Topical skin therapeutics

Question 1

What is a cream?

Answer 1

A semi-solid emulsion of oil in water which contains an emulsifier and a preservative.

Question 2

What are the advantages of using a cream?

Answer 2

Acts as a moisturiser and is non-greasy and easy to apply.

Question 3

What is an ointment?

Answer 3

A semi-solid grease/oil.
It has no preservative.
It restricts water loss.

Question 4

Ointment is greasy - why is this a negative thing?

Answer 4

It means it is less cosmetically attractive.

Question 5

What is a lotion?

Answer 5

It is a liquid formulation. A suspension or solution in water or alcohol.

Question 6

What must you keep in mind if it contains alcohol?

Answer 6

It might sting!

Question 7

On what part of the body are lotions used?

Answer 7

To treat the scalp.

Question 8

What is a gel?

Answer 8

Thickened lotion.

Question 9

On what part of the body are gels used?

Answer 9

Scalp, hairy areas and the face.

Question 10

What is a paste?

Answer 10

A semi solid which is stiff, greasy and difficult to apply.

Question 11

In what circumstances are pastes used?

Answer 11

Used in cooling, drying and soothing bandages.

Question 12

When are emollients used?

Answer 12

Used in dry/scaly conditions since it enhances rehydration of the epidermis.

Question 13

What is a wet wrap?

Answer 13

Common in paediatrics.
Applied to whole body. Steroid or emollient applied and then bandaged up at night time.
Used in xerosis.

Question 14

How do steroids work?

Answer 14

Anti-inflammatories, anti-proliferatives and vasoconstrictives.

Question 15

What steroid should be used in mild cases?

Answer 15

Hydrocortisone 1%

Question 16

What steroid should be used in moderate cases?

Answer 16

Clobetasone butyrate 0.05%

Question 17

What potent steroids can be used?

Answer 17

Betamethasone valerate 0.1%

Question 18

What are the very potent steroids?

Answer 18

Clobetasol proprionate 0.05%

Question 19

In what conditions are steroids used?

Answer 19

Eczema, psoriasis, keloid scars and other non-infective inflammatory skin conditions e.g. lichen planus

Question 20

How much steroid should be used?

Answer 20

1 fingertip is 0.5g and that would do 2 hand areas.

Question 21

What are the issues with using steroids?

Answer 21

Thinning of the skin (atrophy)
purpura (does not blanche) and stretch marks.
Rosacea, perioral dermatitis, rebound flare of disease- especially psoriasis!

Question 22

What do anti-septics do?

Answer 22

Bacteriostatic or bactericidal effects.

Question 23

Examples of antiseptics include

Answer 23

Savlon- chlorhexidane
Aquasept- Triclosan
Crystacide- hydrogen peroxide

Question 24

What antibiotic should be used in acne?

Answer 24

Clindamycin, erythromycin or tetracycline

Question 25

What antibiotic can be used in rosacea?

Answer 25

Metronizadole

Question 26

What antibiotic should be used in impetigo?

Answer 26

Mupirocin (v strong. Often used for MRSA infections), fusidic acid

Question 27

When is a topical antiviral a suitable treatment?

Answer 27

Herpes simplex -cold sore.

Question 28

When should an oral antiviral be used?

Answer 28

Eczema herpeticum and herpes zoster (shingles)

Question 29

What should be used to treat candida?

Answer 29

An anti-yeast like nystatin or clotrimazole

Question 30

How is ringworm treated?

Answer 30

An anti-fungal like terbinafine cream

Question 31

What anti-pruritics are available?

Answer 31

Menthol can be added to calamine lotion to create a cooling sensation Capsaicin (from red chilli peppers) causes burning sensation at first. Need to build up use. Camphor for pruritus ani.

Question 32

When is a keratolytic used?

Answer 32

to soften keratin: | in warts, corns and calluses and to remove keratin plaques in scalp.

Question 33

Give an example of a keratolytic

Answer 33

salicyclic acid

Question 34

How are warts treated?

Answer 34

Mechanical filing, salicylic acid , formaldehyde, cryotherapy. If genital warts: podophyllin

Question 35

What are typical psoriasis treatments?

Answer 35

``` Emollients, coal tar, vitamin D analogue, keratolytic - salicylic acid topical steroids dithranol ```

Question 36

What are the disadvantages of using dithranol?

Answer 36

It can be difficult to use and may be an irritant and stains normal skin

Question 37

What is the treatment for scalp psoriasis?

Answer 37

Greasy ointments to soften the scale, tar shampoo, vitamin D analogues, steroids in alochol base or shampoo

Question 38

What is a common issue with using vitamin D analogues?

Answer 38

Can disrupt calcium metabolism