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Derm1 > Topical/Steroid therapy > Flashcards

Topical/Steroid therapy Flashcards

1
Q

Purpose of topical therapy

A

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

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2
Q

Dry skin/lesion dz is generally due to?

A

Lost lipids/proteins > cant retain water

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3
Q

Dry skin/lesion dz is corrected by?

A

Replacing moisture w/ emollient creams and lotions.

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4
Q

Xerosis is?

A

Severe dry skin called the winter itch

MC on hands/lower legs

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5
Q

Xerosis S/S

A

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

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6
Q

Xerosis TXT

A

Emollients - 2% lactate lotion

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7
Q

Exudative inflammatory dz pathophys

A

Serum pours out which leaches lipids/proteins from epidermis

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8
Q

Exudative inflammatory dz management

A 
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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9
Q

Purpose of emollient creams/lotions

A

Restore water/lipids/proteins to epidermis

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10
Q

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

A

Special lubricanting properties

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11
Q

Creams vs Lotion which is thicker and more lubricating?

A

Creams

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12
Q

Emollient C/L are most effective when

A

Applied on damp skin as freq as prn

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13
Q

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

A

Reduce pruritis

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14
Q

One use for Wet dressings are for?

A

Exudative skin dz

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15
Q

Wet dressing benefits?

A 
-Inflame supression
Evaporative cooling
Superficial v-con =
Decrease erythema/leaking serum
-Wound debridement
-Drying effects
-antibacterial
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16
Q

What is added to a wet dressing for antibacterial effects?

A

Aluminum acetate
Acetic acid
Silver nitrate

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17
Q

Wet dressing technique

A

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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18
Q

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

A

Wet dressings

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19
Q

CCS appropriate use keys

A 
1 - accurate dx
Right 
-strength
-vehicle
-quanity
-txt duration
F/U
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20
Q

Topical steroids actions

A

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

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21
Q

Top steroid potency strength classes

A

Strongest - group I

Weakest - group VII

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22
Q

Best result of top steroid use depends on?

A

Right strength/duration

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23
Q

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

A

1-4wk

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24
Q

Is concentration and potency the same?

A

No

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25
Q

Top steroids req a vehicle which is AKA

A

base

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26
Q

Vehicles are essentially?

A

The substance which active ingredient is dispersed which determines absorption rate

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27
Q

Vehicle examples (SF-COG)

A 
S- solutions/lotions
F- Foams
C- Creams
O- Ointments
G- Gels
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28
Q

Vehicles - Creams attributes

A 
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
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29
Q

Vehicles - Ointments attributes

A

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

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30
Q

Vehicles - Gels attributes

A 
Mix of propylene/water +- Etoh
Clear and jelly like
Not greasy
Good for acute exudative inflam (poison ivy)
Great for scalp (no matting)
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31
Q

Vehicles - Solutions/lotions attributes

A 
Mix of water, Etoh, chems
Clear or milky color
Least lipophilic
Can be very drying
Most useful for scalp
Stinging/drying in intertiginous areas
32
Q

Vehicles - Foams attributes

A

Useful for scalp dermatoses

Useful in AEI areas (poison ivy/plaque psoriasis)

33
Q

Lotions predominant ingredient?

A

Water

34
Q

Lotions predominant ingredient?

A

Water

35
Q

High potency foam preperations

A

Clobetasol propionate (olux)

36
Q

Precautions of foam clobetasol propionate

A

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

37
Q

Clobetasol propionate (Clobex)

A

CCS Group I

38
Q

Fluocinonide (Lidex)

A

CCS Group II

39
Q

Betamethasone dipropionate

A

CCS Group III

40
Q

Mometasone

A

CCS Group IV

41
Q

Triamcinolone acetonide

A

CCS Group V

42
Q

Desonide

A

CCS Group VI

43
Q

Hydrocortisone

A

CCS Group VII

44
Q

Increased barrier also means? Ex?

A

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

45
Q

Decreased barrier also means? Ex?

A 
Increased Absorption
Abrasion
Cracking
FIssuring
Atrophy
Keraolytic agents
Propylene Glycol
46
Q

What chemical can increase potency?

A

Propylene glycol

47
Q

Purpose of occlusion?

A

Enhanced absorption

48
Q

Natural Occlusions?

A

Axilla
Inguinal folds
extra skin folds (fat)
Diaper area

49
Q

How much enhanced potency can an occlusion give a steroid?

A

x100

50
Q

Too much Hydrocortisone under a diaper can do what?

A

Adrenal suppresion

51
Q

Hydration affects CCS absorption how?

A

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

52
Q

Thin Stratum corneum affects CCS absorption how?

A

Increased absorption due to increased blood flow - Face/eyelids

53
Q

Thick Stratum corneum affects CCS absorption how?

A

Decreased absorption - Soles/Palms

54
Q

Some local SE of CCS

A

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

55
Q

Contact allergy to CCS due to

A

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

56
Q

Contact allergy to CCS may present as?

A

Chronic dermatitis
Eczematous condition
Exanthem, purpura, urticaria

57
Q

Contact allergy TXT reflex action?

A

Skin test (patch testing)

58
Q

Some local SE of CCS?

A

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

59
Q

Cushing syndrome occurs in response to?

A

High potency CCS use or w/ occlusion

Mid potency in large areas

60
Q

Other delivery methods of CCS?

A

Intralesional - inj lesion only (PRN dilute)

(IM) - long, easy, less supression, Cant stop after given.

61
Q

Typical Rx used for intralesional CCS?

A

Triamcinolone

62
Q

What is a common SE of IM CCS? Why?

A

Local atrophy - using too short of a needle

63
Q

DM consideration w/ CCS?

A

Topicals elevate blood GLU

64
Q

Pregnancy consideration w/ CCS?

A

CI in 1st trimester (RVB)

65
Q

5 MC mistakes using CCS?

A
  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
66
Q

The number 1 MC CCS Rx mistake?

A

Steroid is too weak for Dz/Area

67
Q

FTU (finger tip unit) is?

A

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

68
Q

One hand area equals?

A

0.25gm of ointment or 0.5 FTU

69
Q

Group I CCS dosing pearls?

A

45-60gm/wk

QD-BID pulse therapy (2wk on - 1wk off)

70
Q

Group II-VI CCS dosing pearls?

A

BID 2-6wks

71
Q

Group I CCS Rx

A

Clobetasol propionate

Augmented betamethasone dipropionate

72
Q

Group II CCS Rx

A

Betamethasone dipropionate
Fluocinonide
Desoximetasone

73
Q

Group VI CCS Rx

A

Alclometasone Dipropionate

Desonide

74
Q

Water - wet dressing indications?

A

Poison Ivy
Sunburn
Non-Infected exudative processes

75
Q

Burow’s sol - wet dressing indications?

A

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

76
Q

Silver nitrate - wet dressing indications?

A

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

77
Q

Acetic acid - wet dressing indications?

A

Dilute w/ vinegar

Bactericidal - G= organisms (pseudomonas)

Derm1 (7 decks)

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