dermatological pharmacology, suryosutanto,dr
TRANSCRIPT
DERMATOLOGICAL PHARMACOLOGY
The essensial function of skin : protection thermoregulation immune responsiveness biochemical synthesis sensory detection social and sexual communication
Therapy to correct dysfunction in any of these activities may be delivered: systemically. intralesionally topically depend on understanding the barrier function of the skin, primarily
within the stratum corneum. ultraviolet radiation
Corticosteroids and retinoids are importantsystemic and topical therapeutic agents for skin disease. Antibacterial, antiviral and antifungal agents are employed widely both oral antimalarial, chemotherapeutic and immunosupressive agents, dapsone, and antihistamine, frequently are used for treatment of dermatological diseases.
Calcipotrien, a vitamine D analog, and anthraline are mayor topical agents for psoriasis.Ultraviolet radiation therapy is frequent modeOf treatment for psoriasis, independently orcombination with drugs such as psoralens or coaltarThe prophylactic use of sunscreens may reduce or prevent premalignant or malignant skin lesions induce by UV light.
General Guidelines for Topical Therapy 1. Regional Anatomic Variation
- Drug penetration higher on the face, intertriginous area, and especially in the perineum. - Sensitization, irritation, and atropy from steroidare more likely to develop in these regions.
2. Altered Barrier Function - psoriasis Str. corneum is abnormal barrier function is lost topical absorption is increased systemic toxicity.
3. Hydration- drug absorption is increased- produce by inhibiting transepidermal loss of
water, (occlusion with an impermeable film,application of lipophilic oclusive vehicle such as oinment)
4. Vechicle- acute inflamation aqueous drying preparation- chronic inflamation hydrating preparations.- soaks acute moist eruptions
- Lotions (powder in water suspension) andsolutions (medications dissolve in a solvent) for hairy and intertriginous areas.
- Creams or oil inwater emulsions are absorbableand are the most cosmetically acceptable.
- Ointments, water in oil emulsions are the mosteffective hydrating agents scally eruption.
- Multiple creams and oinments without activedrug are marketed as moisturizing agents.
5. Age6. apllication frequency
Topical Glucocorticoids Therapeutic Uses: inflamatory skin diseases twice a day application is sufficient hydrocortison is the most potent steroid used
on the face or in occluded areas (axilla or groin) tachyphylaxis can occur. intralesional injection : triamcinolone scalp
allopecia, panniculitis, psoriasis, discoid lupusand inflamed cysts.
Toxicity and Monitoring- skin atrophy, striae, teleangiectasias purpura,
acneiform eruptions, perioral dermatitis,overgrowth of skm fungus and bacteria,
hypopigmentation in pigmented skin, and rosacea.- factors that increase systemic absorption : the
amount of the steroid applied, the extent of thearea treated, the frequency of application, thelength of treatment, the potency of the drug andthe use of occlusion.
- intralesional glucocorticoids can cause cutaneous atrophy and hypopigmentation
Systemic GlucocorticoidsTherapeutic uses: A. Require long-term therapy: - Bullous diseases:- pemphigus vulgaris
- herpes gestationis.- Collagn Vascular Diseases : - S.L.E. - vasculitis- Sarcoidosis - Sweet’s disease - Pyoderma gangrenosum - Type l reactive leprosy
B. Respond to short-term therapy : - Contact dermatitis (acute)- Atopic dermatitis- Lichen planus- Exfoliative dermatitis - Erythema nodosumC. Respond to low-dose bedtime therapy :- Acne- HirsuitismeD. Steroid therapy controversial- Toxic epidermal necrolysis- Erythema multiforme- Cutaneous T - Cell lymphoma - Discoid L.E.
Toxicity and MonitoringShort-term use:> psychiatric problems, cataracts,myopathy,avascular necrosis, hypertension.
Withdrawl syndrome : - transient arthralgias, myalgias, joint effusions
- Isotretinoin ( I ) - Etetrinate ( E)- Tretinoin (T)Mayor Retinoid-Responsive Skin DiseaseaAcne 1,(T) Disorders of keratinization I,E,(T)Skin cancer I,EPrecancereous T,E,(I)Psoriass ECutaneous aging T
TOPICAL ANTIPSORIASIS DRUGS - Calcipotriene- Anthralin PHOTOCHEMOTHERAPY 1. PROSALEN2. BERGAPTEN3. METHOXALEN4. TRIOXALEN
Therapeutic Uses: vitiligo psoriasis PUVA also is employed in the treatment
of:- cutaneous T-Cell lymphoma
atopic dermatitis- alopecia areata- lichen planus
Sunscreens are topical agents that reduce theamount of ultraviolet radiation reaching the Skin or block it altogether.
I. Physical 3 Sunscreen :This sunscreen contain large particulate
ingredients that reflect and scatter UVA, UVB, andvisible light. These ingredients include :
II. Chemical sunscreens. Protection against UVB is more effective, thanProtection against UVA.- p-ammobenzoic acid esters- cinnamates effective UVB - salicylates blocking - benzophenones - anthranilates effective UVA blocking- avobenzone
- Minoxidil Stimulating hair growth.- Keratolytic agent : - lactid acid
- glycolic acid - salcylic acid.-Destructive agents: - Podophyllin - Trichloroacetic acid