Topical/Steroid therapy Flashcards by E *

Purpose of topical therapy

Restore NL skin fx after insult removes water, lipids, proteins from epidermis

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Dry skin/lesion dz is generally due to?

Lost lipids/proteins > cant retain water

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Dry skin/lesion dz is corrected by?

Replacing moisture w/ emollient creams and lotions.

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Xerosis is?

Severe dry skin called the winter itch

MC on hands/lower legs

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Xerosis S/S

Rough skin, w/ fine white scales (thicker tan progression). Itches severely. Might burn
Severe- crisscrossed/fissures

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Xerosis TXT

Emollients - 2% lactate lotion

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Exudative inflammatory dz pathophys

Serum pours out which leaches lipids/proteins from epidermis

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Exudative inflammatory dz management

Wet compress
-suppress inflam
-Debrides crust/serum
-RPT wet/dry cycles
When wet phase contolled > emollient creams and lotions. (Dont over dry)

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Purpose of emollient creams/lotions

Restore water/lipids/proteins to epidermis

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Urea and lactic acid added to emollient C/L cause?

Special lubricanting properties

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Creams vs Lotion which is thicker and more lubricating?

Creams

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Emollient C/L are most effective when

Applied on damp skin as freq as prn

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Purpose of menthol/phenol added to emollient C/L?

Reduce pruritis

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One use for Wet dressings are for?

Exudative skin dz

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Wet dressing benefits?

-Inflame supression
Evaporative cooling
Superficial v-con =
Decrease erythema/leaking serum
-Wound debridement
-Drying effects
-antibacterial

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What is added to a wet dressing for antibacterial effects?

Aluminum acetate
Acetic acid
Silver nitrate

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Wet dressing technique

4-8 layers - clean/soft (folded)
Wet in solution/wring out
Place 30-60m 2-4x/D
D/C when skin is dry

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CCS(po/top) vs Wet dressing which controls acute inflammatory faster?

Wet dressings

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CCS appropriate use keys

1 - accurate dx
Right 
-strength
-vehicle
-quanity
-txt duration
F/U

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Topical steroids actions

Anti-inflam
V-con
Anti-mitotic (slow cell proliferation)

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Top steroid potency strength classes

Strongest - group I

Weakest - group VII

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Best result of top steroid use depends on?

Right strength/duration

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Top steroids w/ no response in how long require reeval?

1-4wk

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Is concentration and potency the same?

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Top steroids req a vehicle which is AKA

base

Vehicles are essentially?

The substance which active ingredient is dispersed which determines absorption rate

Vehicle examples (SF-COG)

``` S- solutions/lotions F- Foams C- Creams O- Ointments G- Gels ```

Vehicles - Creams attributes

``` Mix organic chemicals/oils/water/preserves -white, slightly greasy -use anywhere almost -long use > dries skin Best for exudative inflam dz Most useful intertriginous area ```

Vehicles - Ointments attributes

Limited # of compounds -translucent, greasy, little/no water -preservative free Most- lipophilic, moisturizing, occlusive -too occlusive for acute eczematous inflam or intertriginous areas Greater penetration > increases potency

Vehicles - Gels attributes

``` Mix of propylene/water +- Etoh Clear and jelly like Not greasy Good for acute exudative inflam (poison ivy) Great for scalp (no matting) ```

Vehicles - Solutions/lotions attributes

``` Mix of water, Etoh, chems Clear or milky color Least lipophilic Can be very drying Most useful for scalp Stinging/drying in intertiginous areas ```

Vehicles - Foams attributes

Useful for scalp dermatoses | Useful in AEI areas (poison ivy/plaque psoriasis)

Lotions predominant ingredient?

Water

Lotions predominant ingredient?

Water

High potency foam preperations

Clobetasol propionate (olux)

Precautions of foam clobetasol propionate

Do not use >2 wks HPA suppression CI <12yo

Clobetasol propionate (Clobex)

CCS Group I

Fluocinonide (Lidex)

CCS Group II

Betamethasone dipropionate

CCS Group III

Mometasone

CCS Group IV

Triamcinolone acetonide

CCS Group V

Desonide

CCS Group VI

Hydrocortisone

CCS Group VII

Increased barrier also means? Ex?

Decreases absorption Thick scales Lichenification Thicker Skin (Soles/Palms)

Decreased barrier also means? Ex?

``` Increased Absorption Abrasion Cracking FIssuring Atrophy Keraolytic agents Propylene Glycol ```

What chemical can increase potency?

Propylene glycol

Purpose of occlusion?

Enhanced absorption

Natural Occlusions?

Axilla Inguinal folds extra skin folds (fat) Diaper area

How much enhanced potency can an occlusion give a steroid?

x100

Too much Hydrocortisone under a diaper can do what?

Adrenal suppresion

Hydration affects CCS absorption how?

Intracellular connections stretch Allows 4-5x absorption After bath/or moist wraps w/ occlusion

Thin Stratum corneum affects CCS absorption how?

Increased absorption due to increased blood flow - Face/eyelids

Thick Stratum corneum affects CCS absorption how?

Decreased absorption - Soles/Palms

Some local SE of CCS

Steroid acne/folliculitis (Papular/pustules) Rosacea Hypertrichosis Telangiectasia (atrophy)

Contact allergy to CCS due to

Preservative Coloring Steroid Rx (Chronic dermatitis; fails CCS TXT)

Contact allergy to CCS may present as?

Chronic dermatitis Eczematous condition Exanthem, purpura, urticaria

Contact allergy TXT reflex action?

Skin test (patch testing)

Some local SE of CCS?

Adrenal axis supressed (<2yo or active puberty) Cushings syndrome FTT or stunted growth Cataracts/glaucoma

Cushing syndrome occurs in response to?

High potency CCS use or w/ occlusion | Mid potency in large areas

Other delivery methods of CCS?

Intralesional - inj lesion only (PRN dilute) | (IM) - long, easy, less supression, Cant stop after given.

Typical Rx used for intralesional CCS?

Triamcinolone

What is a common SE of IM CCS? Why?

Local atrophy - using too short of a needle

DM consideration w/ CCS?

Topicals elevate blood GLU

Pregnancy consideration w/ CCS?

CI in 1st trimester (RVB)

5 MC mistakes using CCS?

1. Steroid too weak for Dz/Area 2. Not enough Rx given (tube size) 3. Failed to F/U TXT (Dx confirmed, refills) 4. Too strong on kids 5. Too strong on face

The number 1 MC CCS Rx mistake?

Steroid is too weak for Dz/Area

FTU (finger tip unit) is?

1 FTU (DIP joint) = 5mm nozzle > 0.5gm

One hand area equals?

0.25gm of ointment or 0.5 FTU

Group I CCS dosing pearls?

45-60gm/wk | QD-BID pulse therapy (2wk on - 1wk off)

Group II-VI CCS dosing pearls?

BID 2-6wks

Group I CCS Rx

Clobetasol propionate | Augmented betamethasone dipropionate

Group II CCS Rx

Betamethasone dipropionate Fluocinonide Desoximetasone

Group VI CCS Rx

Alclometasone Dipropionate | Desonide

Water - wet dressing indications?

Poison Ivy Sunburn Non-Infected exudative processes

Burow's sol - wet dressing indications?

mild antiseptic - for acute inflam poison ivy insect bite athletes foot

Silver nitrate - wet dressing indications?

Bactericidal For infected exudative processes (stasis, ulcers, dermatitis)

Acetic acid - wet dressing indications?

Dilute w/ vinegar | Bactericidal - G= organisms (pseudomonas)