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Topical Treatments Flashcards

1
Q

What are the advantages of topical treatments as opposed to systemic treatments?

A
  • Direct application

- Reduced systemic effects

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2
Q

What are the disadvantages of topical treatments?

A

Time consuming

Correct dosage can be difficult

Messy to use

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3
Q

What bases/vehicles can drugs be dissolved in before using on the skin?

A 
Gels          
Creams
Ointments
Pastes
Lotions
Foams
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4
Q

What is a cream?

A

Semisolid emulsion of oil in water

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5
Q

What do creams contain?

A

Contain emulsifier and preservative

High water content

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6
Q

What are the advantages of using a cream?

A
  • Cool and moisturising
  • Non greasy
  • Easy to apply
  • Cosmetically acceptable
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7
Q

What disadvantages can present when using a topical cream?

A

Patients can be allergic to preservatives in the creams

Sometimes they cant be applied to broken skin

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8
Q

Describe the usual bases/vehicles used in hand dermatitis

A

Light cream in the morning

Greasy Ointment for night

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9
Q

What is an ointment?

A

Semisolid grease/oil (soft paraffin)

With No preservative

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10
Q

What are the advantages of ointments?

A

Restrict water loss from the skin

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11
Q

What are the disadvantages of ointments?

A

Greasy - less cosmetically attractive

Highly inflammable! (be conscious if patient is a smoker!)

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12
Q

What is a lotion?

A

Suspension or solution of medication in water, alcohol or other liquids

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13
Q

What is one drawback of using lotions?

A

If they contain alcohol then preparations may sting

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14
Q

What areas do lotions usually treat?

A

Scalp / hair-bearing areas

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15
Q

What is a gel?

A

Thickened aqueous lotions

Semi-solids, containing high molecular weight polymers eg methylcellulose

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16
Q

Where do gels usually treat?

A

Treat scalp, hair bearing areas, face

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17
Q

What are pastes and what do they usually contain?

A

Semisolids

Contain finely powdered material eg ZnO

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18
Q

What are the disadvantages of paste formulas?

A

Stiff
greasy
difficult to apply

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19
Q

What are the advantages of pastes?

A

Protective, occlusive, hydrating

Often used in cooling, drying, soothing bandages

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20
Q

What are foams?

A

Newer treatment option

Colloid with two – three phases

Usually hydrophilic liquid in continuous phase with foaming agent dispersed in gaseous phase

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21
Q

What are the advantages of the new foam therapies?

A

increased penetration of active agents (e.g. steroid, vitamin D)

Can spread easily over large areas of skin, no greasy /oily film

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22
Q

What are the main types of topical therapy?

A 
Emollients
Topical steroids
Antinfective agents
Antipruritics
Keratolytics
Psoriasis therapies
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23
Q

What are antinfective agents?

A

Antiseptic
Antibacterial
Antifungal
Antiviral

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24
Q

What is the main function of emollients?

A

Enhance rehydration of epidermis

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25
What conditions are emollients commonly used in?
Dry/scaly conditions | e.g. Eczema
26
How much emollient should be used per week and how frequently should it be applied?
Prescribe 300-500g weekly (ROUGHLY) Need frequent application
27
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
28
How much do non-proprietary emollients usually cost?
under £5.00 per 500g e.g. Liquid paraffin, white-soft paraffin
29
How much do proprietary emollients usually cost?
£5.00 - over £30.00
30
When are wet wraps used?
For very dry/xerotic skin
31
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
32
Describe the mode of action of corticosteroids
Vasoconstrictive Anti-inflammatory Antiproliferative
33
Name a mild steroid
Hydrocortisone 1%
34
Name a moderate steroid
Clobetasone Butyrate 0.05% EUMOVATE
35
Name a potent steroid
Betamethasone Valerate 0.1% BETNOVATE
36
Name a VERY potent steroid
Clobetasol Proprionate 0.05% DERMOVATE
37
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)
38
What condition can occur as a result of stopping topical corticosteroid treatment in psoriasis?
Rebound pustular psoriasis
39
How large is one full adult body application of topical corticosteroid?
1 application = 20-30g ointment
40
What is a fingertip unit and how much does it cover?
1 fingertip unit = 1/2 g | Covers 2 hand areas
41
Name some side effects of topical steroids
``` Thinning of the skin purpura stretch marks Steroid rosacea Fixed telangiectasia (blood vessels) Perioral dermatitis ```
42
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
43
Give examples of Calicneurin Inhibitors
Tacrolimus | pimecrolimus
44
What is the job of Calcineurin Inhibitors?
Suppress lymphocyte activation
45
What are calcineurin inhibitors usually used to treat?
Topical treatment of atopic eczema | especially face, children
46
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
47
What two effects can antiseptics possess?
bacteriostatic or bacteriocidal
48
Give examples of antiseptics
Povidone iodine Chlorhexidine (e.g. Savlon) Triclosan Hydrogen peroxide
49
When are antiseptics most likely to be used?
Recurrent infections Antibiotic resistance Wound irrigation
50
Give an example of when an antiseptic like a potassium permanganate soak would be used?
acute exudative eczema
51
``` 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**
52
What topical antifungals could be used in a candida (yeast) infection?
nystatin OR clotrimazole
53
What topical antifungal could be used in a Dermatophyte (ringworm) infection?
clotrimazole, OR terbinafine cream
54
What topical antifungal could be used in a Pityriasis versicolor infection?
ketoconazole
55
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
56
Keratolytics are used to soften keratin in what conditions?
Viral warts Hyperkeratotic eczema and psoriasis Remove keratin plaques in scalp Corns and calluses
57
Give an example of a topical keratolytic
salicylic acid 2-20%
58
What treatments are most commonly used for warts?
``` Keratolytics Formaldehyde/Glutaraldehyde Soaks Silver nitrate Cryotherapy (liquid nitrogen) Podophyllin (for genital warts) ```
59
What treatments can be used for psoriasis?
``` EMOLLIENTS and choice of: Coal tar Vitamin D analogue Keratolytic Topical steroid Dithranol ```
60
What factors influence which psoriasis treatments are chosen?
sites affected, extent, severity, side effects | compliance
61
What 3 treatments are most common for chronic stable plaque psoriasis?
Coal Tar Vitamin D analogues Dithranol
62
What are the disadvantages of Coal Tar preparations?
Strong smell | Messy
63
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
64
What are the disadvantages of dithranol
Irritant and stains normal skin
65
What therapies are best for treating scalp psoriasis?
Greasy ointments to soften scale Tar shampoo Steroids in alcohol base or shampoo Vitamin D analogues
66
What therapies should be considered for psoriasis in the axilla?
combination antibacterial, antifungal. Calcineurin inhibitors.
67
What are the main side effects of topical therapies?
Burning or irritation Contact allergic dermatitis Local toxicity Systemic toxicity

DERMATOLOGY (18 decks)

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