Topical Skin Therapeutics

Question 1

Advanatages of topical treatments?

Answer 1

Direct application

Reduced systemic efefects

Question 2

Disadvantages of topical treatments?

Answer 2

Time consuming
Correct dosage can be difficult
Messy to use

Question 3

What are drugs dissolved in when used on the skin?

Answer 3

Bases or vehicles
eg 
Gels
creams
Ointments 
Pastes 
Lotions 
Foams

Question 4

Icythosis?

Answer 4

Lizard skin

Question 5

What do creams contain?

Answer 5

Emulsifier

Preservative

Question 6

Creams are greasy. True or fasle?

Answer 6

False

Non-greasy

Question 7

Ointments are semisolid grease/oil. True or False

Answer 7

True

Question 8

Where do lotions and gel treat?

Answer 8

Hair bearing areas

Question 9

What are pastes often used in?

Answer 9

Cooling
Drying
Soothing Bandages

Question 10

Types of topical therapies?

Answer 10

Emollients 
Topical steroids
Antiinfective agents 
Antipruritecs 
Keratolytics 
Psoriasis therapies 
Cytoxic & antineop,astic aents

Question 11

What do emollients do?

Answer 11

Enhance rehydration of epidermis

Question 12

What are emollients for?

Answer 12

Dry/scaly conditions

Question 13

What emollients need to be?

Answer 13

Effective

Cosmetically acceptable

Question 14

Emollient prescribing tips?

Answer 14

• Apply immediately after bathing
• Apply in direction of hair growth
• Make skin and surfaces slippery
• Use clean spoon or spatula to remove from tub
• Fire risk if parrafin based
• Avoid those containing SLS in leave on products

Question 15

When is wet wrap therapy used?

Answer 15

VERY dry (xerotic) skin

Question 16

Mode of action for topical steroids?

Answer 16

Vasoconstrictive
Anti-inflammatory
Antiproliferative

Question 17

Mild topical steroids?

Answer 17

Hydrocortisone 1%

Question 18

Moderate topical steroid

Answer 18

Modrasone
Clobetasone
Butyrate

Question 19

Potent topical steroids?

Answer 19

Mometasone
Betamethasone
Valerate 0.1%

Question 20

Very potent topical steroids?

Answer 20

Clobetasol

Proprionate 0.05%

Question 21

Use of topical corticosteroids?

Answer 21

• Eczema (dermatitis)
• Psoriasis
• Other non-infective inflammatory dermatoses eg lichen planus
• Keloid scars

Question 22

Side effects of topical steroids?

Answer 22

Thinning of skin 
Purpura 
Stretch marks 
Steroid rosacea 
Perioral dermatitis 
Fixed telangectasia

Question 23

Other side effects of topical steroids?

Answer 23

-May worsen or mask infections
-Systemic absorption (can cause adrenal suppression, cushings syndrome)
Tachyphylaxis: decrease in response to anti-inflammatory effects
Glaucoma and cataract

Question 24

Calicneurin inhibitors?

Answer 24

• Suppress lymphocyte activation
• Topical treatmnet of atopic eczema
• May cause burning sensation on application
• Risk of cutaneous infections/skin cancer

Question 25

Alternative to steroid?

Answer 25

Calicnuerin inhibitors

Question 26

Examples of a calicneurin inhibitors?

Answer 26

Tacrolimus | Pimecrolimus

Question 27

Anti-infectives?

Answer 27

- Antivirals - Antiseptics - Antibiotics - Antifungals

Question 28

What type of effects do antiseptics have?

Answer 28

Bacteriostatic or bacteriocidal effects

Question 29

Examples of antiseptics?

Answer 29

Povidone iodine (betadine) skin cleanser - Chlorhexidine (hibitane, savlon) - Triclosan (aquasept, sterzac) - Hydrogen peroxide (crystacide)

Question 30

Clinical use of antiseptics?

Answer 30

``` Recurrent infections (broad spectrum) Skin cleansing Wound interrogation ```

Question 31

Clinical use of Antibiotics?

Answer 31

Treatmnet of acne/rosacea Skin infections Infected eczematous process

Question 32

Antiviral agents treat?

Answer 32

Herpes simplex- cold sore- topical antiviral Eczema herpeticum- oral antiviral Herpes zoster (shingles)- oral antiviral

Question 33

What do you treat with topical antifungals?

Answer 33

- Candida (thrush) - Dermatophytes (ringworm) - Pityriasis versicolor

Question 34

What you treat candida with?

Answer 34

Anti-yeast | Nystatin, clotrimazole

Question 35

What you treat ringworm with?

Answer 35

Antifungal -Clotrimazole Terbinafine cream

Question 36

What you treat pityriasis versicolor?

Answer 36

Ketoconazole cream or shampoo

Question 37

Examples of antipruritics?

Answer 37

Menthol - cooling sensation Capsaicin - from red chilli peppers Camphor/phenol- for pruritis ani Crotamiton - eurax cream

Question 38

What are keratolytics used for?

Answer 38

To soften keratin Viral warts Hyperkeratotic eczema/psoriasis Corns and calluses

Question 39

Examples of keratolytics?

Answer 39

Salicylic acid ointment

Question 40

Treatment of warts?

Answer 40

``` Keratolytics Formaldehyde Glutaraldehyde Silver nitrate Cryotherapy Podophyllin (for genital warts) ```

Question 41

Topical psoriasis treatments?

Answer 41

Emollients + - Coal tar - Vit D analogue - Keratolytic - Topical steroid - Dithranol

Question 42

Pros and cons of vitamin D analogues for psoriasis?

Answer 42

Clean, no smell Easy to apply Can be irritant Use limited to 100g a week

Question 43

Pros and cons of dithranol for psoriasis

Answer 43

Effective but difficult to use | Irritant and stains normal skin

Question 44

Treatment of scalp psoriasis?

Answer 44

Greasy ointmnet soften scale Tar shampoo Steroids in alcohol base or shampoo Vit D analogues

Question 45

Cytoxic and antineoplastic therapies?

Answer 45

5- Fluorouracil for solar damage, bowens disease and superficial basal cell carcinoma

Question 46

What is imiquimod used to treat?

Answer 46

Solar damage and superficial basal cell carcinoma

Question 47

Side effects of topical therapies?

Answer 47

Burning or irritation Contact allergic dermatitis Local toxicity Systemic toxicity

Question 48

Example of systemic effects

Answer 48

Salicylism- from twice daily (40% salicyclic acid ointment) Hypercalceamia & hypercalcuria with vit D analogues Suppression of pituitary: adrenal axis & cushingoid features with XS topical steroid