Topical Skin Theraputics

Question 1

What are creams?

Answer 1

Semi-solid emulsification of oil in water

Question 2

What 2 chemicals do creams contain?

Answer 2

Emulsifier

Preservative

Question 3

What are 5 features of creams?

Answer 3

Cooling
Moisturising
Non-greasy
Easy to apply
Cosmetically acceptable

Question 4

What are ointments?

Answer 4

Semi-solid grease or oil

Question 5

Do ointments contain preservative?

Answer 5

No

Question 6

What are the 4 main features of ointments

Answer 6

Causes transdermal occlusion => moisturises the skin

Greasy => less cosmetically acceptable

Question 7

What are lotions?

Answer 7

Suspension/solution of medication in water/alcohol/liquid

Question 8

What is the disadvantage of lotions?

Answer 8

They can sting when applied if they contain alcohol

Question 9

What 2 topical therapeutics can be used on hair-bearing areas?

Answer 9

Lotions

Gels

Question 10

What are gels?

Answer 10

Semi-solid, thickened aqueous solutions containing high molecular weight polymers

Question 11

What are pastes?

Answer 11

Semi-solid containing finely powdered material

Question 12

What are pastes often used in?

Answer 12

Cooling/soothing bandages

Question 13

What preparation should be used on acutely inflamed, red, vesiculating, oozing skin?

Answer 13

Lotions

Question 14

What preparation should be used on subacute, chronic, less inflamed skin? 3

Answer 14

Lotions
Pastes
Creams

Question 15

What should be used on dry, scaly, thick, lichenified skin? 2

Answer 15

Ointments

Pastes

Question 16

What 3 preparations should be used on generalised eruptions?

Answer 16

Lotions
Creams
Baths

Question 17

What skin conditions should emollients be used on?

Answer 17

All dry and scaly conditions

Question 18

How do emollients work?

Answer 18

Enhance rehydration of the epidermis

Question 19

How much emollient should you prescribe per week?

Answer 19

300-500g

Question 20

What are the 2 alternative ways in which you can apply emollient?

Answer 20

Soap substitute

Wet wraps in xerotic skin

Question 21

Give 4 prescribing pointers for emollients

Answer 21

Apply immediately after bathing
Apply in direction of hair growth
Fire risk if paraffin based
Use spatula/clean spoon to remove from tub

Question 22

Describe the application of topical steroids

Answer 22

Thin layer over just affected areas >30 mins before emollient application once/twice daily

Question 23

What 2 chemicals/additives can increase the penetration of topical steroids?

Answer 23

Urea

Salicylic acid

Question 24

What are the 2 quantities used to describe application of topical steroids?

Answer 24

1 finger tip unit = 0.5g = 2 hand areas

Whole body = 20-30g

Question 25

Topical steroids have no value in ____ management

Answer 25

Urticaria

Question 26

Topical steroids can worsen _____ or ___ ____ => should not be used on them

Answer 26

Ulcerations | Infected lesions

Question 27

When are topical steroids good for treating piritus?

Answer 27

If inflammation is causing the itch (not good if the origin of itch is unclear)

Question 28

What are the 2 contraindications for long term use of steroids? (>7-14 days)

Answer 28

Face application | Children

Question 29

What are the 4 main skin side effects of topical steroids?

Answer 29

Thinning of the skin Bruising Stretch marks Visible/dilated blood vessels

Question 30

What should be done for long-term monitoring of topical steroids side effects?

Answer 30

Regular optician visits - looking for cataracts and glucoma

Question 31

What are the 4 main uses for topical steroids?

Answer 31

Eczema Psoriasis Keloid scars Non-infective inflammatory dermatoses

Question 32

What is an example of a mild topical steroid?

Answer 32

Hydrocortisone 1%

Question 33

What are 2 examples of a moderate topical steroid?

Answer 33

Modrasone | Clobetasone butyrate 0.05%

Question 34

What are 2 examples of a potent topical steroid?

Answer 34

Mometasone | Betamethasone valerate 0.01%

Question 35

What is an example of a very potent steroid?

Answer 35

Clobetasol proprionate 0.05%

Question 36

Where should potent/very potent steroids not be used? 5

Answer 36

``` Face Groin Armpits Genitals Children (without expert opinion) ```

Question 37

What should very potent steroids not be used in?

Answer 37

Psoriasis

Question 38

What should moderate steroids not be applied to?

Answer 38

Eyelids

Question 39

What is the mechanism of calicneurin inhibitors?

Answer 39

Suppress lymphocyte activity

Question 40

What is the main clinical difference between calicneurin inhibitors and steroids?

Answer 40

CI do not cause thinning of the skin

Question 41

What are 2 examples of calicneurin inhibitors?

Answer 41

Tacrolimus | Pimecrolimus

Question 42

What is the main use for topical calcineurin inhibitors?

Answer 42

Atopic eczema - esp on the face and in children

Question 43

What do calcineurin inhibitors sometimes cause when applied to the skin?

Answer 43

Burning sensation

Question 44

What are the 2 risks with calcineurin inhibitors?

Answer 44

Increased risk of infection and skin cancer

Question 45

What are the 2 contraindications for calcineurin inhibitors?

Answer 45

Cold sores | Infective eczema

Question 46

What are the 3 indications for anti-septics?

Answer 46

Recurrent infection Wound irrigation Antibiotic resistance

Question 47

What is the main use for topical anti-virals?

Answer 47

Herpes simplex cold sores

Question 48

What are the 2 main uses for oral anti-virals?

Answer 48

``` Eczema herpeticum Herpes zoster (shingles) ```

Question 49

What 2 antifungals are used in candida?

Answer 49

Nystatin | Clotriamzole

Question 50

What 2 antifungals are used in dermatophytes (ringworm)?

Answer 50

Clotriamzole | Terbinafine cream

Question 51

What antifungal is used for treatment of pityriasis versicolour?

Answer 51

Ketoconazole

Question 52

What are the 4 main topical anti-pruitics?

Answer 52

Methanol Capsaicin Camphor/phenol Crotamiton

Question 53

What is the mechanism of action of capsaicin?

Answer 53

Depletes substance P at the nerve endings => decreasing transmission Gradual build up to effect

Question 54

What are the 4 main uses for keratolytics?

Answer 54

Viral warts Hyperkeratotic eczema/psoriasis Corns/calluses Removing keratin plaques from the scalp

Question 55

What is an example of keratolytics?

Answer 55

Salicylic acid ointment 2-20%