct application to diseased area
- reduced systemic effects
Disadvantages:
- time consuming to apply
- difficult to dose appropriately
- messy
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2
Q

What is a cream?

A

A semi-solid emulsion of oil in water which also contains emulsifier and preservative

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3
Q

What are topical drugs dissolved in?

A

bases or vehicles

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4
Q

What are the advantages of using a cream preparation?

A
  • cooling and moisturising
  • non-greasy
  • cosmetically acceptable
  • easy to apply
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5
Q

What is an ointment?

A

A semisolid grease/oil (soft paraffin)

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6
Q

Do ointments contain preservative?

A

No

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7
Q

What are the advantages of using an ointment preparation?

A
  • Occlusive & emollient (restricts transepidermal water loss)
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8
Q

What is the disadvantage of using an ointment preparation?

A

They are greasy and so less cosmetically acceptable

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9
Q

What is a lotion?

A

A liquid suspension/solution of medication in water, alcohol or other liquids

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10
Q

What is the disadvantage of alcohol containing lotions?

A

They may sting

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11
Q

What are lotions most useful for?

A

Treating the scalp and other hair-bearing areas

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12
Q

What is a gel?

A

Thickened aqueous lotions (contains high molecular weight polymers)

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13
Q

What are gels most useful for?

A

Treating the scalp & hair bearing areas as well as the face

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14
Q

What is a paste?

A

A semisolid containing finely powdered materials

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15
Q

What are the advantages of using a paste preparation?

A
  • Protective
  • Occlusive
  • Hydrating
  • Useful in cooling & drying bandages/dressing
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16
Q

What are the disadvantages of using a paste preparation\?

A
  • Stiff
  • Greasy
  • Difficult to apply
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17
Q

What are the types of topical therapies?

A
  • Emollients
  • Topical steroids
  • Anti infectives
  • Antipruritics
  • Keratinolytics
  • Assorted psoriasis therapies
  • Camouflage makeup
  • Sunscreen
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18
Q

What is the function of emollients?

A

Enhances rehydration of the epidermis

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19
Q

In which conditions are emollients used?

A

All dry/scaly skin conditions (especially eczema)

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20
Q

How much emollient should be prescribed (in general)?

A

300-500g weekly (needs frequent application)

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21
Q

Certain emollients can be used as soap substitutes. T/F

A

True

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22
Q

Are proprietary or non-proprietary emollients more expensive? Why might it be appropriate to prescribe the more expensive of the two?

A

Proprietary. Often these are more cosmetically acceptable which is important in compliance

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23
Q

When is wet wrap therapy used?

A

On very xerotic (dry) skin

24
Q

What is the disadvantage of wet wraps?

A

Difficult & time consuming to apply

25
Q

What are the effects of topical steroids?

A

Vasoconstrictive, anti-inflammatory and anti-proliferative

26
Q

List, in order of increasing potency, some topical steroids

A

Hydrocostisone > Butyrate/Modrasone/Clobetasone > Mometasone/Betamethasone/Valerate > Clobetasol/Proprionate

27
Q

What are some of the uses of topical corticosteroids?

A

Eczema, psoriasis, non-infective inflammatory dermatoses (e.g lichen planus) & (intralesional) keloid scars

28
Q

How much ointment is needed to apply ointment to the entire (adult) body? How much skin should a fingertip unit cover?

A

20-30g. Two hand areas

29
Q

What are the possible side effects of topical steroids?

A

Thinning of the skin/atrophy, purpura, stretch marks, steroid rosacea, fixed telangectasia, perioral dermatitis, worsening/masking of infection, systemic effects, tachyphylaxis, rebound flare

30
Q

Antiseptics have bacteriostatic but not bactericidal effects. T/F

A

False - they can have either

31
Q

List some antiseptics

A

Povidone iodine (betadine)
Chlorhexidine
Triclosan
Hydrogen peroxide (crystacide)

32
Q

What are the uses of antiseptics?

A

Recurrent infections, antibiotic resistance & wound irrigation

33
Q

Potassium permanganate soaks can be used in every type of eczema apart from acute exudative (pompholyx). T/F

A

False - it is used almost exclusively in pompholyx eczema

34
Q

List some topical antibiotics and their uses

A

+ Clindamycin, erythromycin and tetracycine - Acne
+ Metronidazole - Rosacea
+ Mupirocin, fusidic acid - Impetigo
+ Antibacterial & corticosteroid combo - Infected eczema

35
Q

When might antiviral treatment be useful?

A

If given within a few days of symptom onset it can be useful in:

  • Herpes simplex (cold sore)
  • Eczema herpetiform (oral preparation)
  • Herpes simplex (oral preparation)
36
Q

List some topical antifungals and their uses

A

+ Antiyeast (clotrimazole, nystatin) - Candida
+ Clotrimazole, terbinafine - Dermatophytes
+ Ketoconazole - Pityriasis versicolor

37
Q

List some antipruritics

A

Menthol, Capsaicin, Camphor/phenol, Crotamiton

38
Q

What is menthol used for?

A

Usually added to calamine lotions to provide a cooling effect (dermacool)

39
Q

What is the mechanism of action of capsaicin?

A

Uses up substance P at nerve endings, reducing neurotransmission and so itching. Has a cumulative effect over time

40
Q

What is camphor and phenol used for?

A

Pruritus ani

41
Q

What are keratinolytics used for?

A

Viral warts, hyperkeratotic eczema or psoriasis, corns and calluses, removal of keratin plaques

42
Q

Give an example of a kerainolytic

A

Salicylic acid

43
Q

How are warts treated?

A

Mechanical parring AND:

  • keratinolytics
  • formaldehyde
  • glutaraldehyde
  • silver nitrate
  • cryotherapy (liquid nitrogen)
  • podophyllin (genital warts ONLY)
44
Q

What are the mainstay of topical psoriasis treatments?

A

Emolliants AND:

  • coal tar
  • vitamin D analogues
  • keratinolytic
  • topical steroid
  • dithranol
45
Q

What are the disadvantages to coal tar?

A

Messy and smelly

46
Q

What are the advantages and disadvantages of vitamin D analogues?

A 
Advantages:
- clean 
- no odour 
- easy to apply
Disadvantages: 
- irritant (max 100g weekly)
47
Q

How is scalp psoriasis treated?

A

Greasy ointments, tar shampoo, steroids (alcohol base OR shampoo), vitamin D analogues

48
Q

When are topical steroids considered for used in psoriasis?

A

When the affected areas involve the face, flexures or groin

49
Q

What combination of drugs may be considered in psoriasis?

A

Antifungal and antibacterial (rarely)

50
Q

What is imiquimod?

A

An immune response modulator which enhances innate and T-cell mediated immunity. Antiviral & antitumor

51
Q

When is imiquimod used?

A

Superficial BCC, genital warts, solar keratosis, lentigo maligna, bowen’s, verruca

52
Q

Give some examples of calicneurin inhibitors

A

Tacrolimus, pimecrolimus

53
Q

What is the mechanism of action of calicneruin inhibitors?

A

Suppress lymphocyte activation

54
Q

What are calicneurin inhibitors used for?

A

Atopic eczema treatment (mostly on faces or children)

55
Q

What are the advantages and disadvantages of calicneurin inhibitors?

A 
Advantages:
- no atrophy
Disadvantages:
- may cause burning sensation 
- MAY increase the risk for skin infections and cancer
56
Q

What are some general side effects of topical therapies?

A

Burning/irritation, contact allergic dermatitis, local toxicity, systemic toxicity

Dermatology (26 decks)

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