Topical Therapy

Question 1

4 main vehicles for topical therapies

Answer 1

vehicles, creams, ointments, lotions and gels

Question 2

most greasy vehicle

Answer 2

ointments are the most greasy but they are best at delivering drugs to the skin and protecting skin barrier function. they are also the least irritating to skin of all the formulations which means that they won’t burn or sting when applied to broken skin.

Question 3

how does topical vehicles change the potency

Answer 3

lotions and gels are more diluted and therefore changing the vehicle can result in increased potency of the steroid/drug which in turn increases the chance for side effects.

Question 4

steroid side effects

Answer 4

Question 5

skin features of steroid adverse effects

Answer 5

1. decreased in dermal connective tissue
2. thinning
3. loss of elasticity.
4. stretch marks
5. perioral dermatitis exacerbation

Question 6

how much steroids to prescribe

Answer 6

30 grams to cover the whole body

3g for head/face and arm

6g for a leg

9-12g for the trunk

Question 7

How potent a steroid is required? Usually we choose ____ steroids to treat face or body folds, ____for torso, arms and legs and ____ potency for the palms and soles.

Answer 7

How potent a steroid is required? Usually we choose weak steroids to treat face or body folds, mid-potency for torso, arms and legs and high potency for the palms and soles.

Question 8

how to counsel a patient on steroid use

Answer 8

You also need to decide how long the patient will be using the topical agent and when they should stop.
For chronic skin diseases like psoriasis, patient swill be using the product for many months and maybe even years, but they still need to be counseled to use the product as needed and not every day like a moisturizing cream would be used.

For most patients, it is adequate to tell them they can stop using the steroid 48 hours after the itching has stopped, and thy can restart if the itching recurs.

Question 9

Answer 9

perioral dermatitis exacerbated by steroid use

Question 10

Answer 10

striae due to steroids

Question 11

steroid acne vs acne vulgaris

Answer 11

steroid acne has no comedomes and is mono-morphus, whereas AV is more diverse in the sense that there can be pustules, cysts, nodules and comedones

Question 12

Answer 12

Extreme skin atrophy. Thinning and loss of elasticity. Dermal structures easily seen.