1
Regis NU641 Advanced Clinical Pharmacology:
Dermatology Q&A | Regis College – MSN/FNP
Program.
Module I: Topical Corticosteroids (Questions 1–8)
Q1. A 45-year-old male with stable, localized plaque psoriasis on his elbows and knees is using
triamcinolone acetonide 0.1% cream BID with partial improvement. Which change would be
MOST appropriate for a flare?
A. Continue same potency for 8 more weeks
B. Switch to clobetasol propionate 0.05% ointment BID for 2 weeks [CORRECT]
C. Add oral prednisone 40mg daily for 2 weeks
D. Switch to hydrocortisone 2.5% cream
Correct Answer: B
Rationale: Plaque psoriasis on elbows/knees (thick, keratinized skin) often requires super-high
potency topical steroid (Class I). Triamcinolone 0.1% (Class IV) is insufficient for thick plaques.
Clobetasol ointment BID for 2–4 weeks, then step down to medium potency. Common error:
staying on medium potency indefinitely or adding systemic therapy for localized disease. Clinical
pearl: Limit clobetasol to 4–6 weeks continuous, avoid face/groin/axillae, and monitor for
atrophy.
Q2. An 8-year-old with moderate atopic dermatitis on the face and neck. Which topical
corticosteroid is MOST appropriate for initial treatment in these areas?
A. Clobetasol propionate 0.05% cream
B. Hydrocortisone 2.5% cream or desonide 0.05% ointment [CORRECT]
C. Triamcinolone acetonide 0.1% ointment
D. Betamethasone dipropionate 0.05% lotion
Correct Answer: B
Rationale: Face, neck, axillae, groin, and intertriginous areas require low-potency topical
steroids (Class VI–VII) to prevent atrophy, telangiectasias, perioral dermatitis, and striae.
Hydrocortisone 2.5%, desonide 0.05%, and hydrocortisone butyrate 0.1% are appropriate.
,2
Common error: using medium-high potency on sensitive areas. Clinical pearl: For facial atopic
dermatitis, also consider topical calcineurin inhibitors (tacrolimus 0.03% ointment,
pimecrolimus 1% cream) as steroid-sparing agents.
Q3. A 32-year-old female with chronic hand eczema has been applying betamethasone
dipropionate 0.05% (augmented) ointment to both hands under cotton gloves for 4 weeks. She
now reports fatigue, weight gain, and facial rounding. What is the MOST likely cause?
A. Oral prednisone interaction
B. HPA axis suppression from high-potency steroid with occlusion [CORRECT]
C. Cushing's syndrome from endogenous cortisol excess
D. Hypothyroidism unrelated to therapy
Correct Answer: B
Rationale: Augmented betamethasone dipropionate 0.05% is Class II (high potency). Occlusion
(cotton gloves) dramatically increases systemic absorption. HPA axis suppression presents with
fatigue, weight gain, moon facies, and hyperglycemia. Risk factors: high potency, occlusion, large
BSA, prolonged use, thin skin. Common error: attributing symptoms to unrelated conditions.
Clinical pearl: Avoid occlusion with high-potency steroids; if used, limit to 1–2 weeks and
monitor for systemic effects.
Q4. A patient with atopic dermatitis on the trunk and extremities is prescribed triamcinolone
acetonide 0.1% ointment. The affected area covers approximately 4 palm-sized areas. How
many finger-tip units (FTU) should be applied per application?
A. 1 FTU
B. 2 FTU [CORRECT]
C. 4 FTU
D. 8 FTU
Correct Answer: B
Rationale: One finger-tip unit (FTU) = 0.5g and covers approximately 2 palm-sized areas (adult).
Therefore, 4 palm-sized areas require 2 FTU (1g total). Common error: confusing FTU with
number of affected areas. Clinical pearl: The FTU is measured from the distal finger crease to
the fingertip. For an adult male, 1 FTU ≈ 0.5g; for adult female, ≈ 0.4g; for children,
proportionally less.
, 3
Q5. A 6-month-old infant with moderate atopic dermatitis involving 30% BSA is treated with
medium-potency topical steroids. After 3 weeks, the mother notes the infant is irritable, has
decreased appetite, and linear growth has slowed. What is the NP's priority action?
A. Increase steroid potency for better control
B. Discontinue topical steroids and evaluate for HPA axis suppression [CORRECT]
C. Switch to oral antihistamines only
D. Add topical calcineurin inhibitors without changing steroids
Correct Answer: B
Rationale: Infants have increased skin permeability and higher BSA-to-weight ratio, making
them highly susceptible to HPA axis suppression from topical corticosteroids—especially with
medium-high potency over large areas. Symptoms of adrenal suppression include irritability,
poor feeding, failure to thrive, and hypotension. Common error: continuing or escalating steroid
therapy. Clinical pearl: In infants, use only low-potency steroids (hydrocortisone 1–2.5%) for
short courses, limit BSA, and avoid occlusion.
Q6. A 28-year-old female with plaque psoriasis has been using clobetasol propionate 0.05%
ointment on her elbows continuously for 6 months. She now presents with worsening
erythema, burning, and spreading of plaques after stopping the medication for 3 days. Which
phenomenon is MOST likely occurring?
A. Tachyphylaxis
B. Rebound phenomenon [CORRECT]
C. Allergic contact dermatitis
D. Secondary bacterial infection
Correct Answer: B
Rationale: Rebound phenomenon occurs with abrupt withdrawal of chronic topical steroids,
especially high-potency agents used for psoriasis and atopic dermatitis. The skin flares worse
than baseline due to downregulation of endogenous cortisol production and rebound
inflammation. Tachyphylaxis is diminished response during continued use, not after withdrawal.
Common error: confusing rebound with tachyphylaxis or infection. Clinical pearl: Taper steroids
gradually (step down potency over 2–4 weeks) rather than abrupt discontinuation. Add non-
steroidal agents (calcipotriene, tacrolimus) during taper.
Q7. Which adverse effect of chronic topical corticosteroid use is IRREVERSIBLE?
Regis NU641 Advanced Clinical Pharmacology:
Dermatology Q&A | Regis College – MSN/FNP
Program.
Module I: Topical Corticosteroids (Questions 1–8)
Q1. A 45-year-old male with stable, localized plaque psoriasis on his elbows and knees is using
triamcinolone acetonide 0.1% cream BID with partial improvement. Which change would be
MOST appropriate for a flare?
A. Continue same potency for 8 more weeks
B. Switch to clobetasol propionate 0.05% ointment BID for 2 weeks [CORRECT]
C. Add oral prednisone 40mg daily for 2 weeks
D. Switch to hydrocortisone 2.5% cream
Correct Answer: B
Rationale: Plaque psoriasis on elbows/knees (thick, keratinized skin) often requires super-high
potency topical steroid (Class I). Triamcinolone 0.1% (Class IV) is insufficient for thick plaques.
Clobetasol ointment BID for 2–4 weeks, then step down to medium potency. Common error:
staying on medium potency indefinitely or adding systemic therapy for localized disease. Clinical
pearl: Limit clobetasol to 4–6 weeks continuous, avoid face/groin/axillae, and monitor for
atrophy.
Q2. An 8-year-old with moderate atopic dermatitis on the face and neck. Which topical
corticosteroid is MOST appropriate for initial treatment in these areas?
A. Clobetasol propionate 0.05% cream
B. Hydrocortisone 2.5% cream or desonide 0.05% ointment [CORRECT]
C. Triamcinolone acetonide 0.1% ointment
D. Betamethasone dipropionate 0.05% lotion
Correct Answer: B
Rationale: Face, neck, axillae, groin, and intertriginous areas require low-potency topical
steroids (Class VI–VII) to prevent atrophy, telangiectasias, perioral dermatitis, and striae.
Hydrocortisone 2.5%, desonide 0.05%, and hydrocortisone butyrate 0.1% are appropriate.
,2
Common error: using medium-high potency on sensitive areas. Clinical pearl: For facial atopic
dermatitis, also consider topical calcineurin inhibitors (tacrolimus 0.03% ointment,
pimecrolimus 1% cream) as steroid-sparing agents.
Q3. A 32-year-old female with chronic hand eczema has been applying betamethasone
dipropionate 0.05% (augmented) ointment to both hands under cotton gloves for 4 weeks. She
now reports fatigue, weight gain, and facial rounding. What is the MOST likely cause?
A. Oral prednisone interaction
B. HPA axis suppression from high-potency steroid with occlusion [CORRECT]
C. Cushing's syndrome from endogenous cortisol excess
D. Hypothyroidism unrelated to therapy
Correct Answer: B
Rationale: Augmented betamethasone dipropionate 0.05% is Class II (high potency). Occlusion
(cotton gloves) dramatically increases systemic absorption. HPA axis suppression presents with
fatigue, weight gain, moon facies, and hyperglycemia. Risk factors: high potency, occlusion, large
BSA, prolonged use, thin skin. Common error: attributing symptoms to unrelated conditions.
Clinical pearl: Avoid occlusion with high-potency steroids; if used, limit to 1–2 weeks and
monitor for systemic effects.
Q4. A patient with atopic dermatitis on the trunk and extremities is prescribed triamcinolone
acetonide 0.1% ointment. The affected area covers approximately 4 palm-sized areas. How
many finger-tip units (FTU) should be applied per application?
A. 1 FTU
B. 2 FTU [CORRECT]
C. 4 FTU
D. 8 FTU
Correct Answer: B
Rationale: One finger-tip unit (FTU) = 0.5g and covers approximately 2 palm-sized areas (adult).
Therefore, 4 palm-sized areas require 2 FTU (1g total). Common error: confusing FTU with
number of affected areas. Clinical pearl: The FTU is measured from the distal finger crease to
the fingertip. For an adult male, 1 FTU ≈ 0.5g; for adult female, ≈ 0.4g; for children,
proportionally less.
, 3
Q5. A 6-month-old infant with moderate atopic dermatitis involving 30% BSA is treated with
medium-potency topical steroids. After 3 weeks, the mother notes the infant is irritable, has
decreased appetite, and linear growth has slowed. What is the NP's priority action?
A. Increase steroid potency for better control
B. Discontinue topical steroids and evaluate for HPA axis suppression [CORRECT]
C. Switch to oral antihistamines only
D. Add topical calcineurin inhibitors without changing steroids
Correct Answer: B
Rationale: Infants have increased skin permeability and higher BSA-to-weight ratio, making
them highly susceptible to HPA axis suppression from topical corticosteroids—especially with
medium-high potency over large areas. Symptoms of adrenal suppression include irritability,
poor feeding, failure to thrive, and hypotension. Common error: continuing or escalating steroid
therapy. Clinical pearl: In infants, use only low-potency steroids (hydrocortisone 1–2.5%) for
short courses, limit BSA, and avoid occlusion.
Q6. A 28-year-old female with plaque psoriasis has been using clobetasol propionate 0.05%
ointment on her elbows continuously for 6 months. She now presents with worsening
erythema, burning, and spreading of plaques after stopping the medication for 3 days. Which
phenomenon is MOST likely occurring?
A. Tachyphylaxis
B. Rebound phenomenon [CORRECT]
C. Allergic contact dermatitis
D. Secondary bacterial infection
Correct Answer: B
Rationale: Rebound phenomenon occurs with abrupt withdrawal of chronic topical steroids,
especially high-potency agents used for psoriasis and atopic dermatitis. The skin flares worse
than baseline due to downregulation of endogenous cortisol production and rebound
inflammation. Tachyphylaxis is diminished response during continued use, not after withdrawal.
Common error: confusing rebound with tachyphylaxis or infection. Clinical pearl: Taper steroids
gradually (step down potency over 2–4 weeks) rather than abrupt discontinuation. Add non-
steroidal agents (calcipotriene, tacrolimus) during taper.
Q7. Which adverse effect of chronic topical corticosteroid use is IRREVERSIBLE?
