Topical Corticosteroids

shevyatiwari's version from 2015-08-29 03:56


Question Answer
The most commonly used test of potency is the Stoughton Vasoconstriction AssayT
Corticosteroids are dissolved in 95% alcohol and applied to the volar surface of the arm, covered for 16 hours then the degree of vasoconstriction is assessedT
Hydrocortisone valerate and aclometasone ointment are two TCS that demonstrate higher clinical efficacy than their vasoconstrictive propertiesF, other way around
PK and potency depend on 3 factorsF, 4. The structure, vehicle, concentration, characteristics of skin to which it is applied
Betamethasone is the backbone of most TCSF, hydrocortisone is
Clobetasol binds tighter to GCR than betamethasone due to repalcement of 21-hydroxyl groupT
Betamethasone valerate is 125 times more potent than vetamethasoneT
Double bonds in 1 position increases mineralocorticoid activityF, increases glucocorticoid activity
Enzymes in the dermis cause de-esterification of TCS into inactive metabolitesF, enyzymes in the EPIdermis
Solvents create a more viscous productF, less viscous
Propylene glycol enhances percutaneous absorption and thus increases potencyT
Ointments more potent than othersT
Emulsifiers help distribute the drug evenlyT
Foams are well acceptedT
Penetration of drug correlates directly with thickness of SCF, inverseley
With increased hydration of the skin, humidity and temperature, there is increased absorptionT
Corticosteroids diffuse into target cell and bind to surface GCRF, GCR in the cytoplasm
Corticosteroid-GCR complex traverses the nuclear envelope and directly binds to DNAT, also can indirectly bind to DNA
Negative gene regulation is associated with adverse effectsF, associated with anti-inflammatory action vs, positive gene regulation associated with adverse effects
Positive gene regulation is associated with anti-inflammatory effectsF, associated with adverse effects
Epidermal Langerhan's cells and APC's are increased in numberF, decreased and have decreased cellular receptors
PML's are more likely to adhere to vascular endothelium and are increased in numbers at sites of inflammationF, less liekly to adhere, and numbers are reduced
Monocytes are decreased in numberT
Lymphocytes demonstrate decreased antibody dependent cellular toxicityT
Mast cell sensitisation is reducedT
IL1, 2, IFN gamma, TNF a, GMCSF is reducedT
Lipocortins are reducedF, increased which inhibit phospholipase A
Granular layer becomes reduced/absentT
Basal layer of keratinocytes is flattenedT
Keratinocyte ultrastrcuture is alteredF, normal
BM is unaffectedT
Melanocyte pigment production enhancedF, inhibited
Collagen and elastic fibres reducedf, unchanged
Decreased water content and loss of GAG'sT
Creamed based barrier creams, pimecrolimus, tacrolimus can augment the benefitT
UVB phototherapy and TCS show no effect in time to clearingT
TCS can be synergistic with PUVA, biologics, cyclosporine, salicylic acid, anthralin, calcipotriene, tazaroteneT
RF for systemic adverse effects includeyoung age, liver disease, renal disease, amount and potency of TCS, use of occlusion, lack of supervisionT
RF for local atrophy include older age, potency of TCS, use of occlusion and locationF - younger age
Near puberty, can cause premature epiphyseal closureT
Test of choice for monitoring HPA suppression is the metyrapone testF - 8am plasma cortisol. Definitive diagnosis is the metyrapone test or insulin hypoglycaemia test
Treatment of HPA suppression includes PO steroid while tapering TCST
Daivobet does not cause HPA suppressionT
Low potency TCS cause HPA suppressionF
Foetal growth retardation may occur with potent/very potent TCST
There were increases in orofacial cleft, preterm delivery and feotal death with high potency TCS in pregnancyF, no association
Adverse effects are generally uncommonT - comparable to vehicle
Most common adverse effect is irritationF, atrophy
Atrophy can be seen within 2 weeks of super potent TCS under occlusionF, 7 days
Atrophy can be seen within 2 weeks of use of less potent under occlusion or super potent withoutT
Striae and atrophy which are significant are seen after many weeks to monthsT
Application of TCS to the genitala is 10 times more than glabrous skinF, 40 times more
Sulfur and hydrocortisone does not cause steroid acneT
Periorbital absorption can be 36-40 times higher than palm/soleT
Glaucoma and cataracts are S/ET
Rates of ACD are approx 5%T
Patch testing to TCS and vehicles should give results on routine 2, and 4 day assessmentF, need to check for 7-10 days
TCS often cross react within their group, but rarely betweenT
Treatment of ACD includes the use of a TCS from a different groupT
Facial hypertrichosis, folliculitis, miliaria, genital ulceration and granuloma gluteale infantum are all S/ET
Propylene glycol and sorbitan sesquioeleate are the most common allergens in TCST
Compounding with salicylate, tar, antibiotics and anti fungal can alter stabilityT
Urea 10% is appropriate for compounding with F, causes significant degradation
Mnethol, phenol, camphor, salicylic acid and LCD do not cause degradation of TCST

Recent badges