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Dermatology > Topical Treatments > Flashcards

Topical Treatments Flashcards

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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
Q

What conditions are emollients commonly used in?

A

Dry/scaly conditions

e.g. Eczema

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26
Q

How much emollient should be used per week and how frequently should it be applied?

A

Prescribe 300-500g weekly (ROUGHLY)

Need frequent application

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27
Q

What advice and information should be given to the patient to aid their application of an emollient?

A

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
Q

How much do non-proprietary emollients usually cost?

A

under £5.00 per 500g

e.g. Liquid paraffin, white-soft paraffin

29
Q

How much do proprietary emollients usually cost?

A

£5.00 - over £30.00

30
Q

When are wet wraps used?

A

For very dry/xerotic skin

31
Q

How should a wet wrap be applied?

A

Patient should have a bath, then apply emollient.

Wet wrap should then be applied on top of the emollient

32
Q

Describe the mode of action of corticosteroids

A

Vasoconstrictive
Anti-inflammatory
Antiproliferative

33
Q

Name a mild steroid

A

Hydrocortisone 1%

34
Q

Name a moderate steroid

A

Clobetasone Butyrate 0.05%

EUMOVATE

35
Q

Name a potent steroid

A

Betamethasone Valerate 0.1%

BETNOVATE

36
Q

Name a VERY potent steroid

A

Clobetasol Proprionate 0.05%

DERMOVATE

37
Q

What conditions are topical corticosteroids usually used for?

A

Eczema (dermatitis)

Psoriasis (eg flexures, face , hairline, scalp)

Other non-infective inflammatory dermatoses e.g. lichen planus

Keloid scars (usually intralesional)

38
Q

What condition can occur as a result of stopping topical corticosteroid treatment in psoriasis?

A

Rebound pustular psoriasis

39
Q

How large is one full adult body application of topical corticosteroid?

A

1 application = 20-30g ointment

40
Q

What is a fingertip unit and how much does it cover?

A

1 fingertip unit = 1/2 g

Covers 2 hand areas

41
Q

Name some side effects of topical steroids

A 
Thinning of the skin
purpura 
stretch marks
Steroid rosacea
Fixed telangiectasia (blood vessels)
Perioral dermatitis
42
Q

What more serious systemic side effects can topical steroids cause?

A

Worsen/mask infections

Systemic absorption (adrenal suppression, Cushings syndrome)

Tachyphylaxis : decrease in response to anti-inflammatory effects

43
Q

Give examples of Calicneurin Inhibitors

A

Tacrolimus

pimecrolimus

44
Q

What is the job of Calcineurin Inhibitors?

A

Suppress lymphocyte activation

45
Q

What are calcineurin inhibitors usually used to treat?

A

Topical treatment of atopic eczema

especially face, children

46
Q

What are the advantages and disadvantages of Calcineurin inhibitors?

A

ADV: No cutaneous atrophy

DISADV: May cause burning sensation on application
Unknown risk of cutaneous infections and skin cancer

47
Q

What two effects can antiseptics possess?

A

bacteriostatic or bacteriocidal

48
Q

Give examples of antiseptics

A

Povidone iodine
Chlorhexidine (e.g. Savlon)
Triclosan
Hydrogen peroxide

49
Q

When are antiseptics most likely to be used?

A

Recurrent infections
Antibiotic resistance
Wound irrigation

50
Q

Give an example of when an antiseptic like a potassium permanganate soak would be used?

A

acute exudative eczema

51
Q 
For which of these do you give a topical antiviral?
Herpes simplex (cold sore)
Eczema herpeticum
Herpes Zoster (shingles)
A

Herpes simplex (cold sore)

others are oral antivirals given

52
Q

What topical antifungals could be used in a candida (yeast) infection?

A

nystatin
OR
clotrimazole

53
Q

What topical antifungal could be used in a Dermatophyte (ringworm) infection?

A

clotrimazole,
OR
terbinafine cream

54
Q

What topical antifungal could be used in a Pityriasis versicolor infection?

A

ketoconazole

55
Q

Give examples of antipruritics and briefly how they work to reduce itch

A

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
Q

Keratolytics are used to soften keratin in what conditions?

A

Viral warts

Hyperkeratotic eczema and psoriasis

Remove keratin plaques in scalp

Corns and calluses

57
Q

Give an example of a topical keratolytic

A

salicylic acid 2-20%

58
Q

What treatments are most commonly used for warts?

A 
Keratolytics  
Formaldehyde/Glutaraldehyde Soaks
Silver nitrate
Cryotherapy (liquid nitrogen)
Podophyllin (for genital warts)
59
Q

What treatments can be used for psoriasis?

A 
EMOLLIENTS and choice of:
 Coal tar 
 Vitamin D analogue
 Keratolytic
 Topical steroid
 Dithranol
60
Q

What factors influence which psoriasis treatments are chosen?

A

sites affected, extent, severity, side effects

compliance

61
Q

What 3 treatments are most common for chronic stable plaque psoriasis?

A

Coal Tar
Vitamin D analogues
Dithranol

62
Q

What are the disadvantages of Coal Tar preparations?

A

Strong smell

Messy

63
Q

What are the advantages and disadvantages of Vitamin D analogue preparations?

A

ADV:
Clean, no smell
Easy to apply

DISADV:
can be irritant
Use limited to 100g weekly

64
Q

What are the disadvantages of dithranol

A

Irritant and stains normal skin

65
Q

What therapies are best for treating scalp psoriasis?

A

Greasy ointments to soften scale
Tar shampoo
Steroids in alcohol base or shampoo
Vitamin D analogues

66
Q

What therapies should be considered for psoriasis in the axilla?

A

combination antibacterial, antifungal.

Calcineurin inhibitors.

67
Q

What are the main side effects of topical therapies?

A

Burning or irritation
Contact allergic dermatitis
Local toxicity
Systemic toxicity

Dermatology (18 decks)

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