DERMATOTHERAPY
LECTURE2
DR :ENASS AHMED
Our goal for using topical formulations
to reduced the side effects and toxicity to the organs compared
to systemic medications.
Quantity of topical formulations
How much topical medication to prescribe can challenge the most experienced dermatologist. It depends on:
The vehicle act physically as bases to carry the active drug
The thickness of the application
The total area to be treated
The frequency of the application
The duration of the treatment course.
Vehicles
How does the nature of the dermatosis influence choice of topical
formulation?
For wet or oozy skin conditions — creams , lotions, and drying
pastes are most suitable.
For dry, scaly skin conditions — ointments and oils are appropriate.
For inflamed skin — use wet compresses and soaks followed by
creams or ointments.
Cracks and sores — treat with bland applications; avoid alcohol
and acidic preparations.
How does the site of the skin problem influence choice of topical
formulation?
Palms and soles — an ointment or cream may be preferred.
Skin folds — use a cream or a lotion (ointments are too
occlusive for these sites) .
Hairy areas — a lotion, solution, gel, or foam is usually best.
Mucosal surfaces — take care to prescribe non-irritating
formulations to avoid irritating eroded surfaces.
How does a topical steroid work?
The effects of topical steroid on various cells in the skin
are:
Anti-inflammatory .
Immunosuppressive
Anti-proliferative
Vasoconstrictive.
The potency of topical steroid
The potency of a topical steroid depends on:
The specific molecule
The amount that reaches the target cell
Absorption through the skin (0.25%–3%)
Vehicles.
WHEN WE USE SUPER HIGH AND LOW CORTICOSTEROID
Low-potency steroids are the safest agents for long-term use, on large
surface areas, on the face or areas of the body with thinner skin, and
on children.
More potent agents are beneficial for severe diseases and for areas of
the body where the skin is thicker, such as the palms and bottoms of
the feet.
Side effects of topical steroid?
Cutaneous side effects
Local side effects may arise when a potent topical steroid is applied daily for long periods of time (months). Most
reports of side effects describe prolonged use of an unnecessarily potent topical steroid for inappropriate indications.
Skin atrophy
Stretch marks (striae) in armpits or groin
Easy bruising (senile/solar purpura) and tearing of the skin
Enlarged blood vessels(telangiectasia)
Hypertrichosis
Hypopigmentation.
Systemic side effect not common (cuhing syndrome, hypertension , hyperglycemia ) .
Estimating topical steroid
CON -STMITING TOPICAL STEROID
One Finger tip unit (0.5 grams) = 2% BSA ( 2palmar surfaces)
0.5 grams x 2 times per day = 1 gram (30g per month)
2% BSA=30g
# if the the lesion involved right arm how many tubes we will prescribe for the patient if
the tubes contains 15 g and he will use it 2 times aday
9% BSA=X
X=9X30/2=135g
How many tubes ???????
Rule of nine
What is phototherapy?
Phototherapy, also known as light therapy, is a common form of
treatment that uses bright, ultraviolet (UV-A or UV-B) lights on your
exposed skin. Phototherapy can treat several types of skin conditions,
including psoriasis and eczema.
What are the types of ultraviolet light?
There are different types of ultraviolet light for medical procedures based on the type of
ultraviolet and the size of the wavelength:
UV-B: Ultraviolet light B (UVB) has a medium wavelength that reaches the top layer
of your skin. Overexposure to UVB light can cause sunburns.
Narrow band (UV-B)
UV-A: Ultraviolet light A has a long wavelength that reaches the first two layers of
your skin and treats conditions that affect these deeper regions of the skin.
Overexposure to UVA light can cause sunburn and wrinkles.
PUVA is an acronym for psoralen plus ultraviolet-A radiation
side effects of phototherapy:
Skin redness that fades within 24 hours , Burns or blisters similar to a
sunburn , Dry skin , eye damage, skin aging and cancer.
mohs micrographic surgery :
What is the process of Mohs surgery?
This surgery involves cutting away thin layers of skin. Each thin layer is
looked at closely for signs of cancer(eg. melanomas,SCCs and BCCs). The
process keeps going until there are no signs of cancer. The goal of Mohs
surgery is to remove all of the skin cancer without hurting the healthy skin
around it.
For maximum cosmetic result(facial cancers) .
Cryotherapy
Cryotherapy is a treatment where your healthcare provider applies extreme cold to freeze and
destroy abnormal tissue. To create this severe cold, your provider will use a substance like
liquid nitrogen or argon gas.
Indication :
warts , Seborrheic keratosis , Actinic keratosis .
Side effect of Cryotherapy :
• Pain .
• Nerve damage resulting in loss of feeling.
• Swelling, scarring and skin infection.
•thanks
