PHARMACOLOGY

OF MEDICATIONS
FOR SKIN DISEASE

LECTURER : DR. NANA NOVIA JAYADI, SPKK

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No part of this work may be reproduced, including photocopied, without written permission of Universitas Pelita
Harapan
Learning Objective

 The basic therapeutic regimen for various skin

condition.
 Understand the principles therapy in
dermatology.
 Know the 2 main drugs, antihistamine and
corticosteroid, used for skin diseases.
 Recognize the management of steroid treatment.
MEDICATION FOR SKIN
DISEASE

Medication • Topical
for skin • Systemic
disease • Intralesion

• Radiotherapy
• Phototherapy
Other • Laser
modalities • Cryotherapy
• Electrosurgery
• Surgery
TOPICAL THERAPY
Active substance:
(corticosteroids,
antiobiotics, etc)

+
Vehicle:
(cream, lotion, gel,
etc)
TOPICAL THERAPY

Advantages
• Drug deliverd in high concentration in skin
• Minimal systemic side effects

Disadvantages
• Time consuming
• Messy
• Confusing
• Local side effects
Pharmakokinetics of Topical
Therapy
Drug factors Host factors
 Percutaneous  Site
penetration
 Age
 Percutaneous
 Hydration of skin
absorption
 Temperature of skin
 Vehicle
 Skin barrier (stratum
 Topical formulation
corneum)
 Quantity
 Frequency
 Drug reaction
Stratum corneum
• Barier to percutaneous
drug delivery

• Consist of of 50%
ceramides, 35% cholesterol
and 15% free fatty acids.

• 2 major component 
corneocyte & extraseluler
lipid (“brick & mortar”)

• Compound applied
topically migrate through
passive diffusion
Routes of percutaneous absorption :
 The transepidermal  interceluler & intracellular (transcellular)
 Transappendageal (via hair follicles, sweat & sebaceous glands,
pillosebaceous apparatus).

Diseases of the skin may have altered stratum corneum (increased,

decreased, or absent)  changing barrier function
Increased in:
• Traumatised skin, inflamed skin
• Denaturing st. corneum  solvents,
surfactants, alcohol
• Penetration enhancers  propylene
glycol, urea, ozones, salicylic acid
• Occlusion  increases temperature,
hydration, reduces wash off
I. Occlusion
• Enhanced drug penetration
• Via closed, airtight dressings,
greasy ointments
• Increase hydration & temperature
• Limits rub off/wash off
II. Frequency of application
• Likely has a little effect on increasing
topical drug efficacy
• One daily application is enough for most
topical steroid
• Non spesific emollient or protective
effect of creams and ointments are likely
enhanced by more frequent application
III. Quantity of application
•The fingertip unit (FTU)
is a useful guide to
estimate how much
topical drugs to use
•Represents
approximately 0.5g of 1 Fingertip unit (FTU)

cream or ointment
IV. Adherence
• Often overlooked aspect of medication efficacy

Tachyphylaxis  decrease prologed regimens. in drug response

when used over periode of time

Rebound effect  worsening of preexisting dermatoses who

have been using topical potent corticosteroid for
 “Facilitates drug delivery by bringing the substance in
contact with skin”

 Inactive part of topical preparation

 To enhance the beneficial effects of the
medication
 Beneficial non-specific effect: cooling ,
protective, emollient, occlusive, or
astringent properties
Can be devided into:
•Liquid
•Powder
•Ointment
•Cream
•Gel
•Paste
•Linimen
1.Liquids

 Can be devided into:

a. Solutions  aqueous solution (e.g
aluminium acetate, Burrow’s solution
b. Tincture  hydroalcoholic solution
(alcohol concentration ± 50%)

 Effect : cleansing, drying, cooling,

astringent, vasoconstriction
2. Solutions

a. Compress (open and closed)

b. Bath
c. Full bath
3. Powder

 Absorb moisture, decrease friction, cooling, mild,

anti-inflammation & anti pruritic
 Adhere poorly to the skin  limited to cosmetic &
hygiene purposes
 Used in the intertriginous area, dry & superficial
dermatoses
 Basic material : talcum venetum
 Most contain zinc oxide (antiseptic, astringent, &
antipruritic)
4. Ointment

 Semisolid preparation, Petrolatum-based vehicle

 Used for glaborous skin
 Capable of providing occlusion, hydration, &
lubrication
 Drug potency is often increased by this vehicle
due to its ability to enhance permeability
 Devided into 5 categories: hydrocarbon bases &
absorption bases (ointment) , emulsion w/o or o/w
(cream), watersoluble bases (gel)
5. Cream
Can be used for hairy skin

A. Water in oil emulsion (W/O)

 Two phase systems  involving one or more
immiscible liquids dispersed in another (with the
assistance of 1 or more emulsifying agent.
 < 25% water, oil as as dispersion medium
 Less greasy, spread easily on the skin
 Provide protective film of oil that remains on the
skin as an emollient, while slow evaporation of
the water provides a cooling effect
B. Oil in water emulsions (O/W):
 Water may comprise up to 80% formulation
 Most commonly chosen to deliver a dermatologic
drug
 Spread very easily, water washable, less greasy,
easily removed from the skin and clothing
 Contain preservative (e.g. Paraben) to inhibit thw
growth of molds
 Contain humectant (an agent that draws moisture
into the skin)  glycerin, propylene glycol or
polyethilen glycol

 The oil phase may contain cetyl/stearyl alcohol to

impart stability and velvety smooth feel upon
application

 After application, the aqueous phase evaporates,

leaving a small hydrating layer of oil and a
concentrated deposit of the drug.
6.Gel

 Water soluble bases

 Consist polyethylene glycols (PEG)
 Water soluble, will not support the growth
of mold (no preservative)
 Will be useful if dermatologist desires a
high surface concentration and low
percutaneous absorption of the drug
 Suitable for facial and hairy areas
7. Pastes

 Incorporation of high concentration of powders into an

ointment
 “stiffer” than the original ointment
 Function: to localize the effect of a drug that may be
staining or irritating & act as an impermeable barriers
that serve as protectants or sunblock
 Less greasy, more drying, less occlusive
8. Linimen

 Mixture
of liquids, powder and
ointment
 Indication: subacute dermatoses
 Contraindication: madidans
dermatoses
 Aluminium  Selenium dissulfide
acetate
 Sulphure
 Acetic acid
 Ter
 Benzoic acid
 Urea
 Salicylic acid
 Antiseptic
 Camphora
 Topical
 Menthol corticosteroid
 Podophylin
 Binding to specific receptor in celluler cytoplasm &
modulating the transcription of multiple genes 
suppresion of the production of inflammatory substance &
inhibit the recruitment of inflammatory cells

Most frequently prescribed of all dermatologic drug

products

Effects:

• anti-inflammatory
• immunosuppresive
• antiproliferative
• vasoconstriction
Principles when initiating topical steroid
therapy:

• Lowest potency to sufficiently control disease

• Prolonged use of an insufficient potency agent
should be avoided (max 2-4 weeks)
• When large surface area involved  low to
medium potency recommended
• Low potency should be used on the face and
intertriginous area
 Very potent corticosteroids, frequently under
occlusion, are usually required for hyperkeratotic
or lichenified dermatoses nad for involvement of
palms and soles

 High potency and medium potency should be

avoided in young children other than for short
term application
Local side effects:
 Skin atrophy
 Acneiform eruptions
 Hypertrichosis
 Pigmentary changes
 Development of infections
 Allergic reactions
Systemic side effects :
 Occular effects
Glaucoma, vision loss
 Suppression of the hypothalamic-pituitary-
adrenal (HPA) axis
Has been decribed with the use of potent
topiical corticosteroid  iatrogenic
Cushing syndrome, corticosteroid related
Addison crises
 Metabolic side effects
Increased glucose production and
decreased glucose use induced
hyperglycemia  diabetes mellitus
Continuing use of topical steroid:
 Highly potent formulation should be used
for short periods (2-3 weeks) or intermittently
 Once disease control is partially
achieved less potent compound should
be initiated
 Reduce frequency of application once
disease control is partially achieved
 Topical steroid shoud be avoided on
ulcerated, atrophic skin or skin with
coexistent infectious dermatoses
 Sudden discontinuation after prolonged used
should be avoided
 Special guidelines should be followed when
treating certain body area or certain populations
 Laboratory test should be considered if systemic
absorption is suspected.
Reference

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penyakit kulit dan kelamin, edisi ke-7. Jakarta: Badan
Penerbit FKUI. 2015.

3. James WD, Berger TG, Elston DM, penyunting. Andrew’s

disease of the skin clinical dermatology. Edisi ke-10.
USA: Elsevier Inc., 2006.