Topical and Oral formulations

Question 1

Different formulations that can be used?

Answer 1

Ointment 
Cream 
Gel 
Lotion 
Solution

Question 2

Ointment

What is it mostly made out of?

Pros

What should be avoided?

Answer 2

> 80% oil

Effective for dry skin
Good for holding in moisture

Avoided in weeping eczema as messy and sticky

Question 3

Cream

Contents

Pros

Cons

Used in ……?

Answer 3

50/50 oil and water emulsion

Less messy than ointments

Less effective than ointments
Contains preservatives which may irritate or cause allergy

Used in weeping eczema

Question 4

Gel

Contents

Pro

Answer 4

A semisolid emulsion often containing cellulose which liquefies when on skin

Good for body folds and hairy areas

Question 5

Lotion - what it mainly contains

Answer 5

Mainly water and alcohol but emulsified with small amount of oil to make it a bit thicker

Question 6

Emollients:

Examples

Indications

Side effects

Answer 6

Aqueous cream
Liquid paraffin

To rehydrate skin and re-establish the surface lipid layer
Useful for dry, scaling condition and as soap substitute

Reactions may be irritant or allergic due to preservatives or perfumes

Question 7

Topical or oral corticosteroids

Indications

Side effects of topical steroids

Side effects of oral steroids - CUSHINGOID

Answer 7

Anti-Inflammatory
Anti-proliferative

Skin atrophy - thinning g
Telangiectasia
Striae
May mask, cause or exacerbate skin infections

C – Cataracts
U – Ulcers
S – Striae, Skin thinning
H – Hypertension, Hirsutism
I – Immunosuppression, Infections
N – Necrosis of femoral heads
G – Glucose elevation - DM 
O – Osteoporosis, Obesity
I – Impaired wound healing
D – Depression/mood changes

Question 8

Oral antivirals

Example

Indications

Side effects

Answer 8

Aciclovir

Viral infections due to herpes simplex and herpes zoster virus

GI upset
Raised liver enzymes
Reversible neurological reactions

Question 9

Oral antihistamines

2 types

2 examples of each type
c, l c, h

Indications - 2

Answer 9

Nonsedative - cetirizine, loratadine

Sedative - Chlorpheniramine, hydroxyzine

Blocks histamine receptors providing anti-pruritic effects
Useful for type 1 hypersensitivity reactions and eczema

Question 10

Sedative antihistamines can cause sedation and anticholinergic effects - list a few?

Answer 10

Dry mouth
Blurred vision
Urinary retention
Constipation

Question 11

Topical/oral antibiotics:

Examples of each

Side effects:

• Topical
• Systemic

Answer 11

T - fusidic acid
O - penicillins, gentamicin

Local skin irritation /allergy

GI upset 
Rashes 
Anaphylaxis 
Vaginal candidiasis 
C diff 
Antibiotic resistance

Question 12

Oral retinoids

Examples - 2

Side effects:

• Mucocutaneous reactions
• Liver
• Cholesterol
• Triglyceride
• Joints
• Mood
• Pregnancy

Answer 12

Dry skin, lips, eyes

Disordered liver function

Hypercholesterolaemia
Hypertriglyceridaemia

Athralgia
Depression

Teratogenicity - contraception needed