dermatotherapeutics - topical
DESCRIPTION
CONTENTS Introduction Cytotoxic and Immunomodulatory Drug delivery Patient information Steroids Anti acne Anti-bacterial Anti-fungal Anti-viral Anti-parasitic Calcineurin inhibitors Cytotoxic and Immunomodulatory Keratolytic agents Moisturizers Sunscreen Depigmenting agents Anaesthetic Miscellaneous MCQs Photo QuizTRANSCRIPT
Dermatotherapeutics - Topical
Digital Lecture Series : Chapter 30 Dr. Pallavi Utekar-Telavane
Assistant Professor, Department of Dermatology, Rajiv Gandhi
Medical College and Chatrapati Shivaji Maharaj Hospital, Thane
CONTENTS Introduction Cytotoxic and Immunomodulatory Drug
delivery
Patient information Steroids Anti acne Anti-bacterial Anti-fungal
Anti-viral Anti-parasitic Calcineurin inhibitors Cytotoxic and
Immunomodulatory Keratolytic agents Moisturizers Sunscreen
Depigmenting agents Anaesthetic Miscellaneous MCQs Photo Quiz
Introduction Topical therapy implies delivery of medicines at the
site of the lesion Its a mainstay of treatment in most
dermatological disorders. While prescribing topical agent to the
patient a physician must consider the product itself , the disease
to be treated and the patient. Advantages and disadvantages of
Topical Therapy
Reduced systemic side effects Requires lots of counselling
Accessibility & visibility of the therapy on skin Expected
results might not be achieved due to lack of compliance Few
medicines which cant be used systemically can be used topically
e.g. salicylic acid Allergic reactions can be noted not because of
drug but because of vehicle as well Penetration of molecule is
affected by multiple factors which can affect the desired results
Factors affecting drug delivery
Age of patient: Absorption is more in neonates and children as
compared to adults Traumatised or diseased skin allows easier
penetration Site of application : Absorption is better in the
following sites in descending order : mucous membrane, scrotum,
eyelids, face, chest & back, upper arms & thighs, lower
arms & legs, dorsa of hands & feet, palmar & plantar
skin followed by nails. Potency : Higher the concentration of the
drug in the topical formulation better is the absorption and
therapeutic effect. Vehicle used : Ointments have better
penetration than creams, lotions, gels or pastes Factors affecting
drug delivery
Occlusion : increases hydration and temperature of stratum corneum,
thus increasing penetration of the drug. Hydration: Simple
immersion in water for 5 min prior to application of topical agent
increases absorption. Frequency of application : doesnt
significantly increases effectiveness of molecule except that for
emollients. Quantity of drug applied has negligible effect on
absorption. Massaging: vigorous rubbing or massaging increases the
penetration. Presence of hair follicles : enhances drug
penetration. Vehicle Vehicle is the substance which brings the
topical medication in contact with the skin. Types of vehicles :
Liquids : Solutions , Lotions, Liniments, Suspensions Semisolids :
Creams, ointments, Pastes, Gels Solids : Powders Liquids Solutions
: Wet dressings : These are of 2 types Open and Closed dressings.
Solutions of choice are Normal saline, burrows solution, Condys
compresses etc. Bath : method used when a part or all of the body
has to be treated e.g. 8-MOP bath. Tinctures and Paints : these are
liquid preparations which are applied over skin or mucous membrane
with a brush and left to evaporate. Liquids Lotions : These are
liquid or semisolid preparations and consist of solutions of drug
in water, alcohol or other liquids. On evaporation drug is
deposited on skin surface. Liniments : These are non aqueous
solutions of drugs in oil or alcoholic solutions of soap. Poultices
: These are wet solid masses of particles, sometimes heated, that
are applied to diseased skin. These are used as cleansers and
absorptive agents in chronic exudative lesions such as leg ulcers.
Semisolids Creams : These are semisolid emulsions containing two
immiscible liquids (suspension of water and oil). There are of 2
types: Oil in water type (O/W) Water in oil (W/O) Ointments : These
are semi-solid, soft to firm, greasy preparations that carry active
ingredients in concentration of up to 40%. They are occlusive and
act as emollients. Semisolids Pastes : These are semisolid
preparations of finely powdered material in a greasy base, in
approximately 1: 1 ratio. Pastes protect the skin from
mechanicalforces, absorb moisture and aid drying of oozing and
weeping lesions. Gels : Gels are soft, semisolid preparations,
translucent to transparent in appearance, that liquefy on contact
with the skin and dry as thin, greaseless films. Solids Powders :
Powders are solid preparations used to promote drying or reduce
friction. Newer Drug Delivery System
Nanotechnology : Solid or liquid lipid nanoparticles act as
carriers. Drugs are entrapped within lipid core matrix. It improves
cutaneous bioavailability as it has ability to penetrate follicles.
Microemulsions : This is a thermodynamically stable mixture of oil
and water stabilized by surfactants. Can solubilize many poorly
soluble drugs. Newer Drug Delivery System
Liposomes : These are vesicles which consist of one or more
concentric lipid bilayers separated by aqueous buffer compartment.
These either get adsorbed over skin and release the drugs or
penetrate via lipid rich channels. Microsponges : These have porous
beads which encloses the active drug. Cosmetically better
acceptance. Instruction provided to patients
Frequency of application. Timing of application. Quantity for every
application. Common side effects seen with the medication. Total
duration of use. Not to self-treat. Quantity of application
It is described in terms of Finger Tip Unit and Hand areas. Finger
Tip Unit (FTU) : If a cream or ointment is squeezed out of a tube
which has a nozzle of 5mm, over the distal section of an index
finger from distal skin crease to tip of finger, the amount is
roughly equal to 0.5g. Quantity of application
Site for an adult Quantity in FTU No. of Hand Areas Face and Neck
2.5 5 Front and Back of Trunk 14 28 One arm 4 8 One hand 1 2 One
leg 16 One foot Topical Steroids Mechanism of Action
It acts by binding to specific DNA sequence i.e. Glucocorticoid
responsive elements (GRES) and transcription of specific mRNA.
Anti-inflammatory Immunosuppressive Anti-proliferative
Vasoconstriction Potency ranking of topical corticosteroids
Class 1 (Super potent) Halobetasone Propionate (0.05%) Clobetasol
propionate (0.05%) Class 2 (Potent) Mometasone Furoate oint (0.1%)
Betamethasone dipropionate (0.05%) Class 3 (Potent) Fluticasone
Propionate (0.005%) oint Class 4 (Mid-strength) Mometasone Furoate
cream (0.1%) Triamcinolone Acetonide oint (0.1%) Potency ranking of
topical corticosteroids
Class 5 (Mid strength) Fluticasone Propionate cream (0.05%)
Hydrocortisone Butyrate (0.1%) Class 6 (Mild) Desonide (0.05%)
Fluocinolone Acetonide cream (0.01%) Class 7 (Least potent)
Dexamethasone cream (0.1%) Hydrocortisone (0.5%,1%, 2.5%)
Intralesional corticosteroids
When topical applications are ineffective, few preparations can be
directly injected into the skin lesion. Preferred agent :
Triamcinolone acetonide. Properties : Long acting, small particle
size, stable at room temperature, Easy resuspension by shaking,
lesser effects on pituitary- adrenal axis. Indications :
Nodulocystic acne, keloid, hypertrophic scar, prurigo nodularis,
etc. Nodulocystic Acne Indication Eczematous disorders
Papulosquomous disorders Psoriasis, Lichen planus, etc. Bullous
dermatoses Connective tissue Neutrophilic dermatoses Alopecia
Insect bite reaction Photodermatoses Pigmentary disorders Vitiligo
and many more Contraindications : Absolute h/o hypersensitivity to
tropical corticosteroid. Relative Local untreated bact, fungal,
viral, mycobact infection, infestatation, ulceration. Chronic
Eczema Alopecia Areata Psoriasis Lichen Planus Side effects of
Topical Steroids
Striae Contact dermatitis Telangiectasia Tachyphylaxis Stellate
pseudoscars Facial hypertrichosis Hypopigmentation Folliculitis
Fragile skin, purpura Miliaria Impaired wound healing Increased
susceptibility to bacterial fungal and viral inf. Steroid
dependency Perioral Dermatitis Glaucoma and cataract Rosacea
Atrophy Topical steroid induced hypopigmentation and telangiectasia
Topical steroid induced telangiectasia
Topical steroid inducedperioral dermatitis Intralesional steroid
induced atrophy Topical steroid induced atrophy Tinea Incognito
with striae Acneiform Eruption Acneiform Eruption with
Hypertrichosis Systemic side-effects of topical steroids
Suppression of hypothalamic pituitary adrenal axis Cushings
syndrome Hyperglycemia Intracranial hypertension Growth retardation
in children Reduced bone mineral density Oedema Hypocalcemia
Hypertension Anti acne medicines Class Mechanism of Action Side
Effects Retinoids :
Tretinoin cream(0.025%- 0.05%) Adapalene gel (0.1%) Block
inflammatory cascade Decrease hyperproliferation in the follicles
Stimulate dermal collagen production Causes irritation Are photo
irritants Benzoyl peroxide Oxidising agent so direct toxic action
on P. Acne Lipophilic so penetrates sebaceous follicles better No
resistance has been noted Irritation, erythema, scaling, burning,
dryness,stinging Contact dermatitis Anti acne medicines Class
Mechanism of Action Side Effects
Topical antibiotics Erythromycin (2%) Clindamycin(1%)
Clarithromycin (1%) Azithromycin (2%) Nadifloxacin Dapsone (5%)
Metronidazole gel Reduce population of P. Acne Few have
anti-inflammatory action Should not be used continuously for 3
months for the fear of resistance Azelaic Acid 10%-20%
Antibacterial Anti-keratinizing effect Inhibit tyrosinase enzyme
Irritation Nicotinamide gel 4% Anti-inflammatory Not specific Anti
acne medicines Grade 2 Acne Class Mechanism of Action
Side Effects Salicylic Acid Keratolytic Inhibits comedogenesis
Promote follicular desquamation Lipid soluble so penetrate sebum
laden follicles better Irritation, erythema Ivermectin gel ( used
in rosacea) Anti parasitic action on Demodex folliculorum Grade 2
Acne Antibiotics Bacitracin
Name Bacterial coverage Mechanism of action Bacitracin Bactericidal
against Gram (+) and Neisseria species Interferes with bacterial
wall synthesis;inhibition of phospholipid receptors involved in
peptidoglycan synthesis Polymyxin B Bactericidal against Gram (-)
bacteria only; effective against P. aeruginosa Increases
permeability of bacterial cell membrane;by interacting with
phospholipid components of membrane Neomycin Bactericidal against
Gram (+) and Gram (-) bacteria; good S. aureus coverage Inhibits
protein synthesis; binding to 30s subunit of ribosomal RNA
Antibiotics Impetigo Contagiosa Name Bacterial coverage
Mechanism of action Metronidazole (0.75-1%) Anaerobic bacteria,
parasites Forming free radicals that damages DNA ; Immunomodulatory
Sodium fusidate (fusidic acid) 2% Anti staphylococcal Interfere
with bacterial protein synthesis by preventing translocation of
elongation factor G from ribosome Impetigo Contagiosa Antibiotics
Name Bacterial coverage Mechanism of action Mupirocin
Bactericidal against methicillin-resistant S. aureus; S. pyogenes
Inhibits bacterial RNA and protein synthesis; occurs by reversibly
binding to bacterial isoleucyl transfer RNA synthetase Retapamulin
Bacteriostatic against S. pyogenes, mupirocin-resistant and
methicillin-resistant S. aureus, anaerobes Inhibits bacterial
protein synthesis; occurs by binding to protein L3 on 50s ribosomal
subunits Antibiotics Gentamicin Name Bacterial coverage Mechanism
of action
Bactericidal against Gram (+) and Gram (-) organisms; coverage
includes P. aeruginosa Inhibits bacterial protein synthesis; by
irreversibly binding to 30s ribosomal subunits Silver sulfadiazine
Bactericidal against Gram (+) and Gram (-) organisms Binds to
bacterial DNA and inhibits its replication Antifungal Agents
Azoles
Class and Prototypes Spectrum of action Azoles Eg. Fluconazole,
Ketoconazole, Sertaconazole, Eberconazole ,etc. (Fungistatic)
Dermatophytes, candida, pityrosporum,erythrasma, some action
against staphylococcus Allylamines Eg. Terbinafine, naftifine
Dermatophytes (fungicidal), Candida albicans (fungistatic)
Morpholines Eg. Amrolfine Onychomycosis caused by dermatophytes,
scytalidium spp.,Scopularis spp.,dimorphic fungi, C. Albicans,
Cryptococcus neoformis, dematiaceous fungi. Antifungal Agents
Benzylamines e.g. Butenafine Class and Prototypes
Spectrum of action Benzylamines e.g. Butenafine Dermatophyte
(fungicidal), C. Albicans (fungistatic), P. versicolor Polyenes Eg.
Nystatin Oral and Vaginal Candidiasis Miscellaneous 1. Ciclopirox
olamine Dermatophytes, yeasts, molds e.g. Scytalidium spp.
Scopulariopsis spp. 2. Zinc pyrithione 1% 3. Selenium disulfide
2.5% P.Versicolor Sterol pathway in fungi and steps at which
antifungal drug act.
Allylamines (terbinafine, naftifine) Benzylamines(butenafine)
Tolnaftale Acetyl coenzyme A Squalene Squalene epoxide Squalene
epoxidase Triazoles (fluconazole, itraconazole) Imidazoles
(ketoconazole) Amorolfine Lanosterol 14 Dimethyl Lanosterol
Zymosterol 14 Demethylase 14-Reductasee Amorolfine Fecosterol
Episterol Ergosterol 7 8 Isomerase Amphotericin B Griseofulvin
Fungal cell membrane synthesis Fungal cell replication Antivirals
Agent Indications Acylovir (5%) cream
Herpes labialis, herpes genitalis Penciclovir (1%) cream Herpes
labialis, herpes genitalis (longer duration of activity) Cidofovir
Human papilloma virus, herpes and pox virus infections, Useful in
HIV positive patients Foscarnet In acyclovir resistant cases
Idoxuridine Herpes simplex, herpes zoster, human papilloma virus
infections Topical and intralesional antiviral agents
Viricidal Cytodestructive Immune Enhancer Acylovir Bleomycin
Imiquimod Penciclovir Podophyllin Inteferon Cidofovir
Trichloroacetic acid Foscarnet Cantharidin Idoxuridine Salicylic
acid 5-Fluorouracil Herpes simplex Antiparasitic agents Agent
Mechanism of Action Side effects
Permethrin (5% cream and 1% lotion) Acts on nerve cell membranes of
the parasite causing paralysis and death. Burning, Itching,
Numbness,stinging, tingling,Hypersensitivity Gamma-benzene
Hexachloride (1% lotion) Inhibit inositol to produce CNS excitation
CNS excitation, agitation, delirium, convulsions etc. Benzyl
benzoate (25% emulsion) Not known Pruritus, redness, ACD, Seizures
Malathion (0.5% lotion) Cholinesterase inhibition in a parasite
Irritation to skin Antiparasitic agents Agent Mechanism of Action
Side effects
Crotamiton (10% solution) Not known Pruritus, swelling, redness
Precipitated sulfur (6% lotion) Kills the mite by unknown mechanism
Hypersensitivity to sulfur Ivermectin (1% cream and shampoo)
GABA-nergic action to block chloride channels and causes tonic
paralysis Nil Scabies Calcineurin Inhibitors
Prototypes : Tacrolimus (FK 506), Pimecrolimus Mechanism of Action
: Immunosuppression - by inhibiting proliferation and activation of
CD4+ T Helper cells by inhibition of cytoplasmic enzyme
calcineurin. Immunomodulation - by inhibition of mast cell adhesion
and inhibition of mediators release from mast cells and basophils.
Release of local neuropeptides and transmission of pain and itch.
On Keratinocytes- increase stem cell factor release which causes
proliferation of melanoblasts and melanocytes. Side Effects : Local
burning, Pruritus,Infections, Risk of malignancy (Black Box
Warning) Calcineurin Inhibitors
Indications Contraindications Eczemas, Atopic Dermatitis Pregnancy
Vitiligo Infected lesions Facial and flexural psoriasis Prolonged
exposure to sunlight Oral and Genital lichen Planus, Lichen
striatus, Lichen sclerosus et atrophicus Conditions causing breach
in skin barrier properties Morphea, lupus erythematosus,Bullous
disorders H/o contact sensitization Steroid induced Rosacea,
Chronic actinic dermatitis Pimecrolimus cream should not be applied
to mucous membrane or eyes Cytotoxic and Immunomodulatory
agents
Imiquimod - 5% cream Mechanismofaction Trigger immune system to
recognize the presence of a vital infection or tumor and mounts Th1
weighted cellular immune response. Application : 3 times a week (
hrs ) for 8 12 weeks. Indication : General warts, Actinic
Keratoses, Molluscum contagiosum, intraepithelial neoplasia,
Bowenoid papulosis, verrucous carcinoma, SCC etc. Side effects :
Local : Erythema, irritation. Systemic : Fatigue, fever, myalgia,
central and peripheral nervous system disorder, Influenza like
symptoms Cytotoxic Agents Agent Mechanism of Action Indication Side
effects
Bleomycin Binds to DNA causing cell to accumulate in G2 phase
Intralesional injection Keratoacanthoma Recalcitrant warts Pain
swelling Raynauds ph. syst Myelosuppression Pulm fibrosis,
hyperthermia, hypotension 5-Fluoro-uracil Antimetabolite to uracil
thus block synthesis of DNA in hyper proliferative keratinocytes
Genital warts Actinic keratosis, BCC, bowenoid papulosis,
erythroplasia of queyrat, leukoplakia, etc. Local - erythema,
crusting, scaling, pain, swelling, pruritus hyper and hypo
pigmentation photosensitivity Systemic - Stomatitis,
myelosuppression cardiac toxicity, alopecia, etc. Keratolytic
Agents Used to treat hyperkeratosis
These break cell to cell adhesions, thus help to remove scales Few
of these have hydrating effect, thus used as moisturisers Few have
anti-inflammatory, anti-ageing effect e.g. Salicylic acid, urea,
alpha hydroxy acids such as glycolic acid, lactic acid, coal tar
etc. Moisturizers Moisturizers hydrate the skin.
Classification : Emollients and Humectants Emollients : These are
greasy substances, which hydrate stratum corneum by forming a
greasy layer over the skin surface, thereby preventing
transepidermal water loss and retaining moisture in the skin. E.g.
Liquid paraffin, almond oil etc. Humectants: Humectants arethe
substances which hydrate stratum corneum by absorbing water from
the external environment or from deeper layers of the skin. E.g.
Glycerin, urea, lactic acid and sodium lactate etc. Sunscreen
Protects skin from Ultraviolet radiations
Sun Protection Factor (SPF) : Minimal erythema dose of UVB light
with sunscreen applied Minimal erythema dose of UVB light without
sunscreen Broad spectrum protection : Full spectrum UVB/UVA
protection Water resistant sunscreen : SPF maintained after 40
minutes of water immersion Waterproof sunscreen : SPF maintained
after 80 minutes of water immersion Sunscreen Ingredients in
sunscreen UVB blockers Octinoxate Octisalate
UVA blockers Avobenzone Oxybenzone Physical Blockers Titanium
dioxide Zinc oxide Sunscreen Methods of Application : Quantity
required is 2g/cm2
30 min before exposure to sunlight Reapplication after every 3-4
hours Reapplication after swimming or sweating Indications :
Photodermatoses e.g. polymorphic light eruption Photosensitive
eruptions, rosacea , etc. Systemic Lupus Erythematosus Xeroderma
pigmentosum Depigmenting Agents Agent Mechanism of Action Side
effects
Hydroquinone [2% - 5%] Inhibiting tyrosinase thus inhibiting
conversion of dopa to melanin Alteration of melanosome function
Generation of ROS ICD and ACD Nail discoloration Paradoxical PIH
and surrounding hypopigmentation Exogenous ochronosis Permanent
depigmentation Depigmenting Agents Agent Mechanism of Action Side
effects
Monobenzyl ether of hydroquinone 20% [Residual pigmented areas in
residual vitiligo] Cytotoxic action on melanocytes Permanent
depigmentation Depigmentation at sites other than those being
treated Contact dermatitis Retinoids Tretinoin 0.05% Adapalene 0.1%
Induced dispersion of keratinocyte pigment granules Interference
with pigment transfer Acceleration of epidermal turnover Induce
desquamation Erythema Peeling in areas of application PIH
Depigmenting Agents Agent Mechanism of Action Side effects
Azelaic Acid (9-carbon- dicarboxylic acid isolated from cultures of
P.ovale) 10% and 20% ROS Scavenger capacity Alteration of
mitochondrial metabolism Burning, stinging, itching
hypopigmentation hypertrichosis Kojic acid (Fungal metabolite
derived from acetobacter , aspergillus Penicillium) 1% - 4% Inhibit
Tyrosinase Contact dermatitis, Stinging erythema Depigmenting
Agents Agent Mechanism of Action Side effects
a - Hydroxy Acids Glycolic - 5% - 20% Lactic - 8% - 12% Inhibit
tyrosinase Accelerate turnover of stratum corneum Mild irritation,
burning sensation. Ascorbic acid Antioxidant Interaction with
copper ions at tyrosinase active site Reduce Dopaquinone Liquorice
extract e.g. Glabridin Decrease tyrosinase activity Inhibit UVB
induced skin pigmentation Mild irritation Depigmenting Agents Agent
Mechanism of Action Side effects
Arbutin B-Glycoside of hydroquinone Inhibit tyrosinase Inhibit
melanosome maturation In higher concentration greater risk for
paradoxical hyperpigmentation Niacinamide (derivative of niacin)
Inhibits melanosome transfer from melanocytes to keratinocytes
Common Indications Melasma, solar lentiginosis post inflammatory
hyperpigmentation Most of these agents work best in combination
Kligmanns formula This is a triple formula being used or melasma
(4% hydroquinone, 0.1% tretinoin and 0.1 % Dexamethasone) Melasma
Topical Anaesthetic Agents
Analgesic Indication Side effects Capsaicin Acts by exhaustion of
substance P after repeated application Post herpetic neuralgia pain
Redness, burning sensation EMLA ( Eutectic Mixture of Local
Anaesthetic creams) 50% lidocaine and 50% prilocaine in an oil in
water emulsion Multiple small skin procedures e.g. Needling and
extraction, Dermatosurgeries e.g. Radiocautery, dermaroller therapy
Transient skin blanching, erythema, urticaria, Allergic contact
dermatitis, Irritant contact dermatitis, purpura, hyperpigmentation
Miscellaneous Vitamin D derivatives (Calcipotriol) :
Inhibits epidermal proliferation, induces differentiation and has
anti-inflammatory effects. Indications : Psoriasis, Morphea, etc.
Anthralin : Synthetic derivative of Chrysarobin. Affects DNA
synthesis and thus reduces keratinocyte proliferation. Used as
short contact therapy (5-10min). Indication : Psoriasis.
Miscellaneous Coal Tar : By-product of petroleum
distillation.
Suppresses DNA synthesis in keratinocytes thus decreasing
theirproliferation. Side effects : folliculitis, acne, allergic
sensitization, staining of clothes and phototoxicity. Miscellaneous
Antipruritic : Doxepin 5% cream
H1 and H2 receptors,adrenergic, muscarinic receptor antagonism
Menthol upto 16% Agonist of thermally sensitive receptor, gives
cooling sensation Phenol low concentration ( %) Acts through its
anaesthetic effect. Soothing agent : It reduces itching burning and
discomfort of skin. e.g. Calamine lotion. Anti perspirants
Aluminium chloride hexahydrate , Formaldehyde soaks, Botulinum
toxin injections. Miscellaneous Astringents :
These are compounds used to reduce exudation. Mechanism of action :
Coagulating proteins Coagulated proteins forms a protective coat
Reduces oozing Examples : Potasium Permaganate - 1:4000 to 1:25,000
Condys compresses Aluminium acetate ( 1:10 to 1:40 ) ( Burows
Solution ) Silver Nitrate ( 0.1% - 0.5% ) Miscellaneous Minoxidil :
Mechanism of action :
Vasodilator by opening potassium channel Increases duration of
anagen phase Converts vellus hairs into terminal hairs Uses:
Androgenetic alopecia, alopecia areata, Female pattern baldness
Available as 2%, 5%, 10% solution, gel, foam. Miscellaneous Topical
contact allergens Mechanism of action :
Antigen competition: Immune reaction to one antigen may inhibit the
development of immune response to another unrelated antigen. Also
can stimulate cell mediated cell response in viral infections
Agents : Diphenylcyclopropenone Squaric acid dibutyl ester (SADBE)
Dinitrochlorobenzene (DNCB) Uses : Alopecia areata, Viral warts
MCQs Q.1) Which is the measure for the quantity of drug to be
applied topically? Finger Tip Unit Hand Area Measurement Both of
these None of the above Q.2) Sunscreens provide protection against
UVA UVB UVC UVA and UVB Ans : Q. 1 A, Q. 2 D MCQs Q.3) All are
indications of steroids except
Papulosquamous disorders Pemphigus vulgaris Telangiectsia
Polymorphous light eruptions Q.4) All are keratolytic agents except
Glycolic acid Lactic acid Uric acid Salicylic acid Ans : Q. 3 C,Q.
4 C MCQs Q.5) Following factors affect the drug delivery
except
Time of application Site of application Hydration Massaging before
application Q.6) 28 year old female patient complains of multiple
erythematous papules and pustules in perioral region since last 20
days which is the medication to be avoided in this patient?
Clindamycin Framycetin Mometasone furoate Silver sulfadiazine Ans :
Q. 5 A, Q. 6 C MCQs Q.7) The following drug is commonly used as a
first line therapy for melasma. Salicylic acid Hydroquinone Benzoyl
peroxide Urea Q.8) A 4 year old child presented with pustular and
crusted lesions on the chin. MRSA was isolated on pus culture.
Topical therapy of choice:- Mupirocin Povidone iodine Silver
sulfadiazine Framycetin Ans : Q. 7 B, Q. 6 A Photo Quiz Ans : Q. 7
Topical Antifungal Q. 8 Potassium Permanganate - Used as soaks in
cases of bullous lesion, subacute eczemas etc. Q. 7) Which topical
agent can be used to treat this condition? Q. 8) Identify the
topical preparation and describe its indications? Thank You!