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MBBS 4 Dermatology > Topical Treatment > Flashcards

Topical Treatment Flashcards

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Dermatology Board Prep flashcards
1
Q

What makes up topical treatment?

A
  1. base or vehicle
    with/without
  2. active ingredients
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2
Q

Describe the base/vehicle of topical treatment?

A

Transport of the active constituent into the skin
- The base is determined by the
hydration of the skin

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3
Q

What is the active ingredient in topical treatment?

A

The active constituent is determined by the pathological process

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4
Q

Vehicle/base is made of a combination of?

A
  1. oils and greases
    - liquid paraffin, petrolatum , lanolin, vegetable oils
  2. liquids
    - water, alcohol
  3. powders
    - zinc oxide, starch, talcum
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5
Q

Name the types of bases?

A
  1. OINTMENT ( < 20% WATER)
  2. CREAM (W/O AND O/W)
  3. LOTION: O/W OR POWDER/W
  4. SOLUTION (IN WATER, ALCOHOL)
  5. GEL
  6. PASTE: OIL, WATER, POWDER
  7. FOAM
  8. SOLID
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6
Q

Which bases contain a mixture of grease/oil and water?

A
  1. OINTMENT: 80-100%
  2. CREAM
  3. LOTION
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7
Q

What is needed to mix fat and water?

A

emulsifier

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8
Q

What is an emulsifier?

A

Have a polar group with affinity for water (dissolves in water) and a
non-polar group with affinity for oil (dissolves in oil)
1. emulsion oil/water
e.g. aqueous cream: washed off with water
2. emulsion water/oil
e.g. oily cream cannot be washed of with water

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9
Q

What is an ointment?

A

GREASE OR OIL: WATER-FREE OR NEARLY WATER-FREE (<20%)
1. WATER FREE: NON-EMULSIFYING
2. WITH SOME WATER: EMULSIFYING OINTMENT

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10
Q

Ointment is made of?

A
  1. HYDROCARBON (PARAFFIN)
  2. WOOL FAT,
  3. VEGETABLE OIL (OLIVE OIL, ARACHID OIL, COCONUT OIL)
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11
Q

What happens if you mix ointment with water?

A

EMULSIFIERS
1. LANETTE WAX
2. CETOMACROGOL WAX
3. BEEWAX
3. CETOSTEARYL ALCOHOL AND SODIUM LAURYL
4. SULPHATE
5. GLYCERYL-STEARATE

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12
Q

Example of components in an ointment?

A
  1. PETROLATUM (SOFT PARAFFINE, VASELINE)
    * YELLOW - MAY CAUSE SENSITIZATION REACTIONS
    * WHITE - MAY CAUSE IRRITATION DUE TO TRACES OF BLEACH
    NB. PURIFICATION PROCESS IS EXTENDED FURTHER IN WHITE PETROLATUM
  2. LIQUID PARAFFIN
  3. EMULSIFIER
    * OIL IN WATER / WATER IN OIL
    * LANETTE WAX TO HELP MIX
    * CETOMACROGOL WAX TO HELP MIX
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13
Q

Uses of ointment?

A

FORMS AN IMPERMEABLE LAYER OVER THE SKIN TO PREVENT WATER EVAPORATION AND HEAT LOSS.
1. REDUCE TRANSEPIDERMAL WATER LOSS
2. INCREASE BARRIER FUNCTION
3. SOFTEN DRY SKIN
4. EASE ITCHING
5. REDUCE SCALING
6 ALLOW ACTIVE INGREDIENTS INTO THE SKIN

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14
Q

Medical uses of ointment?

A
  1. DRY SKIN, ECZEMA
  2. PREVENTION FROM FROST-BITE
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15
Q

Advantages of ointments?

A
  1. No need for preservative, so contact
    allergy is rare
  2. Emulsifying ointments are a good
    vehicle for active ingredient
  3. Easy to make, and cheap
  4. longevity
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16
Q

Disadvantage of ointments?

A
  1. Sticky
  2. Occlusive => pommade acne
  3. Difficult to apply, especially on hairy
    skin
  4. Difficult to wash of with water
  5. Bacteria, yeasts and fungi may be
    trapped and will thrive and overgrow
  6. Non-emulsifying ointments: do not
    penetrate the skin, drugs used in
    these ointments will only have
    superficial activity
  7. Increase sunburn by acting like a
    magnifier
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17
Q

What are creams?

A

CREAMS CONSIST OF LIPOPHILIC AND A HYDROPHILIC PHASE COMBINED WITH ONE OR MORE EMULSIFIERS AND PRESERVATIVES

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18
Q

Describe the features of creams and their different types?

A

WATER CONTENT ALLOWS THE CREAM TO RUB IN WELL
1. HYDROPHILIC CREAMS OUTER PHASE IS AQUEOUS
▪ OIL IN WATER&raquo_space; WASHABLE, COSMETICALLY ACCEPTABLE
2. LIPOPHILIC CREAMS THE OUTER PHASE IS FATTY
▪ WATER IN OIL&raquo_space; BETTER DRUG ABSORPTION

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19
Q

Describe oil in water creams?

A

e.g. AQUEOUS CREAM
1. VANISHING CREAM, RUBS INTO THE SKIN EASILY AND MIXES READILY WITH WATER
- SO SUITABLE FOR ECZEMA THAT IS A BIT OOZING, IMPETIGO
2. WHEN WATER EVAPORATES A THIN LAYER OF OIL REMAINS, MAY EVEN BE TOO DRYING.
- SUITABLE FOR PEOPLE WITH NORMAL SKIN OR A BIT FATTY SKIN.
3. CAN ALSO ADD OTHER INGREDIENTS EG. CALAMINE (ZNO) / ZINC

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20
Q

Describe water in oil creams?

A
  1. LIKE AN OINTMENT: OILY BUT WATER CONTENT MAKES IT EASIER TO SPREAD AND ENHANCES ABSORPTION OF ACTIVE INGREDIENTS
  2. DOES NOT MIX WITH EXSUDATES FROM THE SKIN
    => LESS SUITABLE FOR WET DERMATITIS
  3. CAN BE USED AS A VEHICLE FOR LIPID SOLUBLE SUBSTANCES
    - MANY DRUGS INCORPORATED INTO CREAMS ARE HYDROPHOBIC AND WILL BE RELEASED MORE READILY FROM A W/O CREAM
    EG. ZINC OXIDE IS LIPOPHILIC
  4. WATER-IN-OIL CREAMS ARE LESS SUITABLE FOR TROPICAL CONDITIONS SINCE PHYSICALLY LESS STABLE AND PRONE TO MICROBIAL CONTAMINATION
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21
Q

Components of a basic cream?

A
  1. 15 % LANETTE WAX SX = EMULSIFIER
  2. 12,5% LIQUID PARAFFIN = oil phase
  3. 22,5% PETROLATUM = oil phase
  4. 0,15% METHYLPARABEN = PRESERVATIVE
  5. 50 % WATER = water phase
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22
Q

Describe the water phase?

A
  1. WATER IS GENERALLY USED AS HYDROPHILIC PHASE IN CREAMS
  2. WATER IS VULNERABLE, SINCE IT CAN EASILY EVAPORATE
    => HUMECTANTS SUCH AS GLYCEROL OR SORBITOL ARE ADDED TO PREVENT WATER EVAPORATION
  3. EVAPORATION OCCURS IN STORED CREAMS (STABILITY PROBLEM) AND
    AFTER APPLICATION
  4. NEEDS PRESERVATIVE
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23
Q

Advantages of creams?

A
  1. Easy to apply
  2. Cosmetic friendly
  3. Less/non-occlusive
  4. A good base for many active
    ingredients
24
Q

Disadvantages of creams?

A
  1. Has to contain preservatives
  2. Has to contain emulsifiers
  3. Can make skin dry
  4. Cost more
  5. Stability problems
25
Q

What are lotions?

A
  • LOW-VISCOSITY TOPICAL PREPARATIONS
  • TWO DIFFERENT TYPES
    1. shake lotions
    2. diluted creams = emulsion
26
Q

Describe shake lotions?

A
  • POWDER IN A WATER PHASE
  • ANTIPRURITIC, DRYING
  • SHAKE LOTIONS” HAVE A COOLING (ANTI-ITCH) EFFECT BECAUSE AFTER
    THE EVAPORATION OF THE LIQUID THE INERT POWDER IS LEFT ON THE
    SKIN
    e.g. CALAMINE LOTION
27
Q

Describe diluted cream lotions?

A
  • WATER ADDED TO A CREAM.
  • IDEAL FOR HAIRY SKIN, SCALP AND FLEXURAL AREA’S
28
Q

What are solutions?

A
  • LIQUID FORM: WATER OR ALCOHOL.
  • DRYING EFFECT
    EG. GENTIAN VIOLET, POTASSIUM PERMANGANATE SOLUTION
29
Q

What are pastes?

A

COMBINES 3 AGENTS: OIL, WATER, POWDER (UP TO 50%)

30
Q

Describe astes?

A
  • POWDER CONTENT ALLOWS ABSORPTION OF EXUDATE
  • VERY ADHESIVE : STAY WHERE YOU PUT THEM AND DO NOT SPREAD AS THE SKIN WARMS UP
  • PREVENTS SPREAD OF ACTIVE INGREDIENTS TO SURROUNDING SKIN
  • CAN BE USED AS VEHICLES
  • COAL TAR PASTE = ZINC COMPOUND PASTE WITH 7.5% COAL TAR
  • LASSARS PASTE = VEHICLE FOR DITHRANOL
31
Q

What are gels?

A
  • WATER PHASE WITH GELFORMER
  • USED FOR COOLING, DRYING
  • LIQUEFIES UPON CONTACT WITH SKIN
  • NEEDS PRESERVATIVES
32
Q

What do you need to think about when selecting a base?

A
  1. NATURE OF SKIN CONDITION
  2. AREA OF THE BODY
33
Q

Select a base in the accordance of the nature of the skin condition?

A
  1. FOR WET OR OOZY SKIN CONDITIONS
    — O/W CREAMS, LOTIONS, AND DRYING PASTES ARE MOST SUITABLE.
  2. FOR DRY, SCALY SKIN CONDITIONS
    — OINTMENTS AND OILS ARE APPROPRIATE.
  3. FOR INFLAMED SKIN
    — USE WET COMPRESSES FOLLOWED BY CREAMS OR OINTMENTS.
  4. NORMAL SKIN: CREAM
34
Q

Select a base in accordance to site of skin infection?

A
  1. PALMS AND SOLES
    — AN OINTMENT OR CREAM MAY BE PREFERRED.
  2. SKIN FOLDS
    — USE A CREAM OR A LOTION (OINTMENTS ARE TOO OCCLUSIVE FOR THESE SITES)
  3. HAIRY AREAS
    — A LOTION, SOLUTION, GEL OR FOAM IS USUALLY BEST.
  4. MOUTH:
    — ORABASE (COMBINATION OF OINTMENT AND GELATINE), GEL, LIQUID: MOUTHWASH
35
Q

How much do I prescribe for treating one area at time?

A
  1. For the whole body: 20-30 g
  2. For the trunk: 3 + 3 g
  3. For face and neck: 1 g
  4. For a leg: 3 g
  5. For a foot: 1 g
  6. For an arm: 1 ½ g
  7. For a hand: ½
36
Q

What is a fingertip unit?

A

one FTU is 0,5 gram

37
Q

What is the main diffusion barrier of the skin?

A

stratum corneum

38
Q

3 main routes for skin entry?

A
  1. INTERCELLULAR ROUTE
  2. INTRACELLULAR
  3. TRANSAPPENDAGEAL ROUTE
    - MAJORITY OF TOPICALLY APPLIED MOLECULES ARE LIPOPHILIC AND WILL PERMEATE THE SKIN VIA THIS ROUTE
39
Q

What is absorption?

A

means it gets all the way to the c=bottom layer of the skin and then sucked into the bloodstream

40
Q

What is penetration?

A

means it gets all the way to the bottom layer of your skin and then stop

41
Q

Skin entry is dependent on?

A
  1. physical/chemical properties of active ingredient
  2. concentration
  3. the vehicle
  4. variations in skin: thick, folds, temperature, moist, skin diseases
42
Q

How skin entry is dependent on physical/chemical properties of active ingredient?

A

PENETRATION ENHANCED WHEN LOW MOLECULUR WEIGHT, LIPID SOLUBLE, AND NONPOLAR

43
Q

How skin entry is dependent on concentration?

A

DOSE-RESPONSE CURVE: HIGHER CONCENTRATION, GREATER QUANTITY OF MEDICATION ABSORBED

44
Q

How skin entry is dependent on the vehicle?

A
  1. THE MORE OCCLUSIVE THE VEHICLE > HYDRATION STR CORNEUM AND PENETRATION OF MEDICATION
  2. WATER IN OIL PROMOTES HYDRATION AND THEREFORE ABSORBTION
45
Q

How skin entry is dependent on variations in skin?

A
  1. HIGH: SCROTUM, AXILLA’S, FACE + EAR (STR CORNEUM = THIN)
  2. LOW: PALMS AND SOLES
46
Q

Cautions with topical medications?

A
  1. SYSTEMIC ABSORPTION
  2. PREGNANCY
  3. CHILDREN, ESPECIALLY NEONATES
  4. INFLAMMATORY CONDITIONS
    - EROSIVE, WARM, MOIST, HIGHLY VASCULARIZED SKIN INCREASES ABSORPTION
47
Q

Why are neonates at higher risk of systemic toxicity from topical medication?

A
  1. INCREASED RATIO OF SURFACE AREA TO BODY WEIGHT (FOURFOLD GREATER THAN IN ADULTS)
  2. SUBOPTIMAL EPIDERMAL BARRIER FUNCTION DUE TO THE HIGHER PH OF NEONATAL STRATUM CORNEUM (NEUTRAL INSTEAD OF ACIDIC)
  3. DECREASED HEPATIC METABOLISM OF DRUGS
  4. DECREASED RENAL EXCRETION OF DRUGS
  5. INCREASED DISTRIBUTION OF DRUG, INCLUDING THE CNS DUE TO A MORE PERMEABLE BLOOD–BRAIN BARRIER
  6. DECREASED PLASMA PROTEIN BINDING
48
Q

Group of active ingredients?

A
  1. CORTICOSTEROIDS
  2. ANTISEPTICS
  3. ANTIBIOTICS
  4. ANTIFUNGALS
  5. SCABICIDES
  6. KERATOLYTICS
  7. ANTIPRURITICS
  8. SUNSCREENS
  9. OTHER (ANTI-INFLAMMATORY, MOISTURIZERS, VITAMIN D
49
Q

Mode of actionof corticosteroids?

A

1) SUPPRESSION OF INFLAMMATION
2) REDUCTION IN CELL PROLIFERATION
3) VASOCONSTRICTION

50
Q

Classification of corticosteroids?

A

1.WEAK
* HYDROCORTISONE ACETATE 1%
2. MODERATE
* TRIAMCINOLONE ACETONIDE 0,1%
* BETAMETHASONE 17 VALERATE 0,025%
3. STRONG
* BETAMETHASONE 17 VALERATE 0,1%
* BETAMETHASONE DIPROPIONATE 0,1%
4. POTENT
* CLOBETASOL 17 PROPIONATE 0,05%

51
Q

Local side effects of corticosteroids?

A
  1. ATROPHY, STRIAE
  2. BRUISING
  3. HYPERTRICHOSIS
  4. SUPPRESSION OF PIGMENTATION
  5. TELEANGIECTASIA
  6. USED IN THE FACE => PERIORAL DERMATITIS AND ACNE
  7. AROUND THE EYES: GLAUCOMA
    - ALSO: BURNING, STINGING, CONTACTALLERGY, DELAYED WOUND HEALING,
    MASKING OF FUNGAL INFECTION, PSORIASIS
    PUSTULOSA, TRIGGERING OF HERPES
    INFECTION
52
Q

Systemic side effects of corticosteroids?

A

IATROGENIC CUSHING SYNDROME →
1. REDUCED STRESS RESPONSE
2. CENTRAL OBESITAS
3. MUSCLE WEAKNESS
4. STRIAE,
5. ACNE
6. HIRSUTISM HIGH BLOOD PRESSURE,
7. DEPRESSION, ANXIETY

53
Q

How to use steroids?

A
  1. STRONG/POTENT STEROID FOR RAPID EFFECT FOR SERIOUS CONDITION FOR A SHORT
    PERIOD (2-3 WEEKS ONCE -OR TWICE – DAILY) PREFERABLY SMALL AREA AND THIN
    - THEREAFTER ONLY USE INTERMITTENTLY: (E.G. USE 3-4 DAYS/WK, RESP STOP 4-3 DAYS)
  2. IF THE SKIN CONDITION GETS BETTER: LOWER THE STRENGTH AND PROLONG THE INTERVAL
  3. PROPHYLACTIC USE: TWICE A WEEK TO PREVENT RECURRENCE
  4. DON’T USE STRONG/POTENT TOPICAL STEROIDS ON BABIES, FACE OR GENITAL AREA!!!!
  5. WHEN ONLY STRONG TOPICAL STEROIDS ARE AVAILABLE → DILUTE WITH EQUAL AMOUNT OF COOKING OIL
54
Q

How much steroids should you use?

A

DEPENDS ON:
AGE, SKIN SITE, BROKEN SKIN, INFLAMED SKIN, WET SKIN, OCCLUSION,
SKIN TEMPERATURE, VEHICLE BASE
1. STRONG/POTENT: NOT MORE THAN 50 G A WEEK FOR ADULTS
2. INTERMEDIATE: NOT MORE DAN 100 G A WEEK FOR ADULTS

55
Q

Topical steroids in pregnancy?

A
  • PASS THE PLACENTA BUT CAN BE USED.
  • CHOOSE LOWEST POSSIBLE STRENGTH
  • USE FOR SHORT PERIOD OF TIME
56
Q

Consequences of steroids in pregnancy?

A

 INTRA-UTERINE GROWTH REDUCTION
 THIRD TRIMESTER: ADRENAL GLAND SUPPRESSION => NEONATAL
HYPOGLYCEMIA, HYPOTENSION AND IMMUNE SUPPRESSION

57
Q
A

MBBS 4 Dermatology (21 decks)

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