Week 2 - A - Topical therapies (lotions/creams/ointments/gels/pastes/foams), emollients and steroids (mild to very potent)

Question 1

What are the advantages and disadvantages of topical skin treatments?

Answer 1

Advantages * Direct application * Reduced systemic effects

Disadvantages * Time consuming * Correct dosage can be difficult * Messy to use

Question 2

Drugs used on the skin are dissolved in what is known as bases or vehicles ie different topical forms The vehicles range in water content What are the different types of topical treatments? (6 types) (try and rank them in terms of water content)

Answer 2

Lotions

Creams

Ointments

Gels

Pastes

There are also foams

Question 3

Lotions, creams, ointments, gels, pastes, foams What is the definition of a lotion?

Answer 3

A lotion is a liquid formulation - it is a suspension of medication in water, alcohol or liquids

Question 4

What substance may cause lotions to sting?

Answer 4

If lotions contain alcohol,it may sting

Question 5

State what a lotion is again? What is the definition of a cream? What does it contain?

Answer 5

A lotion is a liquid formulation where there is a suspension of medication in water, alcohol or another liquid substance

A cream is a semisolid emulsion of oil in water - it contains an emulsifier and preservative

Question 6

Are creams greasy?

Answer 6

Creams are not greasy

Question 7

Redefine lotions and creams Define ointments?

Answer 7

A lotion is a liquid formulation where there is a suspension of medication in water, alcohol or another liquid

Creams are a semisolid emulsion of oil in water - non greasy, contain emulsifier and preservative

Ointments are a semisolid oil/paraffin

Question 8

What are the advantages and disadvantages of ointments to creams?

Answer 8

Ointments restrict transepidermal water loss a they are occlusive

• Because of preservatives used in creams, ointments are less likely to cause an allergic reaction.

However there is no preservative in ointment and therefore spread of infection via ointment more likely (preservatives inhibit growth of organisms)

Also ointments are greasy - less cosmetically attractive

Question 9

Define what a gel is? What do they contain?

Answer 9

A gel is a semi-solid thickened aqueous solution They contain high molecular weight polymers eg methylcellulose which makes them thickened

Question 10

Redefine lotion, cream, ointment, gel What is a paste?

Answer 10

Lotion - liquid formulation Cream - semisolid emulsion of oil in water Ointment - semisolid oil/paraffin Gel - semi solid thickened aqueous solution Paste - semisolids

Question 11

What is the finely powdered material contained in pastes? What are there advantages and diasdvnatages?

Answer 11

Pastes contain finely powdered material eg zinc oxide Advantages - protective, occlusive and hydrating Disadvantages -stiff greasy and difficult to apply

Question 12

What are the advantages of foam vehicles?

Answer 12

Advantage of increased penetration of active agents and can spread easily over large areas of skin without greasy/oily film

Question 13

We have discussed the vehicle for topical medicants (lotions, creams, ointment, gels, pastes, foams) now we look at the types of topical therapies What are emollients?

Answer 13

Emollients are moisturising treatments applied directly to the skin to soften the skin and rehydrate the epidermis Emollients are available in different forms like creams, ointments, lotions or gels that will have a different feel on your skin

Question 14

What is the recommended weekly amount of emollient that should be prescribed to an adult?

Answer 14

300-500 grams

Question 15

What is the quantity of topical steroid ointment / cream that should cover the whole body (except face) in an adult with eczema? What is the size that should cover two hand surface areas?

Answer 15

20-30g of topical steroid ointment / cream should cover the whole body (except face) of an adult One fingertip unit (FTU) = 0.5g should cover two hand surface areas

Question 16

What is the mechanism of action of corticosteroids?

Answer 16

Corticosteroids bind to receptors within the cells causing the nucleus to down regulate the production of inflammatory mediators

Question 17

What is caused by the steroids binding to receptors within the cell and causing the nucleus to down regulate the roduction of inflammatory mediators? (usually a few effects)

Answer 17

Steroids therefore possess * Anti-inflammatory effects * Immunosuppressant effets * Vasoconstricting effects * Anti-proliferative effects

Question 18

Steroids can be graded as mild, moderate, potent and very potent depending on their increasing anti-inflammatory and immunosuppresant effects Name different steroids from each category?

Answer 18

Mild - hydrocortisone 1% Moderate - Clobetasone butyrate 0.05% (eumovate) Potent - Betamethasone valerate 0.1% (betnovate) Very potent - Clobetasol proprionate 0.05% (dermovate)

Question 19

What are the different side effects of topical steroids?

Answer 19

Short term treatment is generally safe. Long term use may produce serious adverse effects Thinning of skin - skin atrophy Purpura - easy burising Stretch marks (striaae atrophica) and small superficial dilated blood vessels (telangiectasia)

Question 20

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Answer 20

Adult with eczema one week of emollient - 500g Patients can safely smoke after using emollient - Unsure, if contains paraffin it is a fire hazard 10gof steroid ontiment will cover whole adult body -FALSE - it is 20-30g * Hydocortisone 1% is a mild steroid - TRUE * Clobetasone butyrate (0.05%) (eumovate) - Moderate * Bethametasone valerate (betnovate) - Potent * Clobetasol propionate is a mild steroid (dermovate)- FALSE - it is very potent