Topical skin therapeutics

Question 1

What kind of solution is a gel?

Answer 1

Thickened aqueous solution

Question 2

What do gels contain?

Answer 2

High molecular weight polymers

Question 3

Where are gels commonly used?

Answer 3

Scalp, hair baring areas

Question 4

What kind of solution is a cream?

Answer 4

Semisolid emulsion of oil in water

Question 5

What do creams often contain?

Answer 5

Emulsifier and preservative

Question 6

What are the advantages of cream?

Answer 6

High water content- cooling
Easy to apply
Non-greasy
Cosmetically acceptable

Question 7

What kind of solution is an ointment?

Answer 7

Semi-solid grease/oil

Question 8

Why are ointments less cosmetically attractive?

Answer 8

Greasier and heavier

Question 9

What do ointments restrict?

Answer 9

Trans-dermal water loss

Question 10

What is the problem with ointments?

Answer 10

Highly flammable

Question 11

What kind of preparation is a paste?

Answer 11

Semi-solid

Question 12

What are pastes used for?

Answer 12

Cooling, drying, soothing bandages- often around an ulcer

Question 13

What do pastes contain?

Answer 13

Finely powdered material ZNO

Question 14

What kind of solution are lotions?

Answer 14

Suspension of a solution of medication in water, alcohol or other liquid

Question 15

What can make lotions hard to use?

Answer 15

If it contains alcohol it may sting

Question 16

Where are lotions used?

Answer 16

Scalp

Question 17

What kind of solution are foams?

Answer 17

Usually hydrophilic liquid in continuous phase with foaming agent dispersed in gaseous phase

Question 18

What are the advantages of foams?

Answer 18

Increased penetration of active agents

Spread easily over large areas, no greasy/oily film

Question 19

What do emollients do?

Answer 19

Enhance rehydration of epidermis

Question 20

When are emollients needed?

Answer 20

All dry/scaly conditions

Question 21

How much emollient should be prescribed weekly?

Answer 21

300-500g

Question 22

What kind of effects to topical steroids have?

Answer 22

Vasoconstrictive
Anti-inflammatory
Antiproliferative

Question 23

What are topical steroids used?

Answer 23

Mainly eczema, sometimes psoriasis

Question 24

List topical steroids in order of increasing anti-inflammatory and immunosuppressant effect?

Answer 24

1. Hydrocortisone
2. Modrasone Clobetasone
   Butryrate
3. Mometasoine
   Betamethasone
   Valerate
4. Clobetasol Proprionate

Question 25

What is a risk factor of steroid use?

Answer 25

Rebound psoriasis

Question 26

How much does one fingertip unit cover?

Answer 26

2 hand areas

Question 27

What are side effects of long term topical steroid use?

Answer 27

Skin thinning
Purpura 
Stretch marks
Steroid rosacea
Periolar dermatitis
Fixed telangiectasia
Adrenal suppression 
Cushings
Tachyphylaxis
Glycoma
Cataracts

Question 28

What are calcineurin inhibitors?

Answer 28

Non steroid anti-inflammatories

Question 29

What are tacrolimus and pimecromilus the same strength as?

Answer 29

Tacromilus: potent steroid
Pimecromilus: mild steroid

Question 30

How do calcinuerin inhibitors work?

Answer 30

Suppress lymphocyte activation

Question 31

When are calcinuerin inhibitors used?

Answer 31

Atopic eczema

Question 32

What is the negative feedback received after use of calcinuerin inhibitors?

Answer 32

Cause burning sensation on application

Question 33

What is a risk factor of calcinuerin inhibitors?

Answer 33

Risk of skin cancer

Risk of cutaneous infection

Question 34

Name some antiseptic preparations

Answer 34

• povidone iodine (betadine) skin cleanser
• chlorhexidine (hibitane, savlon)
• triclosan (aquasept, sterzac)
• hydrogen peroxide (crystacide)

Question 35

When should antiseptics be used?

Answer 35

Try to use over antibiotics

Recurrent infections

Antibiotic resistance

Wound irrigation

Acute blistering weeping eczema

Question 36

What is given for herpes simplex virus?

Answer 36

Topical antiviral

Question 37

What is given for eczema herpeticum?

Answer 37

Oral antiviral

Question 38

What is given for herpes zoster? (shingles)

Answer 38

Oral antiviral

Question 39

What is given for candida infection?

Answer 39

Antiyeast, clotrimazole

Question 40

What is given for dermatophyte (ringworm) infection?

Answer 40

Antifungal eg

• clorimazole
• Terbinafine cream

Question 41

What is given for pityriasis versicolor?

Answer 41

Ketoconazole

Question 42

How can pityriasis versicolor be identified?

Answer 42

Areas of hyper/hypo-pigmentation

Pink inflammatory areas on the trunk

Question 43

What are some common antipruritics?

Answer 43

Menthol
Capsaicin
Camphor/phenol
Crotamiton

Question 44

How does menthol work?

Answer 44

added to calamine & other lotions and creams to impart cooling sensation

Question 45

How does capsaicin work?

Answer 45

Depletes substance P at nerve endings and reduced neurotransmission, effect gradually builds

Question 46

What is camphor/phenol used for?

Answer 46

Pruritus ani

Question 47

What is crotamiton used for?

Answer 47

After treatment of scabies to relieve residual itch

Question 48

What are wet wraps used in?

Answer 48

Very dry skin in children with severe eczema

Question 49

How can you treat warts?

Answer 49

Keratolytics

Formaldehyde: soaks for whole foot surface

Glutaraldehyde: soaks for whole foot surface

Silver nitrate: solitary wart
cryotherapy (ususally liquid nitrogen), solitary wart

podophullin (genital warts), cryotherapy can be used if localised warts

Question 50

What are the topical psoriasis treatments?

Answer 50

Emollients
Coal Tar 
Vitamin D analogue
Keratolytics
Topical steroid
Dithranol

Question 51

What are the disadvantages of dithranol?

Answer 51

Difficult to use
Stains normal skin
Irritant