Topical Steroids

Question 1

Which vehicle is the most lipophilic, moisturizing, and occlusive?

Answer 1

Ointments

Question 2

Vehicle of choice for occlusve skin folds: ointment, cream, gel, or foam?

Answer 2

Creams

Question 3

creams wet or dry things?

Answer 3

dry

Question 4

Do gels wet or dry things?

Answer 4

dry

Question 5

Best vehicle of choice for a full head of hair?

Answer 5

foams

Question 6

Cautions for foams?

Answer 6

Do not use if age < 12 yrs
Do not use longer than 2 weeks
The steroid affect -> HPA axis suppression

Question 7

Topical steroid + Anti-fungal Combo Therapy

What is Mycolog-II?

Answer 7

Nystatin + Triamcinolone (Kenalog)
Use: Candida in skin folds

Nystatin = Antifungal
Kenalog = Class 3 steroid

Question 8

What is tinea pedis, cruris, capitis?

Answer 8

Tinea is a fungal infection caused by dermatophyes

Tinea pedis = fungal infx of feet
Tinea cruris = fungal infx of crotch “jock itch”
Tinea capitis = fungal infx of scalp

Question 9

Topical steroid + Antifungal Combo therapy

What is Lotrisone?

Answer 9

Lotrimin (Clotrimazole) / Betamethasone dipropionate topical
Use: tinea pedis/cruris/corporis
popular 1st choice for topical anti-inflammatory trmnt

Question 10

Why does Mycolog-II not treat tinea pedis/cruris/capitis?

Answer 10

Mycolog-II = Nystatin/Triamcinolone
Nystatin is an antifungal that works well for Candida, NOT dermatophytes

unsure why exactly, data just says it doesnt work well

Question 11

Should hydrocortisone cream on a diaper rash be used cautiously?

Answer 11

yes, it can still create HPA axis suppression

Question 12

do central or distal areas absorb better?

Answer 12

central

Question 13

Which steroid class is most and least potent?

Answer 13

Class I - most potent
Class VII - least potent

Question 14

SE of steroids?

Answer 14

Striae
Hypopigmentation
Atrophy
Purpura (easy skin bruising)

Question 15

Which SE of steroids is this?

pt put Class II Desoximetasone on her eyelids and it resulted in bleeding eyelids and incr in intraocular pressure.

Answer 15

Atrophy

Question 16

Which SE of steroids is this?

Pt put steroid on his dick and now its bleeding

Answer 16

Atrophy
the foreskin acts like an occlusive dressing and incr absorption of the steroid

Question 17

Pts groin was red and angry, so they put steroids on it. symp go away and come back after stopping steroid use. What else could this be?

Answer 17

underlying fungal infection (tinea cruris)

Fungal infections of this type typically have a sharp, scaly border and show little tendency to spread

Question 18

Possible skin signs of allergic rxn to topical steroids?

Answer 18

MC: eczema look
Exanthema
Purpura
Utricaria

Question 19

Pt uses a Class V topical steroid for more than 6mo. Now she has numerous red papules on her cheeks. What is this?

Answer 19

Steroid Rosacea

Question 20

Pt uses Class V topical steroid on her entire face and then gets diffuse pustular eruptions. The inflammation goes away each time she puts more steroid on and then flares up again when she stops. What is this?

Answer 20

Steroid acne

Question 21

Systemic effects of topical steroids?

Answer 21

Question 22

Use the ____ method when giving IM injections

Answer 22

Question 23

5 common mistakes of topical steroid use

Answer 23

1. steriod too weak for process and area
2. underdosing
3. failure to FU
4. too strong on kids
5. too strong on face

Question 24

the entire skin surface of an average adult = _______ g of cream

Answer 24

20-30

Question 25

1 Fingertip Unit (FTU) = _____ g cream

Answer 25

1 FTU = 0.5g Cream ## Footnote Note: this only works if the tube nozzle aperature is 5mm diameter

Question 26

# Rule of Hand Area 2 HA = ____ FTU or _____ g cream

Answer 26

Question 27

Tachyphylaxis

Answer 27

Decrease in responsiveness to a drug as a result of enzyme induction with successive use overtime, you buld up a tolerance to how well the steroid can vasoconsrict you

Question 28

Vasoconstriction _______ progressively when a potent topical steroid is applied TID for >4days

Answer 28

decreases ## Footnote vasoconstriction response returns after 4 days off the steroid

Question 29

use no more than _____ g of a Class I steroid per week

Answer 29