DERMATOTHERAPY

Tony S Djajakusumah


DERMATOTHERAPHY

DEFINITION:
A science concerning the treatment of skin diseases
SKIN :
Most accessible organ of the body
Greatly fascilitates :
Diagnosis
Treatment

General Principles
Comprehensive evaluation : physical and psychological
Physiology, mikrobiology, anatomy, histology and pathology
Pharmacy
Individualization (characteristic of each patient)
Medical materials
Begin with more conservative treatment then progress to more
aggressive treatment.
Simplifying the composition of topical treatment
Systemic treatment should be given if necessary
The socio-economic condition of patient
Always involve patient in the decision of the treatment which
will be given


Dermatotherapeutic modalities
(1) Pharmacological medication
(2) Skin surgery
scalpel surgery
electro-surgery
chemo-surgery
cryosurgery
(3) Irradiation:
radiotherapy
ultra-violet irradiation
laser-irradiation;
(4) Psychotherapy



PHARMACOLOGICAL MEDICATION

Methods :
1. Topical medication
High concentration of the drug in the skin efficacy
Minimal exposure to other organ safety
Many inflammatory and neoplastic diseases can be managed
topically.
Is the first treatment given
2. Systemic medication
Is given if topical treatment proves ineffective.
TOPICAL DRUGS

Topical Drugs:
Active ingredient/substance
Vehicle


Basic Consideration for Prescribing
Topical Medication
1. Choose the right vehicles:
Stage
Distribution
Localization
2. Acute lesions (moist/oozing) respond best to aqueous, drying
preparations. Chronic scaling lesions more effective treated with
medication incorporated in moisturizing or lubricating
preparation.
3. Give appropriate information on the technique of application.
4. Refrain from unstable active ingredients (KMnO4 solution) or
sensitizers (topical sulfa,penicilin, antihistamine)

Vehicles
Basic Forms:
1. Powder
2. Solution and tincture
3. Ointment
Mixture:
1. Cream
2. Paste
3. Shake lotion

DRUG PREPARATION FORMS
POWDER
SHAKE LOTION COOLING PASTE
PASTE
SOLUTION/
TINCTURE
EMULSION (CREAM) OINTMENT
Solution and Tincture
1. Solution : vehicle made from water
2. Tincture : vehicle made from alcohol
3. Function: cleaning
evaporizing drying
protecting
cooling
heating
supporting epithelization
keratolytic
medication (antibacterial, adstringent)
can be addad to solutions
4. Indication: moist/oozing or acute lesion
5. Contra-indication: dry skin lesion


Powder
Function:
Covering
Adhesive
Smoothening
Absorptive
Cooling
Examples: Oxyd zinci, kaolin, venetum talc,
Magnesium strearate, Zinc stearate, and Ti02
Indication:
Dry lesion
Superficial lesion
Intact acute vesicobullous lesion
Contra-indication: oozing cutaneous lesion


Ointment
1. Consists of lipid-like substances in the form of butter-like
substance at room temperature
2. The advantageous properties :
Protective
Supporting penetration of active ingredients
Lubricative
Heating
3. Indication: dry and chronic skin lesions
4. Contra-indication: moist/oozing skin lesions and lesions in
hairy/folded areas
Shake Lotion
Mixture of powder and solution
Concentration of powder : < 40%
Suspending agent: glycerin.
This vehicle provides:
Cooling effect
Drying effect
Indication : generalized skin disorders
Contra-indication: moist/oozing body surface
Cream (Emulsion)
Forms:
Cold cream (W/O cream)
Vanishing cream (O/W cream)
Effect :
Cooling
Evaporizing
Better penetrating
Indication:
Sub acute dermatosis
Hairy areas
Cosmetics
Contraindication: moist/oozing dermatosis

HOW TO CHOOSE APPROPRIATE
VEHICLES
There are some basic principles:
The clinical features
The localization
The distribution
Expected effect
LOCALIZATION
Localization Pwd Sol Tinct Oint Shake
Lotion
Paste Cream
Generalized + _*) _ _ + _ +
Scalp _ + + _ _ _ +
Face + + +**) + + + +
Chest, Back,
Extremities
+ + + + + + +
Genital +***) + _ _ +***)

_ +

ADMINISTRATION METHODS OF
TOPICAL PREPARATIONS
Solution
Wet dressing
Open wet dressing
Closed wet dressing
Bathing method: Balneotheraphy
TOPICAL APPLICATION
Explain the methods of application to :
Patients
Nurses

1. Powder: require some additional appliances such
as : sponge and cotton
TOPICAL APPLICATION
2. Solution
Open Wet Dressing:
< 30% of surface area,
Use cotton or gauze for 5-10 minutes.
Closed Wet Dressing :
The wet dressing is covered by impermeable
bandage.
Bathing method (Balneotherapy) :
75 100 liters, 35 38C for hour
TOPICAL APPLICATION
3. Ointment:
Open or closed
Clean ointment with oil
4. Paste
Use wooden spatle or directly by finger
Repeated treatment: every 2-3 days after cleaning with
oil