Topical skin therapeutics Flashcards
What kind of solution is a gel?
Thickened aqueous solution
What do gels contain?
High molecular weight polymers
Where are gels commonly used?
Scalp, hair baring areas
What kind of solution is a cream?
Semisolid emulsion of oil in water
What do creams often contain?
Emulsifier and preservative
What are the advantages of cream?
High water content- cooling
Easy to apply
Non-greasy
Cosmetically acceptable
What kind of solution is an ointment?
Semi-solid grease/oil
Why are ointments less cosmetically attractive?
Greasier and heavier
What do ointments restrict?
Trans-dermal water loss
What is the problem with ointments?
Highly flammable
What kind of preparation is a paste?
Semi-solid
What are pastes used for?
Cooling, drying, soothing bandages- often around an ulcer
What do pastes contain?
Finely powdered material ZNO
What kind of solution are lotions?
Suspension of a solution of medication in water, alcohol or other liquid
What can make lotions hard to use?
If it contains alcohol it may sting
Where are lotions used?
Scalp
What kind of solution are foams?
Usually hydrophilic liquid in continuous phase with foaming agent dispersed in gaseous phase
What are the advantages of foams?
Increased penetration of active agents
Spread easily over large areas, no greasy/oily film
What do emollients do?
Enhance rehydration of epidermis
When are emollients needed?
All dry/scaly conditions
How much emollient should be prescribed weekly?
300-500g
What kind of effects to topical steroids have?
Vasoconstrictive
Anti-inflammatory
Antiproliferative
What are topical steroids used?
Mainly eczema, sometimes psoriasis
List topical steroids in order of increasing anti-inflammatory and immunosuppressant effect?
- Hydrocortisone
- Modrasone Clobetasone
Butryrate - Mometasoine
Betamethasone
Valerate - Clobetasol Proprionate
What is a risk factor of steroid use?
Rebound psoriasis
How much does one fingertip unit cover?
2 hand areas
What are side effects of long term topical steroid use?
Skin thinning Purpura Stretch marks Steroid rosacea Periolar dermatitis Fixed telangiectasia Adrenal suppression Cushings Tachyphylaxis Glycoma Cataracts
What are calcineurin inhibitors?
Non steroid anti-inflammatories
What are tacrolimus and pimecromilus the same strength as?
Tacromilus: potent steroid
Pimecromilus: mild steroid
How do calcinuerin inhibitors work?
Suppress lymphocyte activation
When are calcinuerin inhibitors used?
Atopic eczema
What is the negative feedback received after use of calcinuerin inhibitors?
Cause burning sensation on application
What is a risk factor of calcinuerin inhibitors?
Risk of skin cancer
Risk of cutaneous infection
Name some antiseptic preparations
- povidone iodine (betadine) skin cleanser
- chlorhexidine (hibitane, savlon)
- triclosan (aquasept, sterzac)
- hydrogen peroxide (crystacide)
When should antiseptics be used?
Try to use over antibiotics
Recurrent infections
Antibiotic resistance
Wound irrigation
Acute blistering weeping eczema
What is given for herpes simplex virus?
Topical antiviral
What is given for eczema herpeticum?
Oral antiviral
What is given for herpes zoster? (shingles)
Oral antiviral
What is given for candida infection?
Antiyeast, clotrimazole
What is given for dermatophyte (ringworm) infection?
Antifungal eg
- clorimazole
- Terbinafine cream
What is given for pityriasis versicolor?
Ketoconazole
How can pityriasis versicolor be identified?
Areas of hyper/hypo-pigmentation
Pink inflammatory areas on the trunk
What are some common antipruritics?
Menthol
Capsaicin
Camphor/phenol
Crotamiton
How does menthol work?
added to calamine & other lotions and creams to impart cooling sensation
How does capsaicin work?
Depletes substance P at nerve endings and reduced neurotransmission, effect gradually builds
What is camphor/phenol used for?
Pruritus ani
What is crotamiton used for?
After treatment of scabies to relieve residual itch
What are wet wraps used in?
Very dry skin in children with severe eczema
How can you treat warts?
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
What are the topical psoriasis treatments?
Emollients Coal Tar Vitamin D analogue Keratolytics Topical steroid Dithranol
What are the disadvantages of dithranol?
Difficult to use
Stains normal skin
Irritant
