Final Exam Derm Agents

Question 1

Keratinocytes

Answer 1

Cells that make up the basal layer of the epidermis (95%)

As new keratinocytes are made old keratinocytes migrate up the epidermis (differentiation) or stay in the basal layer (basal cells)

Once tin the stratum corneum they become squamous cells that no longer multiply

-Dead skin cells-> tough / dry outer layer of skin

Question 2

Drug absorption through the skin

Answer 2

Drug applied directly to the skin

Drug passively diffuses across the stratum corneum

Absorption through the capillaries in the dermis

Drug can enter systemic circulation

-Transdermal vs topical

Factors that affect drug absorption

Hydration – More moisture, more absorption

Damage to stratum corneum – More damage, more absorption

Temperature / Friction – Increased temperature/friction, increased absorption

Drug particle size – Smaller, soluble drugs absorb better

Question 3

Drug delivery systems

Answer 3

Question 4

Selection of delivery system

Answer 4

Question 5

Common skin diseases treated with topical products

Answer 5

Question 6

Acne – Pathophys

Answer 6

Increased Sebum production – Caused by increase in androgen levels

Hyper-keratinization – causes clogging of the follicle

Colonization of P. acnes – Gram + anaerobe colonizes and proliferates

Release of inflammatory mediators – Papules, pustules, etc

Question 7

Clinical Presentation of Acne

Answer 7

Question 8

Topical treatments for acne

Answer 8

Question 9

Topical Retinoids – MoA

Answer 9

MOA: Stimulate epidermal cell turnover and decrease cell cohesiveness

Unplug follicles

Reduce inflammation

Tretinoin

Naturally occurring form of vitamin A

Adapalene (now available OTC)

Greater anti-inflammatory effects vs. tretinoin?

Tazarotene

Effective, but poorly tolerated

Question 10

Topical Retinoids – ADEs

Answer 10

ADEs:

Skin irritation, peeling, dryness

Erythema

Hyperpigmentation (tretinoin > adapalene)

Acne may worsen with initial use

May take up to 3 months for full effect

Wear sunscreen

Avoid ultraviolet lights

Apply at bedtime

Available in cream and gel

Question 11

Benzoyl peroxide (BPO)

Answer 11

MOA: Antimicrobial, anti-inflammatory, Keratolytic effects

May inactivate some formulations of tretinoin, so avoid use or separate times of administration

Ok to use with adapalene or tazarotene

No reported resistance

Often used in combo with other therapies

Efficacy is not concentration dependent

ADEs: Contact dermatitis, erythema, skin dryness, peeling, bleaching

Question 12

Misc. Topical Treatments for Acne

Answer 12

Question 13

Atopic Dermatitis – PathoPhys

Answer 13

Question 14

Emollients

Answer 14

Cornerstone of management for atopic dermatitis

Made up of a fat-like substance that soften and soothe skin, retain moisture and provide protective barrier

Lanolin

Mineral Oil

Shea Butter

Cocoa Butter

Used in combination with topical steroids

Steroid sparring

Apply emollient first, wait 5-15 minutes, then apply steroid (or other treatments)

Question 15

Topical Steroids – MOA

Answer 15

MOA: Decrease inflammation, modulate immune response and vasoconstrict blood vessels to minimize redness, warmth and swelling

Used for acute flares

Categorized by and differ by potency

Seven groups

Potency determined by vasoconstricter assay

-Also determined by vehicle/formulation

No single agent proven better than another

Once or twice daily admin preferred

Question 16

Steroid agent and potency

Answer 16

Question 17

How to choose Topical steroid

Answer 17

Question 18

Topical steroid ADEs

Answer 18

Skin atrophy

Striae

Rosacea

Superficial infections

Hypopigmentation

Darker skin tones

Contact dermatitis

Tolerance

Tachyphylaxis

Systemic side effects

Adrenal suppression

HTN

Hyperglycemia

Question 19

Application

Answer 19

Question 20

Crisaborole

Answer 20

MOA: Not fully known; Non-steroidal inhibitor of PDE-4

Ointment

Studied in children and adults > 2 years of age

Mild to moderate atopic dermatitis

ADEs:

Common: application related pain (burning stinging)

Rare: hives, itching, swelling

Question 21

Psoriasis PathoPhy

Answer 21

Question 22

Treating mild to moderate Psoriasis

Answer 22

Question 23

Calcipotriene

Answer 23

Synthetic Vit D₃ analog

MOA: Inhibits epidermal keratinocyte hyperproliferation

Can be combined with other treatments including steroids

Steroid sparring effect

Can help improve UVB light therapy

Apply AFTER light therapy not before

ADEs: Cutaneous irritation, burning, stinging, hypercalcemia (rare-> large areas only)

Question 24

Sun protection

Answer 24

Ultra-violet (UV) rays emitted from the sun and indoor tanning systems

UVA -> most abundant rays to reach earth’s surface; penetrate into deep layers of the skin

-Causes aging, wrinkling, increase risk of cancer

UVB-> absorbed into superficial layers of the skin; partial absorption from ozone layer

-Causes reddening sunburn, increase risk of cancer

UVC-> absorbed by ozone layer and do not reach earth’s surface

Question 25

Sunscreen

Answer 25

Should protect against UVA and UVB rays

Sun Protective Factor (SPF) of at least 15 is recommened for protection

SPF 15 protects against 93% of the sun’s UVB rays

-It will take skin 15 times longer to redden with the use of sunscreen compared with no sunscreen

SPF 30 pretects against 97%

SPF 45 protects against 98%

Apply 1 ounce (2 Tbsp) 30 minutes before sun exposure

Reapply every 2 hours or after swimming or sweating

Question 26

Active ingredients in sunscreen

Answer 26

Question 27

Important definitions/claims

Answer 27