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Dermatology > Topical Therapies > Flashcards

Topical Therapies Flashcards

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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
Q

what is the most common cause of secondary seborrhea

A

pyoderma

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26
Q

problem with the epidermal differentiations from the basal layer to the stratum corneum

A

exfoliative dermatitis

27
Q

What can slow down exfoliative dermatitis (epidermal differentiations from the basal layer to the stratum corneum)

A

endocrinopathy (hyperT4, Cushings) and exogenous steroids -> turnover and sebaceous gland atrophy

nutrition can play a role as well

28
Q

What can speed up exfoliative dermatitis

A

inflammation and infection (ie allergy)

29
Q

What causes seborrhea

A

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
Q

epidermal thickening with hypertrophic sebaceous glands

A

lichenification

-Allergy, infection (inflammatory)
-Hypothyroid (infection, accumulation)

31
Q

What causes the epidermal thickening seen with lichenification

A

hypertrophic sebaceous glands

32
Q

How do you differentiate seborrhea from crusts

A

Crusts will be adhered to skin and associated with
-bacterial pyoderma, demodex, or dermatophytosis

33
Q

What are crusts associated with

A

bacterial pyoderma, demodex, or dermatophytosis

34
Q

What causes nutritional seborrhea (oleaosa) in birds

A

Hypovitaminosis A

35
Q

Sebaceouse adentitis causes oleosa or sicca

A

sicca

36
Q

Allergic seborrhea causes seborrhea oleosa or sicca

A

oleosa

37
Q

T/F: seborrhea is a diagnosis

A

False- it is a descriptor

38
Q

What might cause primary seborrhea (although very rare)

A

typically congenital or inherited breed
1) Golden retriever- ichythosis
2) Cockerspaniels- Vitamin A responsive dermamtosis

39
Q

The primary seborrhea seen in cockerspaniels is responsive to

A

Vitamin A

40
Q

What causes feline seborrhea

A

1) Hyperthyroidism
2) Cheyletiella mites (walking dandruff)
3) Decreased grooming (ie orthopedic)

41
Q

For seborrhea oleosa you should ______ while sicca you should ________

A

oleosa: degrease

sicca: moisturize

*moisturizing oleosa or degreasing a sicca can exacerbate signs so choose wisely

42
Q

in seborrheic cases, you should rule out

A

secondary infection

43
Q

When treating seborrhea you should

A

normalize keratinization (keratoplastic)

remove excess keratin (keratolytic)

44
Q

What are keratolytics used to remove excess keratin in treating seborrhea oleosa

A

salicyclic acid
benzoyl peroxide
sulfur
selenium sulfide
coal tar

45
Q

With Seborrhea oleosa do you want to normalize keratin or remove excess keratin?

A

Remove excess keratin (use a keratolytic)

salicyclic acid
benzoyl peroxide
sulfur
selenium sulfide
coal tar

46
Q

In cats with seborrhea oleosa, what should you never use as a keratolytic

A

selenium sulfide or coal tar - will make worse potentially

47
Q

Can you use anti-dandruff human shampoos

A

avoid them - this will make sicca worse, potentially

excess Selnsun blue

48
Q

How do you treat Seborrhea sicca

A

fatty acids (topical or oral)
Phyrosphingosines/ ceramides (Douxo)
-propylene glycol
colloidal oatmeal
Spotons
sometimes leave on sprays can be effective

49
Q

What should you be worried about with Spot On treatment of seborrhea sicca in cats

A

they are groomers and might ingest high amounts concentrated oils

50
Q

What can occur do to potent topical steroid use on the skin

A

calcinosis cutis

51
Q

What are different antipruritic treatments

A

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
Q

Pramoxine

A

topical anesthetic that is antipruritic, short lived-4x daily application

53
Q

Colloidal oatmeal

A

moisturizer, also anti-pruritic

54
Q

Mometasone and Animax are steroidal ointments that are good for

A

focal lesions

55
Q

How should you administer steroid sprays for antipruritic treatment

A

okay to start daily but after a few weeks, 2x weekly

56
Q

How often do normal dogs need to be bathed

A

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
Q

How often do you need to bath allergic dogs (flare)

A

2 to 3x weekly (but may exacerbate pruritus)

58
Q

How often should you bathe infected dogs

A

at least 2x weekly (as often as the owner can be possibly)

59
Q

How should you apply shampoo to a dog

A

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
Q

Can you dry out a dog with bathing

A

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
Q

Why should you use veterinary shampoo products instead of humans

A

canine skin has a pH of 7.0-7.4
while human skin has a pH of 4.5-6.2

62
Q

Can you use expired shampoo

A

No- there can be contamination (post grooming pseudomonas furunculosis)

topical therapy is becoming the preferred treatment forbacterial pyoderma (including MRSP)

63
Q

With cats, what should you beware of with shampoos

A

1) they hate topicals
2) beware toxicity as ingested (polyethylene glycol, e.g

64
Q

What should you do for mane and tail seborrhea seen in horses

A

Duoxo Seborrhea spray but you are still under obligation to look for an infection

Dermatology (10 decks)

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