this presentation aims at dermato pharmacotherapeutics.....at a pharmacologist's view point....only the key points are stressed.....not a complete guide....however it gives the reader, an essential basics....

9. INTERESTING FACTSINTERESTING 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.

12. DRUGS AND THE SKINDRUGS AND THE SKIN
DISORDERSDISORDERS
DR. V.SATHYANARAYANAN M.DDR. V.SATHYANARAYANAN M.D
PROFESSOR OF PHARMACOLOGYPROFESSOR OF PHARMACOLOGY

13. PHARMACOKINETICS OF SKINPHARMACOKINETICS 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

16. OVERVIEWOVERVIEW
• Vehicles – lotion, cream, ointment, paste
• Topical preparations
• TREATMENT OF
• Acne, Alopecia , Scabies
• Seborrhoeic dermatitis (dandruff)
• Psoriasis
• Urticaria
• Pediculosis ( lice ), Nappy rash,
hyperhidrosis
• Cutaneous adverse reactions

17. VEHICLES – LIQUIDVEHICLES – LIQUID
FORMULATIONSFORMULATIONS
• 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
•

20. CREAMSCREAMS
• These are emulsions
• Cosmetic vanishing creams, cold 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

23. OINTMENTSOINTMENTS
• 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

26. PASTESPASTES
• Very adhesive, give good protection to
small areas
• Prevent spread of drug into surroundings
• Absorb discharge
• E.g coal tar paste, lassar’s paste
• COLLODIONS- prep of cellulose nitrate,
irritant, inflammable, used in small areas

28. TOPICAL PREPARATIONSTOPICAL PREPARATIONS
• Demulcents, Emollients,
• Adsorbants
• Astringents
• Irritants , counter-irritants
• Topical analgesics
• Caustics, escharotics, keratolytics
• Antipruritics
• Topical steroids
• Sunscreens,
• melanising agents, demelanising agents
• Miscellaneous

30. DEMULCENTSDEMULCENTS
• Inert substances which sooth inflamed
skin/ denuded mucosa
• Applied as thick colloidal solutions in water
• Eg Gum acacia, gum tragacanth
• Methylcellulose used in nasal drops,
contact lens solutions
• Propylene glycol in cosmetics
• Glycerine – dry skin, cracked lips

33. EMOLLIENTSEMOLLIENTS
• 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

38. ADSORBANTSADSORBANTS
• 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

40. ASTRINGENTSASTRINGENTS
• 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

42. IRRITANTSIRRITANTS
• Stimulate sensory nerve endings 
produce cooling or warmth, pricking and
tingling
• Rubefacients – cause local hyperemia
• Vesicants – form raised vesicles

43. COUNTER-IRRITANTSCOUNTER-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

47. TOPICAL ANALGESICSTOPICAL 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

49. CAUSTICS AND ESCHAROTICSCAUSTICS 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

52. KERATOLYTICSKERATOLYTICS
• Dissolve the intercellular substance in the
horny layer of skin
• Used on hyperkeratotic lesions like corns,
warts, ring worm , psoriasis etc
• Eg salicylic acid- applied under
polyethylene occlusive dressing
• Resorcinol
• Urea

55. ANTIPRURITICSANTIPRURITICS
• 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

57. ADRENOCORTICAL STEROIDSADRENOCORTICAL 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

60. TOPICAL STEROIDSTOPICAL 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

62. ADVERSE EFFECTSADVERSE EFFECTS
• Mild- mod potent are Effective and safe
• 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

65. SUNSCREENSSUNSCREENS
• 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
• Sunburn can be treated with oily calamine lotion,
topical steroids, NSAIDs

69. SUNSCREENSSUNSCREENS
• 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

73. PHOTOSENSITIVITYPHOTOSENSITIVITY
• Doxycycline
• Sulphonamides, Chlorpromazine
• Frusemide, thiazides
• piroxicam
• TREATMENT- withdraw the offending
drug

74. INTERESTING FACTS ABOUTINTERESTING FACTS ABOUT
SKINSKIN
• 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.

76. MELANIZING AGENTSMELANIZING 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

78. DEMELANISING AGENTSDEMELANISING 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

81. MISCELLANEOUSMISCELLANEOUS
• 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

86. • IF IT’S WET, DRY IT;

88. 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."

91. ACNEACNE
• 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

94. ACNEACNE
• 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

96. ALOPECIAALOPECIA
• MALE PATTERN BALDNESS- Topical
minoxidil in UPTO 50% people some
hair growth
• ALOPECIA AREATA- Finasteride by
mouth, PUVA

99. SCABIESSCABIES
• 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

103. ANTI-SEBORRHEICSANTI-SEBORRHEICS
• Drugs effective in seborrheic dermatitis
characterized by erythematous, scaly
lesions ( dandruff )

104. SEBORRHOEIC DERMATITISSEBORRHOEIC DERMATITIS
(DANDRUFF)(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

107. PSORIASISPSORIASIS
• 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

108. PSORIASISPSORIASIS
• 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

110. URTICARIAURTICARIA
• ACUTE URTICARIA, ANGIOEDEMA 
H1 blockers, cortico steroids, adrenaline
for severe cases
• Cyproheptadine preferred for physical
urticarias
• CHRONIC URTICARIA – responds to
cetirizine, loratadine

113. PEDICULOSIS ( LICE )PEDICULOSIS ( LICE )
• Permethrin two applications 7 days apart
• Insecticides like Carbaryl or malathion

116. NAPPY RASHNAPPY RASH
• PREVENTION - Rinse reusable nappies
with soaps, Use emollient cream to protect
skin, Costly disposable nappies
• TREATMENT – MILD- zinc cream or
calamine lotion
• Severe- topical steroid with antimicrobial

119. HYPERHIDROSISHYPERHIDROSIS
• Astringents - reduce sweat
• Antimuscarinics given by iontophoresis
• Botulinum toxin injection locally  axilla
temporary remission for 16 weeks

121. CUTANEUS ADVERSE REACTIONSCUTANEUS 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
• Treatment – remove the cause, cooling
applications ,antipruritics, H1 blockers

123. IF IT’S WET, DRY IT;
IF IT’S DRY , WET IT

125. Right education should help the
student, not only to develop his
capacities, but to understand his own
highest interest -Jiddu Krishnamurti