Topical corticosteroids Flashcards
What is the reason to use topical corticosteroids in the treatment of inflammatory conditions of the skin (other than those arising from an infection)?
Relieve symptoms and suppress signs of disorder when other measures such as emollients are ineffective
What is the most common withdrawal reaction when you stop long-term topical corticosteroid treatment?
A flare of the underlying skin disorder
What is a rare but specific type of withdrawal reaction that may occur when topping long-term topical corticosteroid treatment of an inflammatory skin condition?
Skin redness extends beyond the initial area of treatment, with burning or stinging that is worse than the original condition
Are topical corticosteroids recommended in the routine treatment of urticaria?
NO
Should topical corticosteroids be used indiscriminately in pruritus?
NO
They will only benefit if inflammation is causing the itch
Are topical corticosteroids recommended for use in the treatment of acne vulgaris?
NO
Systemic or very potent topical corticosteroids should be avoided or given only under specialist supervision in psoriasis because, although they may suppress the psoriasis in the short term, (1?) or (2?) occurs on withdrawal (sometimes precipitating severe pustular psoriasis).
- relapse
2. vigorous rebound
Systemic or very potent topical corticosteroids should be avoided or given only under specialist supervision in psoriasis because, although they may suppress the psoriasis in the short term, relapse or vigorous rebound occurs on withdrawal (sometimes precipitating severe (?) psoriasis).
pustular
The most potent topical corticosteroids should be reserved for recalcitrant dermatoses such as (1?), (2?), (3?), and (4?)
- Chronic discoid lupus erythematosus
- Lichen simplex chronicus
- Hypertrophic lichen planus
- Palmoplantar pustulosis
Potent topical corticosteroid should be avoided on which two body areas?
Face
Skin flexures
But specialists occasionally prescribe them for use on these areas in certain circumstances
If topical corticosteroid treatment has failed, what treatment can be used that is more effective than the very potent topical corticosteroid preparations and can be used on localised lesions?
Intralesional corticosteroid injections
Reserved for severe cases where there are localised lesions such as keloid scars, hypertrophic lichen planus, or localised alopecia areata.
Intralesional corticosteroid injections should be reserved for severe cases where there are localised lesions such as (1?), (2?), or (3?).
- Keloid scars
- Hypertrophic lichen planus
- Localised alopecia areata
What topical corticosteroid can be used to treat uninfected inflammatory lesions on the lips?
Hydrocortisone cream 1%
Hydrocortisone cream 1% can be used for up to (?) days to treat uninfected inflammatory lesions on the lips
7 days
What topical preparation can be used to treat inflammatory lesions on the lips where infection by susceptible organisms co-exist (e.g. angular cheilitis)?
Hydrocortisone with miconazole cream or ointment
Initial treatment up to 7 days
Organisms susceptible to miconazole include Candida spp. and many Gram-positive bacteria including streptococci and staphylococci.
Hydrocortisone with (?) cream or ointment is useful where infection by susceptible organisms and inflammation co-exist, particularly for initial treatment (up to 7 days) e.g. in angular cheilitis. Organisms susceptible to miconazole include Candida spp. and many Gram-positive bacteria including streptococci and staphylococci.
miconazole
Hydrocortisone with miconazole cream or ointment is useful where infection by susceptible organisms and inflammation co-exist, particularly for initial treatment (up to 7 days) e.g. in angular cheilitis. Organisms susceptible to miconazole include (?) spp. and many Gram-positive bacteria including streptococci and staphylococci.
Candida
Hydrocortisone with miconazole cream or ointment is useful where infection by susceptible organisms and inflammation co-exist, particularly for initial treatment (up to 7 days) e.g. in angular cheilitis. Organisms susceptible to miconazole include Candida spp. and many Gram-(?) bacteria including streptococci and staphylococci.
positive
Hydrocortisone with miconazole cream or ointment is useful where infection by susceptible organisms and inflammation co-exist, particularly for initial treatment (up to 7 days) e.g. in angular cheilitis. Organisms susceptible to miconazole include Candida spp. and many Gram-positive bacteria including (1?) and (2?).
- Streptococci
2. Staphylococci
Water-miscible corticosteroid creams are suitable for (?) lesions whereas ointments are generally chosen for dry, lichenified or scaly lesions or where a more occlusive effect is required.
moist or weeping
(?) corticosteroid creams are suitable for moist or weeping lesions whereas ointments are generally chosen for dry, lichenified or scaly lesions or where a more occlusive effect is required.
Water-miscible
Water-miscible corticosteroid creams are suitable for moist or weeping lesions whereas (?) are generally chosen for dry, lichenified or scaly lesions or where a more occlusive effect is required.
ointments
Water-miscible corticosteroid creams are suitable for moist or weeping lesions whereas ointments are generally chosen for (?), (?) or (?) lesions or where a more occlusive effect is required.
Dry
Lichenified
Scaly
Water-miscible corticosteroid creams are suitable for moist or weeping lesions whereas ointments are generally chosen for dry, lichenified or scaly lesions or where a more (?) effect is required.
occlusive
Corticosteroid (?) may be useful when minimal application to a large or hair-bearing area is required or for the treatment of exudative lesions.
lotions
Corticosteroid lotions may be useful when minimal application to a large or (?) area is required or for the treatment of exudative lesions.
hair-bearing
Corticosteroid lotions may be useful when minimal application to a large or hair-bearing area is required or for the treatment of (?) lesions.
exudative
Occlusive (?) or hydrocolloid dressings increase absorption of topical corticosteroids, but also increase the risk of side effects; they are therefore used only under supervision on a short-term basis for areas of very thick skin (such as the palms and soles)
polythene
Occlusive polythene or (?) dressings increase absorption of topical corticosteroids, but also increase the risk of side effects; they are therefore used only under supervision on a short-term basis for areas of very thick skin (such as the palms and soles)
hydrocolloid
Occlusive polythene or hydrocolloid dressings (?) absorption of topical corticosteroids, but also increase the risk of side effects; they are therefore used only under supervision on a short-term basis for areas of very thick skin (such as the palms and soles)
increase
Occlusive polythene or hydrocolloid dressings increase (?) of topical corticosteroids, but also increase the risk of side effects; they are therefore used only under supervision on a short-term basis for areas of very thick skin (such as the palms and soles)
absorption
Occlusive polythene or hydrocolloid dressings increase absorption of topical corticosteroids, but also increase the risk of (?); they are therefore used only under supervision on a short-term basis for areas of very thick skin (such as the palms and soles)
side effects
Occlusive polythene or hydrocolloid dressings increase absorption of topical corticosteroids, but also increase the risk of side effects; they are therefore used only under supervision on a short-term basis for areas of (?) (such as the palms and soles)
very thick skin
Occlusive polythene or hydrocolloid dressings increase absorption of topical corticosteroids, but also increase the risk of side effects; they are therefore used only under supervision on a short-term basis for areas of very thick skin (such as the (?) and (?))
palms
soles
The inclusion of (1?) or (2?) also increases the penetration of the topical corticosteroid.
- urea
2. salicylic acid
Where is absorption of topical corticosteroids the greatest? (2)
- Where the skin is thin or raw
- Intertriginous areas (where two skin areas may touch or rub together)
Absorption is also increased by occlusion
What is a suitable quantity of corticosteroid preparations to be prescribed for the face and neck?
15 to 30 g
These amounts are usually suitable for an adult for a single daily application for 2 weeks
What is a suitable quantity of corticosteroid preparations to be prescribed for both hands?
15 to 30 g
These amounts are usually suitable for an adult for a single daily application for 2 weeks
What is a suitable quantity of corticosteroid preparations to be prescribed for the scalp?
15 to 30 g
These amounts are usually suitable for an adult for a single daily application for 2 weeks
What is a suitable quantity of corticosteroid preparations to be prescribed for both arms?
30 to 60 g
These amounts are usually suitable for an adult for a single daily application for 2 weeks
What is a suitable quantity of corticosteroid preparations to be prescribed for both legs?
100 g
These amounts are usually suitable for an adult for a single daily application for 2 weeks
What is a suitable quantity of corticosteroid preparations to be prescribed for the trunk?
100 g
These amounts are usually suitable for an adult for a single daily application for 2 weeks
What is a suitable quantity of corticosteroid preparations to be prescribed for the groins and genitalia?
15 to 30 g
These amounts are usually suitable for an adult for a single daily application for 2 weeks
What is the potency of the topical corticosteroid hydrocortisone 0.1-2.5%?
Mild
What is the potency of the topical corticosteroid eumovate?
Moderate
What is the potency of the topical corticosteroid beclometasone dipropionate 0.025%?
Potent
What is the potency of the topical corticosteroid betamethasone valerate 0.1%?
Potent
What is the potency of the topical corticosteroid betnovate?
Potent
But betnovate-RD is moderate
What is the potency of the topical corticosteroid hydrocortisone butyrate?
Potent
What is the potency of the topical corticosteroid dermovate?
Very potent
A mild corticosteroid such as hydrocortisone 0.5% or 1% is useful for treating (?) and hydrocortisone 1% for atopic eczema in childhood.
Nappy rash
A mild corticosteroid such as hydrocortisone 0.5% or 1% is useful for treating nappy rash and hydrocortisone 1% for (?) in childhood.
atopic eczema
In children, a moderately potent or potent corticosteroid may be appropriate for severe atopic eczema on the limbs, for (?) weeks only, switching to a less potent preparation as the condition improves.
1-2 weeks
Hydrocortisone has (?) glucocorticoid and mineralocorticoid activity.
equal
What. are the contraindications for the use of all topical corticosteroids? (5)
Acne
Perioral dermatitis
Potent corticosteroids in widespread plaque psoriasis
Rosacea
Untreated bacterial, fungal or viral skin lesions
What are the common side effects of all topical corticosteroids?
Skin reactions
Telangiectasia
Topical corticosteroid preparations should be applied no more frequently than (?)
twice daily
Once daily is often sufficient
What does a fingertip unit mean?
The distance from the tip of the adult index finger to the first crease
When administering topical corticosteroids, one fingertip unit is sufficient to cover an area that is (?) that of the flat adult handprint (palm and fingers)
twice
When administering topical corticosteroids, one fingertip unit is sufficient to cover an area that is twice that of the (?)
flat adult handprint (palm and fingers)
How long should you wait in between applying topical corticosteroids and emollients?
Several minutes
In children, ‘(?) bandaging’ increases the absorption of topical corticosteroids into the skin
wet-wrap
should be initiated under the supervision of a trained healthcare professional.
In children, ‘wet-wrap bandaging’ (increases/decreases?) the absorption of topical corticosteroids into the skin
increases
should be initiated under the supervision of a trained healthcare professional.
