Topical Treatments Flashcards
What are the advantages of topical treatments as opposed to systemic treatments?
- Direct application
- Reduced systemic effects
What are the disadvantages of topical treatments?
Time consuming
Correct dosage can be difficult
Messy to use
What bases/vehicles can drugs be dissolved in before using on the skin?
Gels Creams Ointments Pastes Lotions Foams
What is a cream?
Semisolid emulsion of oil in water
What do creams contain?
Contain emulsifier and preservative
High water content
What are the advantages of using a cream?
- Cool and moisturising
- Non greasy
- Easy to apply
- Cosmetically acceptable
What disadvantages can present when using a topical cream?
Patients can be allergic to preservatives in the creams
Sometimes they cant be applied to broken skin
Describe the usual bases/vehicles used in hand dermatitis
Light cream in the morning
Greasy Ointment for night
What is an ointment?
Semisolid grease/oil (soft paraffin)
With No preservative
What are the advantages of ointments?
Restrict water loss from the skin
What are the disadvantages of ointments?
Greasy - less cosmetically attractive
Highly inflammable! (be conscious if patient is a smoker!)
What is a lotion?
Suspension or solution of medication in water, alcohol or other liquids
What is one drawback of using lotions?
If they contain alcohol then preparations may sting
What areas do lotions usually treat?
Scalp / hair-bearing areas
What is a gel?
Thickened aqueous lotions
Semi-solids, containing high molecular weight polymers eg methylcellulose
Where do gels usually treat?
Treat scalp, hair bearing areas, face
What are pastes and what do they usually contain?
Semisolids
Contain finely powdered material eg ZnO
What are the disadvantages of paste formulas?
Stiff
greasy
difficult to apply
What are the advantages of pastes?
Protective, occlusive, hydrating
Often used in cooling, drying, soothing bandages
What are foams?
Newer treatment option
Colloid with two – three phases
Usually hydrophilic liquid in continuous phase with foaming agent dispersed in gaseous phase
What are the advantages of the new foam therapies?
increased penetration of active agents (e.g. steroid, vitamin D)
Can spread easily over large areas of skin, no greasy /oily film
What are the main types of topical therapy?
Emollients Topical steroids Antinfective agents Antipruritics Keratolytics Psoriasis therapies
What are antinfective agents?
Antiseptic
Antibacterial
Antifungal
Antiviral
What is the main function of emollients?
Enhance rehydration of epidermis
What conditions are emollients commonly used in?
Dry/scaly conditions
e.g. Eczema
How much emollient should be used per week and how frequently should it be applied?
Prescribe 300-500g weekly (ROUGHLY)
Need frequent application
What advice and information should be given to the patient to aid their application of an emollient?
Apply immediately after bathing
Apply in direction of hair growth
Makes skin and surfaces slippery – hazard
Use clean spoon or spatula to remove from tub (risk of bacterial contamination)
FIRE risk if paraffin-based
How much do non-proprietary emollients usually cost?
under £5.00 per 500g
e.g. Liquid paraffin, white-soft paraffin
How much do proprietary emollients usually cost?
£5.00 - over £30.00
When are wet wraps used?
For very dry/xerotic skin
How should a wet wrap be applied?
Patient should have a bath, then apply emollient.
Wet wrap should then be applied on top of the emollient
Describe the mode of action of corticosteroids
Vasoconstrictive
Anti-inflammatory
Antiproliferative
Name a mild steroid
Hydrocortisone 1%
Name a moderate steroid
Clobetasone Butyrate 0.05%
EUMOVATE
Name a potent steroid
Betamethasone Valerate 0.1%
BETNOVATE
Name a VERY potent steroid
Clobetasol Proprionate 0.05%
DERMOVATE
What conditions are topical corticosteroids usually used for?
Eczema (dermatitis)
Psoriasis (eg flexures, face , hairline, scalp)
Other non-infective inflammatory dermatoses e.g. lichen planus
Keloid scars (usually intralesional)
What condition can occur as a result of stopping topical corticosteroid treatment in psoriasis?
Rebound pustular psoriasis
How large is one full adult body application of topical corticosteroid?
1 application = 20-30g ointment
What is a fingertip unit and how much does it cover?
1 fingertip unit = 1/2 g
Covers 2 hand areas
Name some side effects of topical steroids
Thinning of the skin purpura stretch marks Steroid rosacea Fixed telangiectasia (blood vessels) Perioral dermatitis
What more serious systemic side effects can topical steroids cause?
Worsen/mask infections
Systemic absorption (adrenal suppression, Cushings syndrome)
Tachyphylaxis : decrease in response to anti-inflammatory effects
Give examples of Calicneurin Inhibitors
Tacrolimus
pimecrolimus
What is the job of Calcineurin Inhibitors?
Suppress lymphocyte activation
What are calcineurin inhibitors usually used to treat?
Topical treatment of atopic eczema
especially face, children
What are the advantages and disadvantages of Calcineurin inhibitors?
ADV: No cutaneous atrophy
DISADV: May cause burning sensation on application
Unknown risk of cutaneous infections and skin cancer
What two effects can antiseptics possess?
bacteriostatic or bacteriocidal
Give examples of antiseptics
Povidone iodine
Chlorhexidine (e.g. Savlon)
Triclosan
Hydrogen peroxide
When are antiseptics most likely to be used?
Recurrent infections
Antibiotic resistance
Wound irrigation
Give an example of when an antiseptic like a potassium permanganate soak would be used?
acute exudative eczema
For which of these do you give a topical antiviral? Herpes simplex (cold sore) Eczema herpeticum Herpes Zoster (shingles)
Herpes simplex (cold sore)
others are oral antivirals given
What topical antifungals could be used in a candida (yeast) infection?
nystatin
OR
clotrimazole
What topical antifungal could be used in a Dermatophyte (ringworm) infection?
clotrimazole,
OR
terbinafine cream
What topical antifungal could be used in a Pityriasis versicolor infection?
ketoconazole
Give examples of antipruritics and briefly how they work to reduce itch
Menthol: imparts cooling sensation
Capsaicin: depletes substance P at nerve endings and reduces neurotransmission
Camphor / phenol – for pruritus at the exit of the rectum
Crotamiton (Eurax) – used after treatment of scabies to relieve residual itch
Keratolytics are used to soften keratin in what conditions?
Viral warts
Hyperkeratotic eczema and psoriasis
Remove keratin plaques in scalp
Corns and calluses
Give an example of a topical keratolytic
salicylic acid 2-20%
What treatments are most commonly used for warts?
Keratolytics Formaldehyde/Glutaraldehyde Soaks Silver nitrate Cryotherapy (liquid nitrogen) Podophyllin (for genital warts)
What treatments can be used for psoriasis?
EMOLLIENTS and choice of: Coal tar Vitamin D analogue Keratolytic Topical steroid Dithranol
What factors influence which psoriasis treatments are chosen?
sites affected, extent, severity, side effects
compliance
What 3 treatments are most common for chronic stable plaque psoriasis?
Coal Tar
Vitamin D analogues
Dithranol
What are the disadvantages of Coal Tar preparations?
Strong smell
Messy
What are the advantages and disadvantages of Vitamin D analogue preparations?
ADV:
Clean, no smell
Easy to apply
DISADV:
can be irritant
Use limited to 100g weekly
What are the disadvantages of dithranol
Irritant and stains normal skin
What therapies are best for treating scalp psoriasis?
Greasy ointments to soften scale
Tar shampoo
Steroids in alcohol base or shampoo
Vitamin D analogues
What therapies should be considered for psoriasis in the axilla?
combination antibacterial, antifungal.
Calcineurin inhibitors.
What are the main side effects of topical therapies?
Burning or irritation
Contact allergic dermatitis
Local toxicity
Systemic toxicity
