Treatments

Question 1

what are the advantages of topical treatments?

Answer 1

• direct application

- reduced systemic effects

Question 2

what are the disadvantages of topical treatments?

Answer 2

• time consuming
• correct dosage can be difficult
• messy to use

Question 3

what are creams?

Answer 3

semi-solid emulsion of oil in water

Question 4

what do creams contain that ointments don’t?

Answer 4

preservatives

Question 5

name some advantages of creams

Answer 5

• high water content
• cooling & mositurising
• non-greasy
• easy to apply
• cosmetically acceptable

Question 6

what are ointments?

Answer 6

semisolid grease/oil (soft paraffin)

Question 7

name some advantages of ointments

Answer 7

• occlusive & emollient

- restrict transepidermal water loss

Question 8

name some disadvantages of ointments

Answer 8

• greasy
• less cosmetically attractive
• higher risk of infection as patients constantly putting hands in & out of tub

Question 9

what are lotions?

Answer 9

a liquid formulation of a suspension or solution of medication in water, alcohol or other liquids

Question 10

what are the advantages of lotions?

Answer 10

can treat hair/scalp well

Question 11

what are the disadvantages of lotions?

Answer 11

if they contain alcohol, they may sting

Question 12

what are gels?

Answer 12

thickened aqueous lotions, semi-solids containing high molecular weight polymers

Question 13

what are gels used for?

Answer 13

to treat scalp, hair bearing areas & face

Question 14

what are pastes?

Answer 14

semisolids containing finely powdered material

Question 15

what are the advantages of pastes?

Answer 15

• protective
• occlusive
• hydrating
  often used in cooling, drying & soothing bandages & can be used for leakage around ulcers

Question 16

what are the disadvantages of pastes?

Answer 16

• stiff
• greasy
• difficult to apply

Question 17

what are emollients used for?

Answer 17

rehydration of the epidermis in all dry/scaly conditions especially eczema

Question 18

what are the disadvantages of emollients?

Answer 18

need frequent application

Question 19

what are the advantages of emollients?

Answer 19

emulsifying ointment can be used as soap substitutes

Question 20

what is wet wrap therapy used for?

Answer 20

very dry (xerotic) skin but difficult & time consuming to apply

Question 21

give an example of a mild topical steroid

Answer 21

hydrocortisone

Question 22

give an example of a moderate topical steroid

Answer 22

modrasone
clobetasone
butyrate

Question 23

give an example of a potent topical steroid

Answer 23

mometasone
betamethasone
valerate

Question 24

give an example of a very potent topical steroid

Answer 24

clobetasol

poprionate

Question 25

when are topical corticosteroids used?

Answer 25

- eczema (dermatitis) - psoriasis - other non-infective inflammatory dermatoses - keloid scars

Question 26

what can intralesional steroids be used for?

Answer 26

hair loss

Question 27

what should one fingertip unit be able to cover?

Answer 27

2 hand areas

Question 28

what are the side effects of topical steroids?

Answer 28

- thinning of the skin (skin creases are most susceptible) - purpura - stretch marks - steroid rosacea - fixed telangectasia - perioral dermatitis - can worsen or mask infections - systemic absorption - tachyphylaxis - rebound flare of disease

Question 29

what is tachyphylaxis?

Answer 29

decrease in response to anti-inflammatory effects

Question 30

which type of infection in particular get much worse when given steroids?

Answer 30

fungal infections

Question 31

which antiseptic is useful in bad eczema?

Answer 31

crystacide

Question 32

what are the disadvantages of antiseptics?

Answer 32

- resistance can be built up - can be irritating to the skin - patients can become allergic

Question 33

when are antiseptics used?

Answer 33

- recurrent infections - antibiotic resistance - wound irrigation

Question 34

which antibiotics are given for acne?

Answer 34

clindamycin erythromycin tetracycline a drying agent

Question 35

which antibiotics are given for rosacea?

Answer 35

metronidazole

Question 36

which antibiotics are given for impetigo?

Answer 36

mupirocin | fusidic acid

Question 37

which antibiotics are given for infected eczema?

Answer 37

combined corticosteroid & antibacterial substance (short-term)

Question 38

what type of antiviral is given in herpes simplex virus?

Answer 38

topical

Question 39

what type of antiviral is given in herpes zoster & eczema herpeticum?

Answer 39

oral

Question 40

when is a topical antiviral given in herpes zoster?

Answer 40

if it's around they eye

Question 41

what is given in candida?

Answer 41

anti-yeast

Question 42

what is given with dermatophytes?

Answer 42

antifungals

Question 43

what is given in pitryasis versicolor?

Answer 43

ketoconazole

Question 44

what is napkin dermatitis?

Answer 44

little inflamed papillose & pustules of yeast infection

Question 45

name some antipruritics

Answer 45

menthol capsaicin camphor/phenol crotamiton

Question 46

how does capsaicin work?

Answer 46

depletes substance P at nerve endings & reduces neurotransmission, effect gradually builds

Question 47

what side effect of capsaicin is particularly unpleasant?

Answer 47

causes a burning sensation when first applied so is used for more localised itch

Question 48

what are keratolytics used for?

Answer 48

to soften keratin: - viral warts - hyperkeratotic eczema & psoriasis - corns & calluses - to remove jeratin plaques in scalp

Question 49

how are warts treated?

Answer 49

mechanical paring plus: - keratolytics - formaldahyde - glutaraldehyde - silver nitrate - cryotherapy - podophyllin

Question 50

how is psoriasis topically treated?

Answer 50

emollients plus: - coal tar - Vit. D analogue - Keratolytic - topical steroid - dithranol

Question 51

what are the advantages & disadvantages of coal tar?

Answer 51

can get a range of mild - strong solutions | messy & smelly

Question 52

what are the advantages & disadvantages of Vit. D analogues?

Answer 52

clean, no smell, easy to apply | can be irritant & use is limited

Question 53

what are the advantages & disadvantages of dithranol?

Answer 53

effective | difficult to use, irritant & stains normal skin

Question 54

how can dithranol be made more manageable?

Answer 54

do a short application, put on for 30 mins & then wash off

Question 55

what treatments can be used for scalp psoriasis?

Answer 55

- greasy ointments to soften scale - tar shampoo - steroids in alcohol base/shampoo - Vit. D analogues

Question 56

what is imiquimod?

Answer 56

an immune response modulator

Question 57

what does imiquimod do?

Answer 57

enhances innate & cell-mediated immunity

Question 58

what effects does imiquimod have?

Answer 58

anti-viral | anti-tumour

Question 59

what is imiquimod used in?

Answer 59

- genital warts - superficial BCC - solar keratoses - lentigo maligna - Bowen's disease - verrucae

Question 60

what do calicneurin inhibitors do?

Answer 60

suppress lymphocyte activation

Question 61

when are calicneurin used?

Answer 61

in atopic eczema with no cutaneous atrophy

Question 62

what are the disadvantages of calicneurin inhibitors?

Answer 62

- may cause burning sensation on application | - risk of cutaenous infection & skin cancer

Question 63

what are the general side effects of topical therapies?

Answer 63

- burning or irritation - contact allergic dermatitis - local toxicity - systemic toxicity