Pharm: Topical Corticosteroids

Question 1

Ointments

Answer 1

-water in oil -good lubricant -facilitate heat retention (never put on burns) -decreased water loss -semi-occlusive (enhances drug penetration and absorption) -most potent** vehicle (b/c its occlusive) -best for dry/thick, hyperkeratotic lesions -avoid hairy and intertriginous areas -greasy

Question 2

Cream

Answer 2

-oil in water -can be washed off w/ water -good lubricating qualities -vanish into skin -less potent than ointment but more than lotions -good for exudative inflammation and intertriginous areas -no occlusive properties

Question 3

lotions/aerosols/solutions

Answer 3

-least greasy and occlusive -good for hairy and large areas -penetrate easy and leave little residue

Question 4

foams

Answer 4

-pressurized collections of gaseous bubbles in liquid film -spread readily and easy to apply -good for inflammed skin and scalp dermatoses -cosmetically acceptable -depend on vehicle delivery (expensive)

Question 5

gels

Answer 5

-oil in water with alcohol in the base (evaporate quickly) -they dry in a thin, greaseless, nonstaining film -efficient for hairy areas and acne -dry quickly and can be applied to scalp -best for exudative inflammation -helpful for drying of oozing lesions (as long as not broken skin)

Question 6

purpose of an occlusive dressing

Answer 6

increase steroid absorption

Question 7

Know this chart

Answer 7

Question 8

contraindications to topical steroids

Answer 8

• acne vulgaris
• scabies
• warts
• fungal infections
• viral infections

Question 9

factors that effect the degree of absorption of topical steroids

Answer 9

• skin integrity: absorbed more at areas of inflammation and desquamation
• pts age: more readily through infants skin
• vehicle used
• use of occlusive dressing
• the area of body on which it is applied: thin skin more permeable than thick

Question 10

Which group of steroids is the most potent and the least potent?

Answer 10

• group 1 = most potent
• group 7 = least potent

Question 11

super high potent topical steroids

Answer 11

clobestasol

Question 12

high potency (group 2) steroids

Answer 12

halcinonide (halog 0.1%)

Question 13

high potentcy (group 3) steroid

Answer 13

triamcinolone acetonide 0.5% cream or ointment

Question 14

medium potentcy (group 4) steroid

Answer 14

triamcinolone acetonide 0.1% cream or ointment

Question 15

low potency (group 5) steroid

Answer 15

flucocinolone acetonide 0.01% solution

Question 16

what is the least potent topical steroid?

Answer 16

hydrocortisone

Question 17

when is the best time to apply topical steroids?

Answer 17

to moist skin

Question 18

what is the appropriate frequency of application of topical steroid?

Answer 18

no more than twice daily (using it more often doesn’t increase effectiveness, just risk of toxicity)

Question 19

areas of the body that are most susceptible to steroid ADRs

Answer 19

• occluded areas
• thin skinned areas (face and flexures)

Question 20

vulnerable populations to steroid ADRs

Answer 20

• children
• eldery
• pts w/ liver failure
• pts who use the highest potency preps for longer than 2 weeks

Question 21

treatment duration w/ a topical steroid

Answer 21

• super high potentcy: should not exceed 3 weeks if possible
• high/med potentcy: rarely cause ADRs if used < 6-8 weeks
• facial, intertriginous, and genital dermatoses should be treated for 1-2 week intervals

Question 22

explain intermittent topical steroid therapy

Answer 22

• twice weekly
• may be effective for maintaining long term dz control

Question 23

tapering after short course of steroids

Answer 23

• dc topical steroids when skin condition resolves
• avoid rebound skin condition by tapering topical tx w/ gradual reduction of potency and frequency at 2-week intervals

Question 24

use of topical steroids in children

Answer 24

• lower potency (groupe 4-7) for short durations
• avoid using potent or super potent topical steroids in children < 12 except for very severe inflammatory dermatoses
• avoid use on face, intertriginous or other thin skinned areas
• use only once daily
• do not use longer than 2 weeks

Question 25

use during pregnancy and lactation

Answer 25

- mild or moderate instead of potent/super potent for pregnant women - if potent are needed, keep at min. dose and monitor fetal growth - unknown if steroid are secreted in breast milk; don't apply to nipples

Question 26

epidermal / dermal atrophy

Answer 26

- usually reversible - thin skin areas most vulnerable

Question 27

telangiectasia

Answer 27

Question 28

striae

Answer 28

- occur MC in cubital and popliteal fossa, groin, axillary and inner thigh - usually permanent

Question 29

purpura

Answer 29

-red or purple discolored spots that don't blanch

Question 30

hypopigmentation

Answer 30

- primarily a problem of dark skinned pts - generally reversible

Question 31

acneiform eruption

Answer 31

-may be induced by prolonged use of topical steroids

Question 32

factors associated w/ systemic absoprtion and ADR w/ topical steroid use

Answer 32

- significant hypothalamic pituitary axis suppression - systemic absorption --\> adrenal suppression - cushingoid features (rarely)

Question 33

nonpharmacologic interventions to decrease pruritus

Answer 33

- skin moisturiation - gentle cleansers during bathing: dove, olay, cetaphil - apply emollients to skin daily - avoidance of excessive and agressive skin washing - use a humidifier

Question 34

topical products that can be used to decrease puritis

Answer 34

- corticosteroids - topical capsaicin - calcineurin inhibitors - anesthetics - astringents - calamine - colloidal oatmeal

Question 35

CIs to self tx of a corn or callus

Answer 35

- DM - peropheral circulatory dz or other medical conditions that contraindicates use of foot care products - lesions that are oozing or bleeding - anatomic defect or fault in body weight distribution - extensive or painful, debilitating corn or calluses - proper but unsuccessful self-tx attempt - hx of RA and complaint of painful metatarsal heads or deviation of great toe

Question 36

CIs to the use of salicyclic acid in treating corns and calluses

Answer 36

- irritated, infected, reddened, or broken skin - moles, birthmarks, warts w/ hair - DM or poor blood circulation - warts on face, mucous membranes or genital warts - avoid in pregant / breastfeeding women

Question 37

patient education needed to decrease or prevent the spread of HPV virus for warts

Answer 37

- avoid cutting, shaving or picking at warts - wash hands before and after treating or touching them - use designated towel to dry warts (a wart towel, if you will) - avoid transmissions to other: avoid sharing towels, razors, socks, shoes - keep wart covered and don't go barefoot

Question 38

tx duration w/ salicylic acid in the tx of warts

Answer 38

should not exceed 12 weeks

Question 39

mechanism of cryotherapy for warts

Answer 39

- freezing causes intracellular ice crystals, microthrombi formation leading to ischemic necrosis and destruction of the HPV infected keratinocytes - also causes local inflammation that may clear the wart through a cell-mediated process - a blister forms under wart and will fall off after 10 days