DERMATOTHERAPY

Department of Dermatovenereology
Faculty of Medicine Padjadjaran
University
TYPE OF THERAPY
• Medication:
• Topical
• Systemic
• Surgery:
• Electrosurgery, chemical surgery, cryotherapy
• Light therapy
• Psycotherapy
TYPE OF THERAPY
• Medication:
• Topical
• Systemic
PRINCIPAL OF MEDICATION THERAPY
• Give chance for natural • Causative
healing process • As simple as possible
• Examine the patient entirely • Individual
• Acknowledge the • Economic
physiological, pathological,
biochemical, and anatomical
aspect
• Understand the knowledge
about the medicaion
PRINCIPAL OF TOPICAL THERAPY
• Topical medication contain two part:
• Active part
• Vehiculum
• Active part:
More acute less consentration
• Explain to the patient how to applied the medication
• Avoid the use of sensitizer
• Limiting the use of unstable medication
PRINCIPAL OF TOPICAL THERAPY
Vehiculum

Skin surface

Inactive part in stratum corneum

topical medication,
epidermis and/or
Role: carrying the its apendix
active part into the Dermis
skin
vesel
 PRINCIPAL OF TOPICAL THERAPY
Choosing the right vehiculum is as important as
choosing the active part
• Ideal vehiculum: • Depend on:
• Nonititative, nonalergenic, • Stadium of the skin disease
aesthetical • Distribution and location
• Easy to applied • Wanted efect
• Accepted by the
patient good
compliance

There are no universal vehiculum

 CLASIFICATION OF VEHICULUM
• Monofasic
• Powders
• Liquids (water/ alcohol)
• Grease (ointment)
• Bifasic
• Powder+ liquid : lotions
• Powder+ grease (ointment) : Pastes containing grease
• Liquid+ grease (ointment) : creams
• Trifasic
• Powder+ liquid + oil (ointment) : cooling pastes
POLANO Powders

Lotion Pastes
Cooling containing
pastes greases

Liquid Cream Greases

(ointment)
O/W W/O
POWDER
• Inert material, very small sized particle, used based on its
physical nature:
• To cover protection
• To absorb to dry
• Slipping power reduce friction
• Adhesive
• Cooling
• Prevent bacterial growth
• Deodorant
• Exp: titanium oxide, zinc oxide, calamine
POWDER
• Indication: • Contra indication:
• Dry lesion • Wet-exudative lesion
• Superficial lesion
• Disadvantage
• Acute
vesicobulous • Iritation, adhesion, forming
lesion granulomatous lesion
• Intertriginous area • Inhaled by the patient

• Application:
• With sponge, sprinkled
• 1-3x dailly, clean previous application before re-apply
LIQUID
• Water solution,
• Alcohol (≥50%)  tincture

Ability: • Indication:
• Clean • Wet-acute lesion, acute
lesion
• Dry
• Protect • Contra indication:
• Warmth the lesion • Very dry lesion
• Chilled the lesion • Aplication:
• Induce epitelization • Soaking
• Anti pruritus • Wet dressing
GREASE (OINTMENT)
Ability
• Oclusion prevent evaporation hidration
• Protection
• Slipping power
• Increase the penetration of the active substance
• Warmth the lesion
• Not contain water no aditional presevative agent
GREASE (OINTMENT)
Indication: Disadvantage:
• Dry/chronic lesion • Oily
• Hard to clean
Contra indication:
• Stain
• Wet lesion
• Cannot used as solvent for
• Intertriginous lesion water-soluble substance
• Lesion in terminal hair area

Aplication:
• Apply by finger
• Clean 1x daily using greasy cotton/cloth
LOTION
Suspension of powder in liquid
Aplication:
Ability:
• Shake before used not
• To dry shake concentration not
• Antipruritus homogen disadvantage
• Aplied wih brush
Advantage:
• Clean 1x daily with soaking,
• Easy to use
wash with water
• Can used more than 40% of
Contra indication:
body surface area
• Productive lesion
Indication:
• Terminal hair area
• Wide area-generalized lesion
• Very dry lesion
 CREAM
Semisolid emulsion : oil + liquid + emulgator
W/O cream: mostly water (>31-80%) O/W cream: mostly grease

Indication Ability
• Subacute lesion • Protect
• Wide lesion • To dry
• Terminal hair area: Contra indication
O/W cream
• Productive/ wet lesion
• Dry lesion : W/O
cream Aplication
• Apply by finger
 Cream
W/O O/W
WATER IN OIL OIL IN WATER
OIL >> WATER >>

Skin lesion
More dry More Wet

SUB ACUTE
PASTE CONTAINING GREASE AND COOLING
PASTE
• Paste containing grease : grease+ powder
• Cooling pastes : grease+ powder+ liquid
Ability Contra indication:
• Absorb exudate • Productive lesion, terminal hair area
• Localize active
substance effect Aplication:
• Impermeable barier • Applied with spatulewrapped
• Protection
• To dry Indication:
• Subacute lesion
Disadvantage hard to
apply and hard to clean • Nonproductive lesion
OTHER TYPE OF VEHICULUM
• Gel :
• Water soluble substance+ water
• Easy to applied and to clean, not oilly, esthetically accepted

• Poultices :
• Oldest form of topical therapy solid mass

• Microsponges :
• Drug carrier system

• Liposomes :
• Aqueous phase covered with grease capsule
MICROSPONGES
PETROLATUM
POULTICES
 CHOOSING VEHICULUM BASED ON DISTRIBUTION/
LOCATION

Location Powder Liquid Grease Lotion Paste Cream

Generalized
+ -* - + - +
Scalp
- + - - - +
Face
+ + + + + +
Trunk-extremity
+ + + + + +
Genital
+ + - + - +
Intertriginous
+ + +@ + - +
 CHOOSING VEHICULUM BASED ON :
CLINICAL MANIFESTATION / LESION / STADIUM

Acute Chronic
Wet Sub acute Dry

Wet dressing O/W cream W/O cream Grease

Concentration
 CHOOSING VEHICULUM BASED ON WANTED EFFECT

• Protective : grease, paste, cooling paste, cream

• Absorbsion : powder
• To dry : liquid
• High penetration : ointment, cream, tincture
• Soften dry skin : ointment, W/O cream
• Clean lesion : liquid
• Cooling effect : Liquid
• UV protection : powder (Ti02)
• Warmth the lesion : closed dressing
MEDICA DERMATOLOGICA MATERIAL
Liquid: Water, alcohol, glycerine
• Glycerine
• Thick, colourless
• Hygroscopic
• High solubility in water
• Sweet, sticky
• Stabillize suspension
MEDICA DERMATOLOGICA MATERIAL

Powder Talcum venetum

• White powder, not soluble in water
• Good slipping power

Oxyd zincii
Magnesium/ zinc stearat • White powder-not soluble in water
• Fine powder • Good absorbtion
• Low density • Adstringent
• Slipping power • Antiseptic
• Antipruritic
MEDICA DERMATOLOGICA MATERIAL
GREASE/ OIL
• Natural grease:
• Adaps lanae
• Oleum arahidis
• Oleum iecoris aseli
• Mineral grease:
• Vaseline album
• Vaseine flavum
 FREQUENT MATERIAL FOR DRESSING
1 Acidum White -Low solubility - Dressing : - Adstringent
boricum chrystal in cold water 1-3 % - Low antiseptic
--High - Ointment,
solubility in cream, paste,
warm water cooling paste.
2. KMn04 Dark purple - High - Dressing : - Adstringent
chrystal solubility in 1/5000 – - Antiseptic
water (1:19) 1/10.000 - Deodorant

3. Rivanol Yellow - High - Dressing: - Antiseptic

powder solubility in l0,5 – 1 % - Adstringent
water (1:15)
4. Salicylic White - Low - Dressing : - Anti pruritus
acid chrystal solubility in lar 1 ‰ - Keratolitic
water - Powder, - Antiseptic
(1:650) lotion,
- High ointment,
solubility in paste,cooling
alcohol (1:4) paste
 ANTIFUNGAL MATERIAL
1. Benzoic Yellow- Water: low Cream, ointment
acid brown solubility, Unguentum Whitfield :
chrystal oil/alcohol: high - Benzoic a. 6-12 %
solubility
- Salycilylic a. 3-6 %
 Dermatophytosis
treatment
2. Gentian Purple Water/alcohol: 3 % liquid, 0,5-2 % tincture
violet high solubility  Th/ Candidiasis
Stomatitis
Intertriginous fungal infect.
3. Acidum Yellow 2-5 % Cream/ ointment
undecy- liquid
lenicum
4. Sodium Colourles High solubility in 25 % liquid
tiosulfat chrystal, water Th/ Tinea Versikolor
sulfuric odor (“Panu”)
ANTI SCABEIC MATERIAL
1. Benzoal bencylicus/ benzyl
benzoat
• Colourless, smelly material
• Not soluble in water
5. Gamma benzena
hexacloride/ “Gamexan”
• In form of 0,5-1% cream,
ointment, or powder

• Soluble in alcohol/ oil • Effect: scabicide,

pediculocide, repellent
• Form: 10-25% ointment:
• Side effect: neurotoxic
• Children : 10-15%
• Not safe for baby-
• Adult : 25% pregnant women
2. Sulphur: in “2-4 ointment”
combined with salycilyc acid
3. Crotamiton
4. Permethrin
MATERIAL IN CHEMICAL SURGERY
1. Acidum tricholoru aceticum
• Colourless chrystall, vinegar odour
• Effect: caustic (20-35%)

2. Podophyline
• Yellow powder, soluble in alcohol
• Effect: caustic (20%)
• Th/ condiloma acumina
 OTHER MATERIAL

1. Sulphur: 2. Camphora:
• Yellow coloured, brimstone • White-smelly chrystal
odor • Low solubility in water
• Ointment, cream, lotion • Antipruritic

• Effect:
3. Menthol
• Reducing sebaceous gland
activity acne • Smelly, white chrystal
• Antiseptic • Low solubility in water
• Antimicotic • Antipruritic
• Scabicide • Cooling effect
OTHER MATERAL
4. Vioform:
• Yellow powder
• Antiseptic, antimycotic
• Th/ seborrhoic dermatitis

5. Antibiotics
• Do not used sensitizer
• Used antibiotic rarely
systemic used
• Exp: gentamycin, bacytracin,
neomycin, polimyxcin
SYSTEMIC MEDICATION
Antihistamine
• Competitive inhibitor of histamine
• Other effect:
• Sedative, antiemetic
• Anticonvulsant
• Local anaesthesia
• Exp: chlorpheniramine maleat, diphenhydramine,
promerazine, loratadine, fexofenadine, ceritizine
SYSTEMIC MEDICATION
• Corticosteroid
• Delivery : topical, peroral. Perenteral, intradermal
• Side effect: peptic ulcer, atrophy, osteophorosis, sodium
retention, immunosupresan
• Absolute contraindication: peptic ulcer
• Relative contraindication: TB, DM, hypertension, pregnancy
• Exp: cortisone, hydrocortisone, prednisone, triamcinolone,
betametasone, dexametasone
SIDE EFFECT OF TOPICAL CORTICOSTEROID
• Skin atrophy
• Acneiform eruption
• Telangiektasia
• Hypertrikosis
• Striae
• Hiper/hypopigmentation
Thank you