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Dermatological Pharmacology 2020 prof satyanarayan

This is an excellent ppt on Dermatological pharmacology highlighting types of formulations, topical preparations and the treatment of individual skin disorders with illustrations...!!

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Dermatological Pharmacology 2020 prof satyanarayan

  1. 1. INTERESTING FACTS • body’s largest organ • average adult’s skin spans 21 square feet • weighs 4.1 kg • contains more than 11 miles of blood vessels. • skin releases as much as 11 litres of sweat a day in hot weather. • skin sheds 50,000 cells every minute.
  2. 2. Skin has three layers: • The epidermis, the outermost layer of skin, provides a waterproof barrier and creates our skin tone. • The dermis, beneath the epidermis, contains tough connective tissue, hair follicles, and sweat glands. • The deeper subcutaneous tissue (hypodermis) is made of fat and connective tissue
  3. 3. DRUGS AND THE SKIN DISORDERS DR. V.SATHYANARAYANAN MBBS.,M.D., ACME PROFESSOR OF PHARMACOLOGY SRM MCH & RC
  4. 4. OVERVIEW • Types of skin formulations – lotion, cream, ointment, paste • Topical preparations • Treatment of individual skin disorders like Acne, Alopecia , Scabies, Seborrhoeic dermatitis (dandruff), Psoriasis, Urticaria, Pediculosis ( lice ), Nappy rash, hyperhidrosis • Cutaneous adverse reactions
  5. 5. SPECIFIC LEARNING OBJECTIVES • AT THE END OF THE SESSION ALL THE LEARNERS SHALL BE ABLE TO • Enumerate types of skin formulations and compare, contrast each • Define and Describe different topical preparations with examples • Outline the treatment of common individual skin disorders appropriately
  6. 6. Common types of topical formulations • cream • ointment • paste • lotion • gel
  7. 7. CREAM • emulsion of water and oil • classified as oil in water (o/w) or water in oil (w/o) emulsions • o/w creams (e.g. vanishing creams) spread easily and do not leave the skin greasy and sticky • w/o creams (e.g. cold cream) are more greasy and more emollient
  8. 8. CREAMS • Oil-in-water creams- aqueous cream, vehicle for water-soluble drugs • Water-in-oil creams- oily cream, used on hairy parts, vehicle for lipid soluble drugs • creams contain emulsifiers and preservatives  may cause contact allergy
  9. 9. OINTMENTS • semi-solid preparations of hydrocarbons • Greasy and thicker than creams • By occlusion promote dermal hydration • Used in chronic dry conditions • Water-soluble ointments- easily washed off • Non-emulsifying ointment- adhere to skin, a form of occlusive dressing, messy, e.g- paraffin ointment- for chronic dry, scaly conditions • contains no water and does not require a preservative
  10. 10. PASTES • mixture of powder and ointment • Very adhesive  give good protection to small areas • Prevent spread of drug into surroundings • Absorb discharge • E.g coal tar paste, lassar’s paste
  11. 11. LOTION • any liquid preparation in which inert or active medications are suspended or dissolved • an o/w emulsion with a high water content • lotions are easy to apply to large areas • lotions are suitable for hairy areas, skin prone to folliculitis/acne, intertriginous areas
  12. 12. LOTION • most lotions are aqueous or hydroalcoholic systems; • small amounts of alcohol are added to aid solubilization of the active ingredient(s) and • to hasten evaporation of the solvent from the skin surface
  13. 13. GEL • transparent preparations containing cellulose ethers or carbromer in water or a water-alcohol mixture • gels liquify on contact with the skin, dry and leave a thin film of active medication • gels tend to be drying • they are useful in hairy areas • they are cosmetically acceptable
  14. 14. Collodion • flammable, syrupy solution of nitrocellulose in ether and alcohol. • There are two basic types: flexible and non- flexible. • The flexible type is often used as a surgical dressing or to hold dressings in place. • When painted on the skin, collodion dries to form a flexible nitrocellulose film • prep of cellulose nitrate
  15. 15. VEHICLES – LIQUID FORMULATIONS • Water is the most important component • Can be a soak, a bath or a paint • Wet dressings - to cleanse, cool and relieve pruritus in acute inflammation e.g normal saline • SHAKE LOTIONS – e.g Calamine lotion – applies powder conveniently & cools skin • Can cause excessive drying •
  16. 16. PHARMACOKINETICS OF SKIN • Stratum corneum is the principal barrier and reservoir • Vehicles are designed to increase hydration • Absorption varies with site • Absorption further increased in inflammation , burns , exfoliation • Occlusive dressing increases absorption by 10 fold
  17. 17. Factors to consider when choosing a topical preparation: • Always consider the effect of the vehicle. • An occlusive vehicle enhances penetration of the active ingredient and improves efficacy. • The vehicle itself may have a cooling, drying, emollient, or protective action. • It can also cause side effects by being excessively drying or occlusive.
  18. 18. Factors to consider when choosing a topical preparation: • Match the type of preparation with the type of lesions. • For example, avoid greasy ointments for acute weepy dermatitis. • Match the type of preparation with the site (e.g., gel or lotion for hairy areas). •
  19. 19. Factors to consider • Consider irritation or sensitization potential. • Generally, ointments and w/o creams are less irritating, while gels are irritating. • Ointments do not contain preservatives or emulsifiers if allergy to these agents is a concern.
  20. 20. TOPICAL PREPARATIONS
  21. 21. TOPICAL PREPARATIONS • Demulcents, Emollients, • Adsorbants • Astringents • Irritants , counter-irritants • Topical analgesics • Caustics, escharotics, keratolytics • Antipruritics • Topical steroids • Sunscreens, • melanising agents, demelanising agents • Miscellaneous
  22. 22. DEMULCENTS • Inert substances which sooth inflamed skin/ denuded mucosa • Applied as thick colloidal solutions in water
  23. 23. EXAMPLES FOR DEMULCENTS • Gum acacia, • Gum tragacanth • Methylcellulose used in nasal drops, contact lens solutions • Propylene glycol in cosmetics • Glycerin – dry skin, cracked lips
  24. 24. EMOLLIENTS • Hydrate , sooth, smoothen dry scaly conditions – olive oil, arachis oil, cocoa butter, liquid paraffin • Short-lived action • Barrier Preparations- dimethicone cream, Protect skin from discharges and secretions, irritant • Silicone sprays – pressure sores • Masking creams- titanium oxide in an ointment base • Dusting powders- zinc ,starch, talc- cool, lubricate, reduce friction
  25. 25. ADSORBANTS • Finely powdered solids that bind irritants to their surface • Also Afford physical protection to the skin • Magnesium/ zinc stearate, Boric acid • aloe vera gel • Feracrylum – stops oozing blood • Sucralfate (topical ) – applied on bed sores, burns
  26. 26. ASTRINGENTS • Substances that precipitate proteins in the superficial layer • Toughen the surface, decrease exudation • Eg tannic acid, tannins used for bleeding gums • Ethanol, methanol prevents bed sores, used as after- shave • Heavy metal ions – alum, zinc
  27. 27. IRRITANTS • Stimulate sensory nerve endings  produce cooling or warmth, pricking and tingling • Rubefacients – cause local hyperemia • Vesicants – form raised vesicles
  28. 28. COUNTER-IRRITANTS • Turpentine oil, eucalyptus oil • When massaged  relieve headache, muscular pain • Camphor – produces cooling sensation of skin, added in pain balms • Thymol, methyl salicylate • Menthol – from mint – has cooling, soothing action • Mustard plaster, capsaicin, canthridin
  29. 29. TOPICAL ANALGESICS • Counterirritants and rubefacients- stimulate nerve endings in intact skin , relieve pain in skin, viscera or muscle supplied by same nerve root - e g salicylates, menthol, camphor, capsaicin • Topical NSAIDs - Relieve musculoskeletal pain • Local Anesthetics- lidocaine and prilocaine available as gels, ointments and sprays • Volatile aerosol sprays- sports people use, produces analgesia by cooling and placebo effect
  30. 30. CAUSTICS AND ESCHAROTICS • Caustic – corrosive,escharotic – cauterizer • Cause local tissue destruction and sloughing • Used to remove moles, warts • Eg podophyllum resin, silver nitrate, phenol, trichloroacetic acid
  31. 31. KERATOLYTICS • Dissolve the intercellular substance in the stratum corneum • Used on hyperkeratotic lesions like corns, warts, ring worm , psoriasis etc • Eg salicylic acid- applied under polyethylene occlusive dressing • Resorcinol • Urea
  32. 32. ANTIPRURITICS • Histamine and other autocoids involved • Generalized pruritus – treat the cause, oral H1 Antihistamines, sedatives • Localized pruritus – covering the lesion, topical corticosteroids for eczema, application of aqueous menthol cream, calamine, astringents ( tannic acid ), crotamiton • Local anesthetics, topical antihistamines induce allergic dermatitis and better avoided
  33. 33. ADRENOCORTICAL STEROIDS • Suppress inflammation, immune responses • Antimitotic activity- useful in psoriasis • Vasoconstriction reduces entry of inflammatory cells • Used For Symptom Relief • apply thinly for short duration • Most useful in eczematous disorders • Choose appropriate vehicle and potency • Use combined with antimicrobials if infection present
  34. 34. TOPICAL STEROIDS • VERY POTENT- clobetasol – needed for lichen planus, DLE • POTENT- beclomethasone, fluocinolone • MODERATELY POTENT- Clobetasone • MILDLY POTENT- hydrocortisone (0.1-1%)- adequate for eczema • Intralesional injections occ. used
  35. 35. ADVERSE EFFECTS • Infection may spread • Skin atrophy occur in long term use • Local hirsutism • Depigmentation, acne • Allergic dermatitis • Potent steroids - not applied on face • On eyelids enter eye cause glaucoma • Rebound exacerbation of disease after abrupt cessation • Mild- mod potent are Effective and safe •
  36. 36. SUNSCREENS • Substances that protect the skin from harmful effects of exposure to sunlight • Para-aminobenzoic acid, camphors absorb UVB ( protection against sunburn, tanning, skin cancer, aging) • Benzophenone absorb UVA which cause skin cancer, aging • Titanium dioxide, zinc oxide, calamine act as a physical barrier to UVA, UVB ( reflect ) • Useful in photosensitivity due to drugs or disease
  37. 37. Sunburn • can be treated with • oily calamine lotion, • topical steroids, • NSAIDs
  38. 38. SUNSCREENS • Performance of a sunscreen is expressed as SPF ( sun protective factor ) • Daily application protects more • Useful in drug induced phototoxicity • Facilitate tanning • Adjuncts in vitiligo therapy
  39. 39. DRUG INDUCED PHOTOSENSITIVITY • Doxycycline • Sulphonamides, Chlorpromazine • Frusemide, thiazides • piroxicam • TREATMENT- withdraw the offending drug
  40. 40. INTERESTING FACTS ABOUT SKIN • White skin appeared just 20,000 to 50,000 years ago, as dark-skinned humans migrated to colder climates and lost much of their melanin pigment. • In a lifetime the average person sheds enough skin cells to fill an entire 2 story house. • Every square inch of the human body has about 19,000,000 skin cells. •
  41. 41. MELANIZING AGENTS • Drugs that promote repigmentation of vitiliginous areas of skin • Psoralen – stimulate melanocytes and induce their proliferation • Methoxsalen, trioxsalen • Sensitize skin to sunlight • Topically or orally and vitiliginous area is exposed to sunlight under supervision
  42. 42. DEMELANISING AGENTS • Lighten the hyperpigmented patches on skin • Hydroquinone – inhibits tyrosinase, decrease formation and increase degradation of melanosomes • Used for melasma, chloasma of pregnancy etc – incomplete response • Monobenzone- destroys melanocytes • Azelaic acid – weak agent
  43. 43. MISCELLANEOUS • Squalene used in prevention of bedsores • TARS- mild antiseptic, antipruritic, inhibit keratinization in psoriasis • Zinc oxide- astringent, barrier • Urea- topically used to assist skin hydration in ichthyosis • Insect repellents – deet, dimethyl phthalate
  44. 44. There is an ancient story ... man asked God, "God, why did you make women so pretty?“ "So you will like them," God answered. And man asked God, "Why did you make women so soft? "So you will like them," God answered again. "And why," asked man again, "did you make them so stupid?“ And God answered, "So they will like you.!!"
  45. 45. INDIVIDUAL SKIN PROBLEMS
  46. 46. ACNE • Androgen  increases sebum  with abnormal keratin form debris  plugs follicle, propionibacterium acnes colonizes  releases inflammatory fatty acids irritate ducts  comedones are formed • Apply mild keratolytics- benzoyl peroxide, azelaic acid, salicylic acid • Systemic or topical antimicrobial therapy low dose erythromycin, tetracycline
  47. 47. ACNE • VITAMIN A DERIVATIVES- Tretinoin topically, may promote skin cancer, teratogenic • Adapalene- better tolerated synthetic retinoid • Isotretinoin- highly effective, used only in severe cases as it’s a serious teratogen, raise Cholesterol, TG, cause depression • HORMONE THERAPY- Estrogen, cyproterone, cyclical use of OCPills • Topical corticosteroids should not be used
  48. 48. ALOPECIA • MALE PATTERN BALDNESS- Topical minoxidil in UPTO 50% people some hair growth • ALOPECIA AREATA- Finasteride by mouth, PUVA
  49. 49. SCABIES • Caused by Sarcoptes scabiei • Permethrin dermal cream • Topical Benzyl benzoate emulsion • Topical Gamma benzene hexachloride • Topical crotamiton in children • Oral ivermectin single dose  recently • Apply to all members, change bed clothes after application
  50. 50. ANTI-SEBORRHEICS • Drugs effective in seborrheic dermatitis characterized by erythematous, scaly lesions ( dandruff )
  51. 51. SEBORRHOEIC DERMATITIS (DANDRUFF) • Shampoo containing selenium sulfide, zinc pyrithione or coal tar • Ketoconazole shampoo in more severe cases • Keratolytics –salicylic acid • Sulfur, resorcinol – mildly effective • Occasionally corticosteroid lotion
  52. 52. PSORIASIS • An Immunological disorder • Manifests as localised or widespread erythematous scaling lesions or plaques • Increased proliferation , inflammation of epidermis and dermis • Drugs can decrease lesions but not cure
  53. 53. PSORIASIS • Topical Emollients, keratolytics, antifungals • Dithranol paste • Topical adrenal steroids- primary drugs • Vitamin D – calcipotriol topically • Vitamin A derivatives – acitretin • PUVA therapy – psoralen followed by ultraviolet light , used in severe cases • Ciclosporin , methotrexate
  54. 54. URTICARIA • ACUTE URTICARIA, ANGIOEDEMA  H1 blockers, corticosteroids, adrenaline for severe cases • Cyproheptadine preferred for physical urticarias • CHRONIC URTICARIA – responds to cetirizine, loratadine
  55. 55. PEDICULOSIS ( LICE ) • Permethrin two applications 7 days apart • Insecticides like Carbaryl or malathion
  56. 56. NAPPY RASH • PREVENTION - Rinse reusable nappies with soaps, Use emollient cream to protect skin, disposable nappies • TREATMENT – MILD- zinc cream or calamine lotion • Severe- topical steroid with antimicrobial
  57. 57. HYPERHIDROSIS • Astringents - reduce sweat • Antimuscarinics given by iontophoresis • Botulinum toxin injection locally  axilla temporary remission for 16 weeks
  58. 58. CUTANEUS ADVERSE REACTIONS • Allergic contact dermatitis – caused by antimicrobials , local anesthetics • Patients with AIDS- increased risk • Maculopapular reactions are the most frequent – ampicillin, sulfonamides, sulfonylureas • Fixed eruptions – sulfa • Pigmentation- OCPills
  59. 59. Treatment • remove the cause, • cooling applications , • antipruritics, • H1 blockers
  60. 60. SUMMARY
  61. 61. • IF IT’S WET, DRY IT; IF IT’S DRY , WET IT
  62. 62. MCQs • 1. Which of the following substance is a keratolytic ? • A) Tannic acid B) Liquid paraffin • C) Salicylic acid D) Sucralfate • 2. Eucalyptus oil and Turpentine oil are • A) Demulcents B) Emollients • C) Counter-irritants D) Caustics • 3. Which of the following is a VERY POTENT topical corticosteroid preparation ? • A) Clobetasol B) Clobetasone • C) Hydrocortisone D) Beclomethasone
  63. 63. MCQs • 4. Vitiligo is treated with • A) Hydroquinone • B) Trichloroacetic acid • C) Calamine • D) Psoralen • 5. Topical Minoxidil is helpful in treating • A) Acne vulgaris • B) Alopecia • C) Scabies • D) Seborrheic dermatitis
  64. 64. PART 2. WRITE SHORT NOTES ON • 1. Sunsreens - preparations and uses • 2. Drugs used in the treatment of Acne • 3. Drug therapy of Psoriasis
  65. 65. Right education should help the student, not only to develop his capacities, but to understand his own highest interest - Jiddu Krishnamurti

This is an excellent ppt on Dermatological pharmacology highlighting types of formulations, topical preparations and the treatment of individual skin disorders with illustrations...!!

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