Topical Skin Theraputics

Question 1

what are some advantages of topical treatments over systemic treatments?

Answer 1

can be applied directly to the affected area

reduces systemic effects

Question 2

what are some disadvantages of topical treatments compared to systemic treatment?

Answer 2

application is time consuming and difficult
messy to use
hard to quantify specific dosage

Question 3

why are different vehicles/bases used for topical treatments?

Answer 3

give different consistency and therapeutic benefits

Question 4

what is a cream?

Answer 4

semisolid emulsion of oil in water containing emulsifier and preservatives

Question 5

what are the advantages of creams as bases?

Answer 5

advantages = high water content, cooling and moisturising, non-greasy, easy to apply, cosmetically acceptable

Question 6

what are the disadvantages of creams as bases?

Answer 6

emulsifier can make creams nippy

preservative can cause allergic response

Question 7

what are ointment bases?

Answer 7

semisolid grease/oil (soft paraffin)

occlusive and emollient

Question 8

what are the benefits of ointments?

Answer 8

no preservatives so no allergy

restrict transepidermal water loss so good for thick eczema and psoriasis

Question 9

what are the disadvantages of ointments as bases?

Answer 9

greasy - less cosmetically attractive
no preservatives so can be contaminated by bacteria
highly flammable

Question 10

what are lotions?

Answer 10

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

Question 11

give a benefit and drawback of lotions

Answer 11

may sting if it contains alcohol

good at treating scalp and hairy areas

Question 12

what are gels?

Answer 12

thickened, semisolid aqueous lotions containing high molecular weight polymers

Question 13

what is a good use for gels?

Answer 13

treatment of scalp, face and hairy areas

Question 14

what are pastes?

Answer 14

semisolids containing finely powdered material like Zinc Oxide

Question 15

give a benefit and drawback of pastes

Answer 15

protective, occlusive and hydrating

stiff, greasy and difficult to apply

Question 16

what is a common use of pastes?

Answer 16

used in cooling and drying
used in leg ulcers to prevent surrounding skin becoming boggy
used in bandages to cool and sooth (e.g eczema)

Question 17

what are foams?

Answer 17

colloid with 2-3 phases

usually hydrophilic liquid in continuous phase with foaming agent in dispersed in gaseous phase

Question 18

what are some advantages of foams?

Answer 18

increased penetration of active agents

can spread easily over skin with no greasy film

Question 19

what do emollients do?

Answer 19

enhance rehydration of epidermis
for all dry/scaly conditions
can be also be used as a soap

Question 20

what is the best way to apply emollient?

Answer 20

immediately after bathing in direction of hair growth
remove from tub using clean spatula
beware of fire risk
avoid SLS containing products

Question 21

proprietary vs non-proprietary emollients?

Answer 21

non-propriety = cheaper, less cosmetically accetable

Question 22

what is wet wrap therapy?

Answer 22

medicated bandages (e.g with zinc xide paste) used for xerotic skin (dry, scaly)
often used on top of moisturizer/steroid

Question 23

what are 3 actions of topical corticosteroids?

Answer 23

vasoconstrictive
anti-inflammatory
antiproliferative

Question 24

what 4 strengths of steroid can be used?

Answer 24

mild
moderate
potent
very potent

Question 25

name 4 uses for topical corticosteroids

Answer 25

eczema (dermatitis)
psoriasis (only on small areas i.e flexures, hairline etc)
keloid scars
non-inflammatory dermatoses like lichen planus

Question 26

what is steroid rebound?

Answer 26

if used extensively, once steroid use is stopped, can have a massive psoriasis flare up

Question 27

how much is in a general steroid tube and how much is needed for 2 hands?

Answer 27

20-30g per tube
fingertip amount (1/2g) covers 2 hands

Question 28

name 8 potential side effects of steroid use?

Answer 28

thinning of skin, purpura and stretch marks
steroid rosacea
perioral dermatitis
fixed telangectasia
worsening of infections
systemic absorption (cushings)
tachyphylaxis (tolerance)
rebound flare

Question 29

what are calcineurin inhibitors? give 2 examples

Answer 29

non-steroidal anti-inflammatories

tacrolimus and pimecrolimus

Question 30

what do calcineurin inhibitors do and what are they used for?

Answer 30

suppress lymphocyte activation

used topically ALL over body in atopic eczema without causing the side effects of steroids

Question 31

what are the risks of calcineurin inhibitors

Answer 31

can cause burning sensation

higher risk of cutaneous infection

Question 32

what are antiseptics and when are they used?

Answer 32

bacteriostatic/bacteriocidal treatments
used in place of antibiotics where possible to prevent resistance
e.g recurrent infections, wound irrigation

Question 33

give an example of an antiseptic and how its used

Answer 33

potassium permanganate

dissolved in water and used in acute exudative eczema

Question 34

what viral infection can be treated with topical antivirals?

Answer 34

herpes simplex (cold sore)

Question 35

give 3 situations where topical antifungals would be used

Answer 35

candida (thrush)
dermatophytes (ringworm)
pityriasis versicolor (scaly pigmentation)

Question 36

name 4 antipuritics and what theyre used for

Answer 36

menthol (e.g dermacool) - cools
capsaicin
camphor/phenol - pruritic ani
crotamiton (eurax) - scabies

Question 37

what are keratolytics and when are they used?

Answer 37

soften keratin (e.g salicylic acid)
used in:
- viral warts
- hyperkeratotic eczema/psoriasis
- corns/calluses
- remove keratin plaques in scalp

Question 38

how are warts treated?

Answer 38

mechanical pairing plus one of:

• keratolytics
• formaldehyde
• silver nitrate
• cryotherapy
• glutaraldehyde
• podophyllin

Question 39

how is psoriasis treated topically?

Answer 39

emollient + one of:

• coal tar
• vit D analogue
• keratolytic
• topical steroid
• dithranol

Question 40

which type of psoriasis generally benefits from light therapy?

Answer 40

that which is triggered by throat infection

Question 41

benefits and drawbacks of vit D analogues?

Answer 41

clean and pleasant to use

can irritate and cause hypercalcaemia if overused

Question 42

drawback of dithranol?

Answer 42

stains the skin

irritant

Question 43

good general treatment for scalp psoriasis?

Answer 43

greasy ointments
tar shampoo
vit D analogues
steroids in shampoo or alcohol base if inflamed