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Topical Therapies Flashcards

1
Q

Why are topical therapies important

A

multimodal management of dermatology patients

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2
Q

what are different categories of topical therapies

A

-Shampoos
-Conditioners
-Mousses
-Sprays
-Wipes
-Ointments
-Balm

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3
Q

Should you bath cats

A

no- but unless the cat is already acclimated to bathing from a young age

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4
Q

When considering topical therapies, it needs to be

A

1) Achievable
2) Sustainable
3) Adherence to the treatment plan

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5
Q

dermatitis is often a combination of

A

inflammatory and infectious disease

successful management of the conditions of veterinary skin conditions requires treatment of both the underlying cause and secondary skin changes/infection

unlike many most other body systems, we have the opportunity for topical rather than systemic therapies

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6
Q

What cells are within the Stratum corneum of the epidermis

A

corneocytes- keep foreign material out
and hold moisture within

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7
Q

What are the cells within the living epidermis

A

-Granular cells
-Spinous Cells
-Basal Cells

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8
Q

What is the normal turnover of the living epidermis

A

three weeks

but can be abnormal- faster or slower

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9
Q

What is the importance of topical therapy

A

-Avoiding systemic therapies may be desirable
-Treatment of infection
-Treatment of seborrhea
-Treatment of pruritus
-Strengthen the skin carrier

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10
Q

What are the 4 layers of the epidermis

A

1) Stratum corneum
2) Stratum granulosum
3) Stratum spinosum
4) Stratum basale

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11
Q

What ingredients in topical are important when treating an infection

A

-Chlorhexidine gluconate 2-4%
-Benzoyl peroxide <5%
-Acids (acetic, salicyclic, boric)
-Hypochlorous acid
-Ethyl lactate
-Iodine/betadine
-Mupirocin 2% ointment
-SSD Cream

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12
Q

How long does Chlorhexidine gluconate 2-4% last

A

up to 48 hours with proper application

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13
Q

Benzoyl peroxide <5% is both

A

antibiotic and anti-seborrhitic

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14
Q

How does hypochlorous acid differ from chlorhexidine for treating an infection

A

hypochlorous is not cytotoxic why chlorhexidine is

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15
Q

What is true of the acids (acetic, salicyclic, and boric) for treating an infection

A

good for maintenance but not good at killing bacteria

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16
Q

Why is iodine/betadine not commonly used when treating an infection

A

because they have a short residual time- only about 4-6 hours

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17
Q

What is Mupirocin 2% ointment used for

A

good for gram +s, specifically methicillin resistant staph

dont use on rods because rods are more likely to be gram - and this has no activity against gram -

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18
Q

SSD cream is primarily good against

A

gram - bacteria

ex: urine scald / e coli

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19
Q

How does Mupirocin 2% ointment differ from SSD cream in treating infections

A

Mupirocin: gram + bacteria

SSD: gram - bacteria

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20
Q

excessive discharge of sebum from the glands

exfoliative or glandular abnormalities of the epidermis

A

seborrhea

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21
Q

excessive discharge of sebum from the glands that is greasy, exudative, oily

A

seborrhea oleosa

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22
Q

excessive discharge of sebum from the glands that is scaly and dry

A

seborrhea sicca

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23
Q

seborrhea tells you there is

A

exfoliative or glandular abnormalities of the epidermis

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24
Q

Why is it important to distinguish the type types of seborrhea - oleosa and sicca

A

Oleosa and sicca have divergent treatments so there isnt just one solution - need to diagnose the cause

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25
what is the most common cause of secondary seborrhea
pyoderma
26
problem with the epidermal differentiations from the basal layer to the stratum corneum
exfoliative dermatitis
27
What can slow down exfoliative dermatitis (epidermal differentiations from the basal layer to the stratum corneum)
endocrinopathy (hyperT4, Cushings) and exogenous steroids -> turnover and sebaceous gland atrophy nutrition can play a role as well
28
What can speed up exfoliative dermatitis
inflammation and infection (ie allergy)
29
What causes seborrhea
increased or decreased production of sebum or fatty acids 1) Decrased production/atrophy -sebaceous adenitis (immune) -hyperadrenocorticism (endocrine) -Dietary (fatty acid deficiency) 2) Increased production/hypertrophy -Allergy, infection (inflammatory) -Hypothyroid (infection, accumulation)
30
epidermal thickening with hypertrophic sebaceous glands
lichenification -Allergy, infection (inflammatory) -Hypothyroid (infection, accumulation)
31
What causes the epidermal thickening seen with lichenification
hypertrophic sebaceous glands
32
How do you differentiate seborrhea from crusts
Crusts will be adhered to skin and associated with -bacterial pyoderma, demodex, or dermatophytosis
33
What are crusts associated with
bacterial pyoderma, demodex, or dermatophytosis
34
What causes nutritional seborrhea (oleaosa) in birds
Hypovitaminosis A
35
Sebaceouse adentitis causes oleosa or sicca
sicca
36
Allergic seborrhea causes seborrhea oleosa or sicca
oleosa
37
T/F: seborrhea is a diagnosis
False- it is a descriptor
38
What might cause primary seborrhea (although very rare)
typically congenital or inherited breed 1) Golden retriever- ichythosis 2) Cockerspaniels- Vitamin A responsive dermamtosis
39
The primary seborrhea seen in cockerspaniels is responsive to
Vitamin A
40
What causes feline seborrhea
1) Hyperthyroidism 2) Cheyletiella mites (walking dandruff) 3) Decreased grooming (ie orthopedic)
41
For seborrhea oleosa you should ______ while sicca you should ________
oleosa: degrease sicca: moisturize *moisturizing oleosa or degreasing a sicca can exacerbate signs so choose wisely
42
in seborrheic cases, you should rule out
secondary infection
43
When treating seborrhea you should
normalize keratinization (keratoplastic) remove excess keratin (keratolytic)
44
What are keratolytics used to remove excess keratin in treating seborrhea oleosa
salicyclic acid benzoyl peroxide sulfur selenium sulfide coal tar
45
With Seborrhea oleosa do you want to normalize keratin or remove excess keratin?
Remove excess keratin (use a keratolytic) salicyclic acid benzoyl peroxide sulfur selenium sulfide coal tar
46
In cats with seborrhea oleosa, what should you never use as a keratolytic
selenium sulfide or coal tar - will make worse potentially
47
Can you use anti-dandruff human shampoos
avoid them - this will make sicca worse, potentially excess Selnsun blue
48
How do you treat Seborrhea sicca
fatty acids (topical or oral) Phyrosphingosines/ ceramides (Douxo) -propylene glycol colloidal oatmeal Spotons sometimes leave on sprays can be effective
49
What should you be worried about with Spot On treatment of seborrhea sicca in cats
they are groomers and might ingest high amounts concentrated oils
50
What can occur do to potent topical steroid use on the skin
calcinosis cutis
51
What are different antipruritic treatments
1) Douxo 2) Pramoxine - topical anesthetic, short lived-4x daily application 3) Colloidal oatmeal- moisturizer, also anti-pruritic 4) Hydrocortisone- very mild steroid, reason it is over the counter, less worried about use 5) Steroid sprays or ointments (strong stuff) -Genesis (triamcinolone) -Betamethasone/ gentamcin spray (GenOne) -Ointments: mometasone, Animax (good for focal lesions) *potent and can cause cutaneous steroid reactions *okay to start daily but after a few weeks, 2x daily
52
Pramoxine
topical anesthetic that is antipruritic, short lived-4x daily application
53
Colloidal oatmeal
moisturizer, also anti-pruritic
54
Mometasone and Animax are steroidal ointments that are good for
focal lesions
55
How should you administer steroid sprays for antipruritic treatment
okay to start daily but after a few weeks, 2x weekly
56
How often do normal dogs need to be bathed
as needed- monthly? yearly? controlled allergic dogs: as needed or weekly allergic dogs (flare)- 2 to 3x weekly (may exacerbate pruritus) infected dogs: at least 2x weekly (as often as possible) primary seborrheic (rare): as needed, typically 2-3x/week
57
How often do you need to bath allergic dogs (flare)
2 to 3x weekly (but may exacerbate pruritus)
58
How often should you bathe infected dogs
at least 2x weekly (as often as the owner can be possibly)
59
How should you apply shampoo to a dog
10 minutes of contact time use tepid water (if they have allergies, their skin is already warm) duration of therapy: forever (or 2-4 weeks)
60
Can you dry out a dog with bathing
Yes- with keratlytic (oleosa) shampoos typically not with other types shampoo dryness is often way overemphasized it is often the disease that is causing the scale
61
Why should you use veterinary shampoo products instead of humans
canine skin has a pH of 7.0-7.4 while human skin has a pH of 4.5-6.2
62
Can you use expired shampoo
No- there can be contamination (post grooming pseudomonas furunculosis) topical therapy is becoming the preferred treatment forbacterial pyoderma (including MRSP)
63
With cats, what should you beware of with shampoos
1) they hate topicals 2) beware toxicity as ingested (polyethylene glycol, e.g
64
What should you do for mane and tail seborrhea seen in horses
Duoxo Seborrhea spray but you are still under obligation to look for an infection

Dermatology (10 decks)

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