TOPICAL DERMATOTHERAPY

Dr. dr. Farida Tabri, Sp.KK(K)

The

main

topical

requirement

for

dermatotherapy

is

selection of the suitable base,

also called vehicle.

Vehicle is used for those

substance

that

bring

specific drugs into contact

with the skin.

The most important vehicles

for topical use divided into :
I. Monophasic Vehicles.
II. Biphasic Vehicles.
III. Triphasic Vehicles.

POWDER
POWDER

PASTA
PASTA

OIL
OIL // FAT
FAT

Cool
Cool
Pasta
Pasta

EMULTION
EMULTION ::
CREAM
CREAM (O
(O // W)
W)
OINTMENT
OINTMENT (W
(W // O)
O)

LOTION
LOTION

LIQUID
LIQUID

IMPORTANT BASES FOR TOPICAL

TREATMENT

I . Monophasic Vehicles
A.

LIQUID

1. Baths :
Effect cleansing effect
(crusts, scales, secretions).

 Example : full bath, sit bath,

foot bath, hand bath.
Side

effect

maceration

(limited 30 minutes).
Preparation :
Sol acid salicyl.
Sol kalium permanganate.

2. Wet Dressing
Type :
Open wet dressing
rapid evaporation.
Closed wet dressing
retards evaporation.

 Indicated
:
superficial,
inflammatory, crusted, &
erosive skin lesions.
Effect :
Cooling.
Reduces swelling.
Anti-inflammatory.
Softening & removing
accretion.

 Side Effect :
Maceration.
Increase
growth.

in

bacterial

B. P O W D E R
Effect :
Covering protective.
Cooling.
Anti-frictional.
Superficial anti-inflammatory.
Drying.

 Indicated :
Superficial Dermatoses.
Erythematous Exanthema.
Vesicle

or

bullae

protective.
Contraindicated : Madidans
lesion.

 Specifics drugs contain :

Zinc oxide.
Magnesium oxide.
Titanium oxide.
Bismuth

subnitrate

(preputial area).

II . Biphasic Vehicles
A. L O T I O N
Synonyms

shake

lotion,

liquid powder mixture.

Definition : suspensions of
solid

material

in

water

or

ethanol two phase systems.

 Effects :
Cooling.
Astringents.
Drying.
Superficial
inflammatory.

anti-

 Indicated :
Acute,

sub-acute

superficial

&

inflammatory

dermatoses.
Seborrheic & intertrigenous
dermatoses.

 Side effect :
Drying action indicated
for short term use.
Abrasive the powder
particle may clump.
Commercial preparations :
Calamine USP.
Caladryl lotion.

B. C R E A M
Synonym : hydrophilic cream.
Definition : emulsion of oil in
water (O / W), a two phase
systems

of

substances.

water

&

fatty

 Effects :
Cooling.
Anti-inflammatory effect.
Moisturizing

&

emollient

effect.
Rapidly penetrate the skin.
Water washable.

 Indicated :
Dermatitis acute / subacute.
Cosmetic
(cleansing
lotion).

indication
or

body

 Contraindicated :
Dry skin condition.
Madidans lesion.
Side effect :
Promote drying
application).
Pruritic

(prolong

effect (because
evaporated tendency)

C. O I N T M E N T
Synonym : lipophilic cream.
Definition

emulsions

of

water in oil (W / O), a two

phase systems of fat and a
limited

amount

(about 30%).

of

water

 Effect :
Covering.
Softening

scales

&

crusts.
Greasing.
Indicated
:
chronic
Inflammations psoriasis,
chronic eczema.

 Contraindicated :
Seborrheic condition.
Acute inflammatory skin
(Madidans lesion).
Side effect :
Promote inflammation
occlusion effect.
Promote dyhidrosis.

D.

PASTA

Definition : ointment into

which 20 - 50% powder, a
two phase system or as
highly
suspensions.

concentrated

 Effects :
Cooling.
Anti-inflammatory.
Secretion absorbing
(drying).
Skin protective action.

 Indicated :
Ulcers.
Chronic

exudative

dermatoses.
Thick lichenified plaque.
Secondary
infection.

bacterial

 Contraindicated :
Acute

inflammatory

skin.
Scalp skin.

III . Triphasic Vehicles

COOLING PASTA
Definition

triphasic

vehicles that consist of oil

water powder mixtures
in varying proportions.

 Effects :

B.POWDER :

Soothing.
Cooling.
Weeping skin.

The basic formula for cooling

pasta : zinc oxide, calcium
hydroxide solution, & oil.

Specific Topical Treatment

1. Tars.
2. Keratolytic drug.
3. Antibiotic drugs.
4. Anti-fungal drugs.
5. Parasiticides.
6. Corticosteroids.

1. T A R
Definition : are produces
by dry distillation of coal,
wood, or peat.

 Effects :
Anti-pruritic.
Anti-inflammatory.
Keratoplastic.
Anti-infective actions.
Indicated :
Chronic lichenified.
Atopic eczema.
Psoriasis vulgaris.

 Contraindicated : exudative
or infection dermatoses.
Side effects :
Phototoxic dermatitis.
Tar folliculitis.
Tar acne.
Carcinogenicity of coal
tar (long term use).

2. KERATOLYTIC DRUGS
a. Salicylic acid
At Low concentrations (0.5 2%), it has an antiseptic,
keratoplastic,

an

inflammatory action.

anti-

 At a concentration of 3 10%,

it

has

keratolytics,

loosen scales in psoriasis or

hyperkeratotic eczema.
Side effect : toxic effect is
used

in

large

(especially : children).

area

b. Sulfur
Effect :
Astringent action (2 - 10%).
An anti-fungal (10%).
Cosmetic & medical facial
& scalp preparation (no
sebum suppressive effect).

c. Resorcinol
Effect :
Drying.
Astringent.
Keratolytics effect (high
concentration).
Indicated :
Scaling dermatoses.
Comedones acne (by Vit A
acid).

3. ANTIBIOTIC DRUGS
a. Penicillin
recommend
their

high

can

not

because

of

potential

for

contact sensitization & not

absorbed.

b. Tetracyclines

bacteriostatic Gram (+ / -)
Eg

oxytetracycline,

chlortetracycline.
b. Neomycin & Framycetin :
broad spectrum.
Eg : neopolycin, neosporin.

d. Gentamicin : active
Pseudmonas A.
Eg
:
gentamycine.

for

garamycin,

d. Fusidic
Acid
:
Staphylococcal infections
& erythrasma.
Eg : fucidine cream.

f. Polymyxin

very

broad

Spectrum, especially Gram

(E.Coli, Pseudomonas A)
g. Nitrofurazone : bactericidal
& bacteriostatic Gram (+ / ).

h. Clindamycin
spectrum

:
of

broad
Penicillin

resistant & treatment for

acne.
Eg : cleocin, sobelin.

4. ANTIFUNGAL

a. Tolnaftate : anti-fungal drug

for all dermatophytes.
Eg : aftate, tinactin, tonoftal.

b. Tolciclate
tolnaftate.

analogue

of

Eg : fungifos.
c. Imidazole derivates : for
dermatophytoses,
Candida
albicans, Pityriasis versicolor.
Eg : canesten,
micatin.

mycospor,

d. Amphotericin B : anti-fungal
antibiotic,

especially

for

superficial infections.
Eg

fungizone,

moronal.

ampho-

e. Nystatin : no systemic action,

minimally absorbed from GI
Tract, especially Candida A.
Eg : mycostatin, mycolog.

5. PARASITICIDES

a. Benzyl Benzoate : antiscabies

children.

for

infants

&

b. Hexachlorocyclohexane
antiscabies,

antipediculosis,

antiphtriasis.
Eg : lindane (gamene, kwell,
scabene).

c. Crotamiton
phtriasis,
folliculitis,
drug.

:
&

scabies,
demodex
antipruritic

Eg : eurax lotion, crotamitex

gel.
c. Thiabendazole : creeping
eruption, scabies (> 80%
cases are cleared).

6. CORTICOSTEROID
Effects :
Anti-inflammatory.
Anti-pruritic.
Granulomatous dermatoses.

group

classification

of

topical corticosteroid :
a. Mild

corticosteroid

hydrocortisone 0.1 2.5%.

b. Moderate corticosteroid :
clobetasone 0.05%.

c. Potent

corticosteroid

triamcinolone

0.1%

betamethasone 17 valerate
0.5%.
d. High potency corticosteroid :
fluocinolone acetonide 0.2%.

 Side effects corticosteroid :

Allergic contact dermatitis.
Atrophy & thinning of the
epidermis.
Steroid acne.
Steroid striae.

 Leucoderma.
Steroid

ulcer

(chronic

venous insufficiency).
Rebound effect (psoriasis
vulgaris).