Topicals

Question 1

Creams

Answer 1

Semisolid emulsion of oil in water
Contain emulsifier & preservative
High water content
Cool & moisturise
Non greasy
Easy to apply
Cosmetically acceptable
Sometimes pts can be allergic to preservatives in the creams

Question 2

Ointments

Answer 2

Semisolid grease/oil (soft paraffin)
No preservative
Occlusive and emollient
Restrict transepidermal water loss
Greasy - less cosmetically attractive
Inflammable

Question 3

Lotions

Answer 3

Liquid formulation
Suspension or solution of medication in water, alcohol or other liquids
If contain alcohol, may sting
Treat scalp, hair-bearing areas

Question 4

Gels

Answer 4

Thickened aqueous lotions
Semi-solids, containing high molecular weight polymers, e.g. methylcellulose
Treat scalp, hair bearing areas, face

Question 5

Pastes

Answer 5

Semisolids
Contain finely powdered material, e.g. ZNO
Stiff, greasy, difficult to apply
Protective, occlusive, hydrating
Often used in cooling, drying, soothing bandages

Question 6

Emollients

Answer 6

Enhance rehydration of epidermis
For all dry/scaly conditions esp. eczema
Need to be effective and cosmetically acceptable
Prescribe 300-500g weekly
Need frequent application

Question 7

What is wet wrap therapy used for?

Answer 7

Very dry (xerotic) skin

Question 8

Mode of action of topical corticosteroids

Answer 8

Vasoconstrictive
Anti-inflammatory
Anti-proliferative

Question 9

Uses of topical corticosteroids

Answer 9

Eczema
Psoriasis
Non-infective inflammatory dermatoses, e.g. lichen planus
Keloid scars

Question 10

How much topical corticosteroid is neede for a whole body application?

Answer 10

20-30g

Question 11

Side effects of topical steroids

Answer 11

Thinning of the skin, purpura and stretch marks
Worsen or mask infections
Systemic absorption
Tachyphylaxis
Rebound flare of disease (esp. psoriasis)

Question 12

Topical antibiotic used in rosacea

Answer 12

Metronidazole

Question 13

For the following conditions would we use topical or oral antivirals:
Herpes simplex (cold sore)
Eczema herpeticum
Herpes zoster (shingles)

Answer 13

Herpes simplex - topical
Eczema herpeticum - oral
Herpes zoster - oral

Question 14

Name some antipruritics

Answer 14

Menthol
Capsaicin
Camphor/ phenol
Crotamiton

Question 15

What are keratolytics used for?

Answer 15

Used to soften keratin: 
Viral warts
Hyperkeratotic eczema & psoriasis
Corns and calluses
To remove keratin plaques in scalp

Question 16

Example of a keratolytic

Answer 16

Salicylic acid

Question 17

Treatment of warts

Answer 17

Mechanical paring plus:
Keratolytics, e.g. Salicylic acid
Formaldehyde
Glutaraldehyde
Silver nitrate
Cryotherapy (usually liquid nitrogen)
Podophyllin (genital warts)

Question 18

Topical psoriasis treatments

Answer 18

Emollients and choice of:
 Coal tar 
 Vitamin D analogue
 Keratolytic
 Topical steroid
 Dithranol

Question 19

What conditions can imiquimod be used in?

Answer 19

Genital warts
BCC
Solar keratoses
Lentigo maligna
Bowen's disease
Verrucae

Question 20

How do calcineurin inhibitors work?

Answer 20

Suppress lymphocyte activation

Topical treatment of atopic eczema

Question 21

Difference between chemical & physical sunscreens

Answer 21

Chemical ones work by absorbing the sun’s rays but physical ones deflect or block the sun’s rays