Topical Treatment Flashcards
(102 cards)
1
Q
What makes up topical treatment?
A
- base or vehicle
with/without - active ingredients
2
Q
Describe the base/vehicle of topical treatment?
A
Transport of the active constituent into the skin
- The base is determined by the
hydration of the skin
3
Q
What is the active ingredient in topical treatment?
A
The active constituent is determined by the pathological process
4
Q
Vehicle/base is made of a combination of?
A
- oils and greases
- liquid paraffin, petrolatum , lanolin, vegetable oils - liquids
- water, alcohol - powders
- zinc oxide, starch, talcum
5
Q
Name the types of bases?
A
- OINTMENT ( < 20% WATER)
- CREAM (W/O AND O/W)
- LOTION: O/W OR POWDER/W
- SOLUTION (IN WATER, ALCOHOL)
- GEL
- PASTE: OIL, WATER, POWDER
- FOAM
- SOLID
6
Q
Which bases contain a mixture of grease/oil and water?
A
- OINTMENT: 80-100%
- CREAM
- LOTION
7
Q
What is needed to mix fat and water?
A
emulsifier
8
Q
What is an emulsifier?
A
Have a polar group with affinity for water (dissolves in water) and a
non-polar group with affinity for oil (dissolves in oil)
1. emulsion oil/water
e.g. aqueous cream: washed off with water
2. emulsion water/oil
e.g. oily cream cannot be washed of with water
9
Q
What is an ointment?
A
GREASE OR OIL: WATER-FREE OR NEARLY WATER-FREE (<20%)
1. WATER FREE: NON-EMULSIFYING
2. WITH SOME WATER: EMULSIFYING OINTMENT
10
Q
Ointment is made of?
A
- HYDROCARBON (PARAFFIN)
- WOOL FAT,
- VEGETABLE OIL (OLIVE OIL, ARACHID OIL, COCONUT OIL)
11
Q
What happens if you mix ointment with water?
A
EMULSIFIERS
1. LANETTE WAX
2. CETOMACROGOL WAX
3. BEEWAX
3. CETOSTEARYL ALCOHOL AND SODIUM LAURYL
4. SULPHATE
5. GLYCERYL-STEARATE
12
Q
Example of components in an ointment?
A
- PETROLATUM (SOFT PARAFFINE, VASELINE)
* YELLOW - MAY CAUSE SENSITIZATION REACTIONS
* WHITE - MAY CAUSE IRRITATION DUE TO TRACES OF BLEACH
NB. PURIFICATION PROCESS IS EXTENDED FURTHER IN WHITE PETROLATUM - LIQUID PARAFFIN
- EMULSIFIER
* OIL IN WATER / WATER IN OIL
* LANETTE WAX TO HELP MIX
* CETOMACROGOL WAX TO HELP MIX
13
Q
Uses of ointment?
A
FORMS AN IMPERMEABLE LAYER OVER THE SKIN TO PREVENT WATER EVAPORATION AND HEAT LOSS.
1. REDUCE TRANSEPIDERMAL WATER LOSS
2. INCREASE BARRIER FUNCTION
3. SOFTEN DRY SKIN
4. EASE ITCHING
5. REDUCE SCALING
6 ALLOW ACTIVE INGREDIENTS INTO THE SKIN
14
Q
Medical uses of ointment?
A
- DRY SKIN, ECZEMA
- PREVENTION FROM FROST-BITE
15
Q
Advantages of ointments?
A
- No need for preservative, so contact
allergy is rare - Emulsifying ointments are a good
vehicle for active ingredient - Easy to make, and cheap
- longevity
16
Q
Disadvantage of ointments?
A
- Sticky
- Occlusive => pommade acne
- Difficult to apply, especially on hairy
skin - Difficult to wash of with water
- Bacteria, yeasts and fungi may be
trapped and will thrive and overgrow - Non-emulsifying ointments: do not
penetrate the skin, drugs used in
these ointments will only have
superficial activity - Increase sunburn by acting like a
magnifier
17
Q
What are creams?
A
CREAMS CONSIST OF LIPOPHILIC AND A HYDROPHILIC PHASE COMBINED WITH ONE OR MORE EMULSIFIERS AND PRESERVATIVES
18
Q
Describe the features of creams and their different types?
A
WATER CONTENT ALLOWS THE CREAM TO RUB IN WELL
1. HYDROPHILIC CREAMS OUTER PHASE IS AQUEOUS
▪ OIL IN WATER»_space; WASHABLE, COSMETICALLY ACCEPTABLE
2. LIPOPHILIC CREAMS THE OUTER PHASE IS FATTY
▪ WATER IN OIL»_space; BETTER DRUG ABSORPTION
19
Q
Describe oil in water creams?
A
e.g. AQUEOUS CREAM
1. VANISHING CREAM, RUBS INTO THE SKIN EASILY AND MIXES READILY WITH WATER
- SO SUITABLE FOR ECZEMA THAT IS A BIT OOZING, IMPETIGO
2. WHEN WATER EVAPORATES A THIN LAYER OF OIL REMAINS, MAY EVEN BE TOO DRYING.
- SUITABLE FOR PEOPLE WITH NORMAL SKIN OR A BIT FATTY SKIN.
3. CAN ALSO ADD OTHER INGREDIENTS EG. CALAMINE (ZNO) / ZINC
20
Q
Describe water in oil creams?
A
- LIKE AN OINTMENT: OILY BUT WATER CONTENT MAKES IT EASIER TO SPREAD AND ENHANCES ABSORPTION OF ACTIVE INGREDIENTS
- DOES NOT MIX WITH EXSUDATES FROM THE SKIN
=> LESS SUITABLE FOR WET DERMATITIS - CAN BE USED AS A VEHICLE FOR LIPID SOLUBLE SUBSTANCES
- MANY DRUGS INCORPORATED INTO CREAMS ARE HYDROPHOBIC AND WILL BE RELEASED MORE READILY FROM A W/O CREAM
EG. ZINC OXIDE IS LIPOPHILIC - WATER-IN-OIL CREAMS ARE LESS SUITABLE FOR TROPICAL CONDITIONS SINCE PHYSICALLY LESS STABLE AND PRONE TO MICROBIAL CONTAMINATION
21
Q
Components of a basic cream?
A
- 15 % LANETTE WAX SX = EMULSIFIER
- 12,5% LIQUID PARAFFIN = oil phase
- 22,5% PETROLATUM = oil phase
- 0,15% METHYLPARABEN = PRESERVATIVE
- 50 % WATER = water phase
22
Q
Describe the water phase?
A
- WATER IS GENERALLY USED AS HYDROPHILIC PHASE IN CREAMS
- WATER IS VULNERABLE, SINCE IT CAN EASILY EVAPORATE
=> HUMECTANTS SUCH AS GLYCEROL OR SORBITOL ARE ADDED TO PREVENT WATER EVAPORATION - EVAPORATION OCCURS IN STORED CREAMS (STABILITY PROBLEM) AND
AFTER APPLICATION - NEEDS PRESERVATIVE
23
Q
Advantages of creams?
A
- Easy to apply
- Cosmetic friendly
- Less/non-occlusive
- A good base for many active
ingredients
24
Q
Disadvantages of creams?
A
- Has to contain preservatives
- Has to contain emulsifiers
- Can make skin dry
- Cost more
- Stability problems
25
What are lotions?
- LOW-VISCOSITY TOPICAL PREPARATIONS
- TWO DIFFERENT TYPES
1. shake lotions
2. diluted creams = emulsion
26
Describe shake lotions?
- POWDER IN A WATER PHASE
- ANTIPRURITIC, DRYING
- SHAKE LOTIONS” HAVE A COOLING (ANTI-ITCH) EFFECT BECAUSE AFTER
THE EVAPORATION OF THE LIQUID THE INERT POWDER IS LEFT ON THE
SKIN
e.g. CALAMINE LOTION
27
Describe diluted cream lotions?
- WATER ADDED TO A CREAM.
- IDEAL FOR HAIRY SKIN, SCALP AND FLEXURAL AREA’S
28
What are solutions?
* LIQUID FORM: WATER OR ALCOHOL.
* DRYING EFFECT
EG. GENTIAN VIOLET, POTASSIUM PERMANGANATE SOLUTION
29
What are pastes?
COMBINES 3 AGENTS: OIL, WATER, POWDER (UP TO 50%)
30
Describe astes?
* POWDER CONTENT ALLOWS ABSORPTION OF EXUDATE
* VERY ADHESIVE : STAY WHERE YOU PUT THEM AND DO NOT SPREAD AS THE SKIN WARMS UP
* PREVENTS SPREAD OF ACTIVE INGREDIENTS TO SURROUNDING SKIN
* CAN BE USED AS VEHICLES
* COAL TAR PASTE = ZINC COMPOUND PASTE WITH 7.5% COAL TAR
* LASSARS PASTE = VEHICLE FOR DITHRANOL
31
What are gels?
- WATER PHASE WITH GELFORMER
- USED FOR COOLING, DRYING
- LIQUEFIES UPON CONTACT WITH SKIN
- NEEDS PRESERVATIVES
32
What do you need to think about when selecting a base?
1. NATURE OF SKIN CONDITION
2. AREA OF THE BODY
33
Select a base in the accordance of the nature of the skin condition?
1. FOR WET OR OOZY SKIN CONDITIONS
— O/W CREAMS, LOTIONS, AND DRYING PASTES ARE MOST SUITABLE.
2. FOR DRY, SCALY SKIN CONDITIONS
— OINTMENTS AND OILS ARE APPROPRIATE.
3. FOR INFLAMED SKIN
— USE WET COMPRESSES FOLLOWED BY CREAMS OR OINTMENTS.
4. NORMAL SKIN: CREAM
34
Select a base in accordance to site of skin infection?
1. PALMS AND SOLES
— AN OINTMENT OR CREAM MAY BE PREFERRED.
2. SKIN FOLDS
— USE A CREAM OR A LOTION (OINTMENTS ARE TOO OCCLUSIVE FOR THESE SITES)
3. HAIRY AREAS
— A LOTION, SOLUTION, GEL OR FOAM IS USUALLY BEST.
4. MOUTH:
— ORABASE (COMBINATION OF OINTMENT AND GELATINE), GEL, LIQUID: MOUTHWASH
35
How much do I prescribe for treating one area at time?
1. For the whole body: 20-30 g
2. For the trunk: 3 + 3 g
3. For face and neck: 1 g
4. For a leg: 3 g
5. For a foot: 1 g
6. For an arm: 1 ½ g
7. For a hand: ½
36
What is a fingertip unit?
one FTU is 0,5 gram
37
What is the main diffusion barrier of the skin?
stratum corneum
38
3 main routes for skin entry?
1. INTERCELLULAR ROUTE
2. INTRACELLULAR
3. TRANSAPPENDAGEAL ROUTE
- MAJORITY OF TOPICALLY APPLIED MOLECULES ARE LIPOPHILIC AND WILL PERMEATE THE SKIN VIA THIS ROUTE
39
What is absorption?
means it gets all the way to the c=bottom layer of the skin and then sucked into the bloodstream
40
What is penetration?
means it gets all the way to the bottom layer of your skin and then stop
41
Skin entry is dependent on?
1. physical/chemical properties of active ingredient
2. concentration
3. the vehicle
4. variations in skin: thick, folds, temperature, moist, skin diseases
42
How skin entry is dependent on physical/chemical properties of active ingredient?
PENETRATION ENHANCED WHEN LOW MOLECULUR WEIGHT, LIPID SOLUBLE, AND NONPOLAR
43
How skin entry is dependent on concentration?
DOSE-RESPONSE CURVE: HIGHER CONCENTRATION, GREATER QUANTITY OF MEDICATION ABSORBED
44
How skin entry is dependent on the vehicle?
1. THE MORE OCCLUSIVE THE VEHICLE > HYDRATION STR CORNEUM AND PENETRATION OF MEDICATION
2. WATER IN OIL PROMOTES HYDRATION AND THEREFORE ABSORBTION
45
How skin entry is dependent on variations in skin?
1. HIGH: SCROTUM, AXILLA’S, FACE + EAR (STR CORNEUM = THIN)
2. LOW: PALMS AND SOLES
46
Cautions with topical medications?
1. SYSTEMIC ABSORPTION
2. PREGNANCY
3. CHILDREN, ESPECIALLY NEONATES
4. INFLAMMATORY CONDITIONS
- EROSIVE, WARM, MOIST, HIGHLY VASCULARIZED SKIN INCREASES ABSORPTION
47
Why are neonates at higher risk of systemic toxicity from topical medication?
1. INCREASED RATIO OF SURFACE AREA TO BODY WEIGHT (FOURFOLD GREATER THAN IN ADULTS)
2. SUBOPTIMAL EPIDERMAL BARRIER FUNCTION DUE TO THE HIGHER PH OF NEONATAL STRATUM CORNEUM (NEUTRAL INSTEAD OF ACIDIC)
3. DECREASED HEPATIC METABOLISM OF DRUGS
4. DECREASED RENAL EXCRETION OF DRUGS
5. INCREASED DISTRIBUTION OF DRUG, INCLUDING THE CNS DUE TO A MORE PERMEABLE BLOOD–BRAIN BARRIER
6. DECREASED PLASMA PROTEIN BINDING
48
Group of active ingredients?
1. CORTICOSTEROIDS
2. ANTISEPTICS
3. ANTIBIOTICS
4. ANTIFUNGALS
5. SCABICIDES
6. KERATOLYTICS
7. ANTIPRURITICS
8. SUNSCREENS
9. OTHER (ANTI-INFLAMMATORY, MOISTURIZERS, VITAMIN D
49
Mode of actionof corticosteroids?
1) SUPPRESSION OF INFLAMMATION
2) REDUCTION IN CELL PROLIFERATION
3) VASOCONSTRICTION
50
Classification of corticosteroids?
1.WEAK
* HYDROCORTISONE ACETATE 1%
2. MODERATE
* TRIAMCINOLONE ACETONIDE 0,1%
* BETAMETHASONE 17 VALERATE 0,025%
3. STRONG
* BETAMETHASONE 17 VALERATE 0,1%
* BETAMETHASONE DIPROPIONATE 0,1%
4. POTENT
* CLOBETASOL 17 PROPIONATE 0,05%
51
Local side effects of corticosteroids?
1. ATROPHY, STRIAE
2. BRUISING
3. HYPERTRICHOSIS
4. SUPPRESSION OF PIGMENTATION
5. TELEANGIECTASIA
6. USED IN THE FACE => PERIORAL DERMATITIS AND ACNE
7. AROUND THE EYES: GLAUCOMA
- ALSO: BURNING, STINGING, CONTACTALLERGY, DELAYED WOUND HEALING,
MASKING OF FUNGAL INFECTION, PSORIASIS
PUSTULOSA, TRIGGERING OF HERPES
INFECTION
52
Systemic side effects of corticosteroids?
IATROGENIC CUSHING SYNDROME →
1. REDUCED STRESS RESPONSE
2. CENTRAL OBESITAS
3. MUSCLE WEAKNESS
4. STRIAE,
5. ACNE
6. HIRSUTISM HIGH BLOOD PRESSURE,
7. DEPRESSION, ANXIETY
53
How to use steroids?
1. STRONG/POTENT STEROID FOR RAPID EFFECT FOR SERIOUS CONDITION FOR A SHORT
PERIOD (2-3 WEEKS ONCE -OR TWICE – DAILY) PREFERABLY SMALL AREA AND THIN
- THEREAFTER ONLY USE INTERMITTENTLY: (E.G. USE 3-4 DAYS/WK, RESP STOP 4-3 DAYS)
2. IF THE SKIN CONDITION GETS BETTER: LOWER THE STRENGTH AND PROLONG THE INTERVAL
3. PROPHYLACTIC USE: TWICE A WEEK TO PREVENT RECURRENCE
4. DON’T USE STRONG/POTENT TOPICAL STEROIDS ON BABIES, FACE OR GENITAL AREA!!!!
5. WHEN ONLY STRONG TOPICAL STEROIDS ARE AVAILABLE → DILUTE WITH EQUAL AMOUNT OF COOKING OIL
54
How much steroids should you use?
DEPENDS ON:
AGE, SKIN SITE, BROKEN SKIN, INFLAMED SKIN, WET SKIN, OCCLUSION,
SKIN TEMPERATURE, VEHICLE BASE
1. STRONG/POTENT: NOT MORE THAN 50 G A WEEK FOR ADULTS
2. INTERMEDIATE: NOT MORE DAN 100 G A WEEK FOR ADULTS
55
Topical steroids in pregnancy?
- PASS THE PLACENTA BUT CAN BE USED.
- CHOOSE LOWEST POSSIBLE STRENGTH
- USE FOR SHORT PERIOD OF TIME
56
Consequences of steroids in pregnancy?
INTRA-UTERINE GROWTH REDUCTION
THIRD TRIMESTER: ADRENAL GLAND SUPPRESSION => NEONATAL
HYPOGLYCEMIA, HYPOTENSION AND IMMUNE SUPPRESSION
57
Why use antiseptics?
less resistance than antibiotics
58
Name types of antiseptics?
1. chlorhexidine
2. iodine/povidone iodine
3. chlorine/chlorine releasing preparations
4. potassium permanganate (0.1%)
5. gentian violet (0.5%)
6. silver nitrate
7. sulphur (5-10%)
59
Describe chlorhexidine and its uses?
* CHEAP & WELL TOLERATED
* NO ACTION AGAINST FUNGI
* QUICK ACTION AGAINST GRAM-POS, GRAM NEG, SOME PSEUDOMONAS AND PROTEUS SPECIES
* STILL ACTIVE IN PRESENCE OF BLOOD AND PUS
* NON-TOXIC TO HUMAN-CELLS
* RESISTANCE OCCURS
* REASONABLY STABLE, DECOMPOSITION PRODUCTS ARE TOXIC
* USED CONCENTRATION 1-2%
60
Describe iodine and its uses?
* GOOD ACTIVITY, AGAINST BACTERIAL SPORES AND VIRUSSES
* QUICK ACTION
* UNSTABLE
* EXPENSIVE
* STINGS AND STAINS
* ALLERGIES!
61
Side effects of iodine use?
SIDE EFFECTS: LARGE PARTS OF THE BODY => THYROID FUNCTION MAY BE INFLUENCED
62
Describe chlorine and its uses?
* CHEAP AND EFFECTIVE
* RESISTENCE UNLIKELY
* RAPIDLY INACTIVATED BY ORGANIC MATTER
* MAY CAUSE DISSOLUTION OF BLOOD CLOTS AND BLEEDING
* EUSOL = SODIUMHYPOCHLORIET 0,25% IN PARRAFFIN
63
Describe potassium permanganate and its uses?
* CHEAP
* QUICK ACTION
* NO RESISTANCE
* RAPIDLY INACTIVATED BY ORGANIC MATTER (BLOOD, PUS, COTTON SWABS SKIN)
* UNSTABLE IN DILUTE SOLUTION, FRESH PREPARED FROM STOCK SOLUTION
64
Describe gentian violet and its uses?
* USED AGAINST STREPTOCOCCI, STAPHYLOCOCCI AND CANDIDA INFECTIONS
* SOME EFFECTIVELY AGAINST GRAM NEGATIVE ORGANISM
* STAINS, USED ON WOUNDS STAINS MAY BE PERMANENT
* 0.5% OR BELOW, HIGHER PERCENTAGES CAUSE NECROTIC REACTIONS
* THE WATER IN THE SOLUTION CAN EVAPORATE, HIGHER PERCENTAGES CAN
OCCUR.
* SUSPECTED CARCINOGENS, NOT PROVEN
65
Describe silver nitrate and its uses?
* EXPENSIVE
* NON SENSITISING
* WELL TOLERATED
* VERY SMALL THERAPEUTIC WINDOW (0,1% INEFFECTIVE,
0,5% EFFECTIVE, 1,0% TOXIC)
* STAINS SKIN AND CLOTHS
* USED FOR TREATMENT OF BURNS, FOR TREATMENT OF LEG
ULCERS.
* STICKS => HYPERGRANULATIONS
66
Describe sulphur and its uses?
* KERATOLYTIC AND ANTISEBORRHEIC EFFECT, SUPPOSEDLY
ANTIMICROBIAL EFFECT
* USE FOR PERIANAL DERMATITIS, ACNE, SEBORRHOIC
DERMATITIS, SCABIES, PITYRIASIS VERSICOLOR
* NONTOXIC AND SAFE
67
Disadvantages of antibiotic use?
1. BACTERIAL RESISTANCE: SKIN > SYSTEMIC
* RELATED TO PRESENCE OF LARGE NUMBERS OF BACTERIA + VIRUSES ON SKIN, PARTICULARLY IN SKIN INFECTIONS, AND FLUCTUATING CONCENTRATIONS OF THE ANTIBIOTIC
2. HYPERSENSITIVITY MAY DEVELOP QUICKLY AFTER TOPICAL USE
* DANGEROUS AS IT CAN PROHIBIT LATER SYSTEMIC USE IN LIFE
THREATENING SITUATIONS
3. GENERALLY UNSTABLE CHEMICALS
* PREPARATIONS CONTAINING WATER TEND TO HAVE LIMITED SHELF LIFE
68
Name antibiotics used in dermatology?
1. tetracycline
2. chloramphenicol
3. neomycin
4. bacitracin
5. erythromycin/clindamycin
6. fusidic acid
7. mupirocin
69
Describe tetracycline and its uses?
* WELL TOLERATED
* UNSTABLE IN WATER, DECOMPOSITION PRODUCTS TOXIC
* IMMUNOMODULATORY PROPERTIES
* PHOTOSENSITIVITY
* IN PREGNANCY: DO NOT USE AFTER WEEK 16
70
Describe chloramphenicol and its uses?
* MODERATELY SENSITISING
* REASONABLY STABLE
* SIDE EFFECT: RISK OF BONE MARROW DEPRESSION
71
Describe neomycin and its uses?
* RELATIVELY SMALL SPECTRUM, NON TOXIC TO SPREPTOCOCCI,
COMBINE WITH OTHER ANTIBIOTIC
* STABLE
* HYPERSENSITIVITY NOT UNCOMMON, CROSS SENSITIVITY TO
OTHER AMINOGLYCOSIDES
72
Describe bacitracin and its uses?
* GENERALLY COMBINED WITH NEOMYCIN
* WELL TOLERATED
* UNSTABLE, CAN ONLY BE USED IN WATER-FREE PREPARATIONS
73
Describe erythromycin/clindamycin and its uses?
* WELL TOLERATED
* UNSTABLE IN WATER
* USED FOR ACNE, FOLLICULITIS AND BACTERIAL VAGINOSES
74
Describe fusidic acid and its uses?
* UNSTABLE IN WATER
* LESS ACTIVE IN PRESENCE OF BLOOD AND PUS
* USED FOR RESISTANT STAPHYLOCOCCI
75
Describe mupirocin and its uses?
* USED FOR RESISTANT STAPHYLOCOCCI
76
Use of antifungals?
TOPICAL ANTIFUNGALS CAN BE USED FOR SUPERFICIAL MYCOSES
77
Name antifungals?
1. Whitfields ointment
2. Gentian violet
3. Imidazoles
4. Nystatin
5. Sodium thiosulphate
78
Describe Whitfields ointment and its uses?
* SALICYLIC ACID 3%, KERALOTYTIC
* BENZOIC ACID 6%
* ACTIVE AGAINST DERMATOPHYTES, NOT AGAINST CANDIDA SP
* EMULSIFYING OINTMENT IS MORE EFFECTIVE THAN
PETROLATUM
* CREAM IS CONSIDERED TO BE SOMEWHAT MORE ACTIVE
79
Describe gentian violet and its uses?
* CANDIDA INFECTIONS AND SOME
BACTERIA
* 1-2 DD 4-7 DAYS
80
Describe imidazoles and their uses?
* BROAD SPECTRUM
* ACTIVE AGAINST DERMATOPHYTES AND CANDIDA SPP. AND SOME BACTERIA ( CORYNEBACTERIA IN
ERYTHRASMA AND PITTED KERATOLYSIS)
* NON TOXIC
* QUICKER BUT EQUALLY EFFECTIVE AS WHITFIELD’S OINTMENT
81
Describe nystatin and its uses?
- ACTIVE AGAINST CANDIDA INFECTIONS
- EXTREMELY UNSTABLE
- MUCH RESISTANCE
- APPLY TWICE A DAY.
- ON THE AREA AND 1 CM AROUND
- IS THE AREA COMPLETELY HEALED? CONTINUE FOR TWO EXTRA DAYS.
82
Describe sodium thiosulphate (25%) and its uses?
* PITYRIASIS VERSICOLOR
* WELL TOLERATED
* NON TOXIC
* VERY CHEAP
83
Name scabicides?
1. permetrine 5% cream
2. benzylbenzoate emulsion 10-25%
84
Describe permetrine 5% cream and its uses?
* TWICE, ONE WEEK APART. 30 GRAM PER TIME PER ADULT.
- ALSO HEAD, FACE AND EARS IN BABIES (AND ELDERLY)
* 8-12 HOURS BEFORE WASHING OFF
85
Describe benzylbenzoate emulsion and its uses?
* APPLY TWICE 1 WEEK APART
* LESS EFFECTIVE THAN LINDANE
* MORE EXPENSIVE THAN PERMETRINE
* TOXICITY NOT SO WELL DOCUMENTATED
86
Use of keratolytics?
1. DISSOLVE CALLUS AND WARTS
2. DIMINISH FLAKINESS (IE PSORIASIS)
3. ENHANCE PENETRATION OF OTHER INGREDIENTS
87
Types of keratolytics?
1. MILD KERATOLYTICS: RESORCINOL, SULPHOR
2. STRONG KERATOLYTICS: SALICYLIC ACID, TRICHLOROACETIC ACID,
SILVERNITRATE
=> CAREFULL NOT FOR WARTS IN FACE!
3. Other - propylene glycol, urea, silver nitrate, lactic acid, glycolic acid, tar
88
Describe salicylic acid and its uses?
* KERATOPLASTIC => DISSOLVE THE KIT SUBSTANCE IN THE HORNY LAYER
(CONC. 2-3%)
* KERATOLYTIC (ABOVE 3%)
* CAUSTIC EFFECT (ABOVE 10%)
* ENHANCES PENETRATION OF CORTICOSTEROIDS
* LITTLE ANTISEPTIC ACTIVITY
* USED FOR ACNE, HYPERKERATOSIS, ANTIMITOTIC
* SUFFICIENTLY STABLE
Note: USE OF SALICYLIC ACID IS NOT RECOMMENDED IN
CHILDREN UNDER 2 YEARS DUE TO HIGHER ABSORPTION
89
Salicylic acid intoxication signs?
HEADACHE
DIZZINESS
RAPID BREATHING
NAUSEA
SWEATING
DISORIENTATION
90
Describe benzoyl peroxide and its uses?
* KERATOLYTIC
* DRYING
* BACTERIOSTATIC
* BLEACHES SKIN, HAIR AND CLOTHING
* IRRITATION AND SENSITIZATION
* STRONGER THAN SALICYLIC ACID
91
Retinoic acid and its uses?
* ACCELERATE BOTH THE FORMATION AND SHEDDING OF
HORNY LAYER
* ANTI-INFLAMMATORY
* USED FOR ACNE
* IRRITATIVE
* DO NOT USE IN PREGNANCY!
* UNSTABLE COMPOUNDS IN PREPARATION; REFRIGERATOR
* EXPENSIVE
92
Describe tar and its uses?
* KERATOPLASTIC
* ANTISEPTIC
* ANTIPRURITIC, ANTI-INFLAMMATORY
* USED FOR ECZEMA AND PSORIASIS
* WOOD OR COAL
* CHEAP
* TEMPORARY DISCOLOURARTION OF THE SKIN
* DIFFICULT TO HANDLE DURING PRODUCTION
93
Describe resorcinol and its uses?
* KERATOLYTIC (FOLLICULAR KERATIN PLUG: HIDRADENITIS SUPPURATIVA)
* SOME ANTIMITOTIC
* ANTIPRURITIC
* ABSORBTION THROUGH HEALTHY SKIN => SYSTEMIC SIDE EFFECTS (SELDOM,
HIGH CONCENTRATIONS > 20%: CONVULSIONS, DIZZINESS, COLOURED URINE
* FREQUENTLY IRRITATION
94
Describe urea and its uses?
* STRONG MOISTURIZING
* KERATOLYTIC
* ANTIMITOTIC
* VERY USEFUL FOR VARIOUS DRY HYPERKERATOTIC SKIN DISEASES
* PENETRATION ENHANCER FOR CORTICOSTEROIDS AND OTHER DRUGS
* SIDE EFFECT: EPIDERMAL THINNING AND MAY CAUSE BURNING
SENSATION ON DAMAGED SKIN
* DO NOT USE ON BABIES: CANNOT TELL IF IT ITCHES
Note; optimal concentration is 5-10%
95
Describe sulphur and its uses?
* ANTIBACTERIAL, KERATOLYTIC, ANTISEBORRHOIC
96
Name antipruritics?
1. CORTICOSTEROIDS
2. CAPSAICIN (0,025% OR 0,075%): DESENSIBILIZES NOCISENSORS
3. LOCAL ANESTHETICS - LIDOCAINE 1%
5. MENTHOL/CAMPHOR (2%)
- ANESTHETIC EFFECT IN LOW CONCENTRATIONS
- CHANGES PERCEPTION OF ITCH (CONCN OF 0.25%-1%)
- DO NOT USE IN SMALL CHILDREN => LARYNGOSPASMS
6. phenol
97
Describe phenol and its uses?
* ANESTHETIC
* ANTIPRURITIC => 0.5% - 1%
* ANTISEPTIC => TO 2%
* MORE THAN 2 % => CAUSTIC => NAILBED TREATMENT,
CHEMICAL PEELINGS
* SIDE EFFECTS: LOCAL IRRITATION, NECROSIS,
PIGMENTATION DISORDERS
MOSTLY CONC. 1% AND MORE
* ABSORBED THROUGH SKIN
* 0.5% IS REASONABLY SAFE
* PURE COMPOUND IS CAUSTIC AND TOXIC
98
Describe dithranol and its uses?
* ANTI-INFLAMMATORY: BINDS TO DNA AND INHIBITS MITOSIS
* ANTIPROLIFERATIVE EFFECT KERATINOCYTES
* WHITE SKIN MORE SENSITIVE THAN COLOURED SKIN
* MOST EFFECTIVE IN EMULSIFYING OINTMENT OR PETROLATUM
* INCREASING STRENGTHS OF CREAMS 0.05%-3%
* SHORT CONTACT THERAPY 10-30 MINUTES, DAILY
* EFFECT AFTER 2-3 WEEKS. CONTINUE 6-12 WEEKS
* AVOID CONTACT WITH HEALTHY SKIN, SKINFOLDS AD EYES
* STAINS CLOTHES.
* BURNS.
99
Describe vitamin D and its uses?
* CALCIPOTRIOL : 0,005%
* NORMALIZES DIFFERENTIATION OF KERATINISATION
* DEMINISHES CEL PROLIFERATION
* ANTI-INFLAMMATORY (FOR PSORIASIS AND ECZEMA USES)
* > 100 GRAM A WEEK: HYPERCALCIEMIA
100
Types of sunscreens?
1. physical
2. chemical
101
Describe physical sunscreens and their uses?
* PREPARATIONS WITH HIGH AMOUNT OF POWDER: ZINC
OXIDE AND TITANIUM DIOXIDE: UV REFLECTANTS
* PROTECT AGAINST UVB AND UVA
* STABLE
* CHEAP TO MAKE
* WHITE CAST EFFECT (LESS WITH NANOPARTICLES)
102
Describe chemical sunscreens and their uses?
* ABSORB PART OF THE RADIATION
* SUN PROTECTION FACTOR (SPF)
- AN INDICATION OF HOW MUCH LONGER THE SKIN MAY BE EXPOSED TO UVB BUT NOT UVA.
