DERMATOTHERAPY

DR. Endang Sutedja, dr. SpKK(K)

DERMATOTHERAPY

Science concerning theraphy of skin diseases

TYPE OF THERAPY

1. Medicamentous : topical, systemic

2. Skin surgery: scalpei surgery,electrosurgery,

chemical surgery, cryosurgery

3. Radiation: radiotherapy, UV light, laser

4. Psycotherapy

MEDICATION

1. Nature

2. Treat the patiet holystic

3. Attention for physiology, pathology, biochemical, anatomy

4. Medical material

5. Attention pharmacy & pharmacology of drugs

MEDIKAMENTOUS THERAPY

6. Causal therapy

7. Simplest drug

8. Individualization

9. Economical

Principles of Topical Therapy

1. Choice of vehiculum depend on :

a. Stage of the diseases

b. Distribution & localisation

c. Effect

2. More acute low concentration

3. Explain usage & cleansing

4. Avoid sensitizer

5. Restrict unstable drugs

Topical therapy: type of Vehiculum

1. V.monophasic : a. powder

b. solution

c. ointment

2. V. biphasic : powder + solution

powder + ointment

solution + ointment

3. V. triphasic : powder + solution + paste

Solution Oint.

Powder

Lotion Paste

Cream

Cold paste

O/W W/O

POWDER

* Inert, used`of physical effect

A. Effect : cover

adhesion

slipping power

absorption

cooling power

B. Indication : dry lesion

superficial lesion

acute vesicobulous

C. contraindication : dermatoses wet & eksudative

D. usage : with sponge, sprinkle

SOLUTION

* If the soluble agent water : solution

alcohol : tinctura

A. effect : 1. cleansing

2. drying

3. protective

4. cooling

5. warming

6. epitelialisation

7. anti prurytic

SOLUTION

B. Indication : wet and acute dermatoses,

acute dermatitis

C. Contraindication : dry lesion

D. Usage : bathing

open dressing

close dressing

OINTMENT

• ≈ fat, fat like material with butter consistency, oil

• Fat : natural fat : adeps lanae

mineral fat : vaseline

• A. Effect : 1. Covering

2. Protective

3. Slipping

4. Penetrative

5. Warming

OINTMENT

• B. Indication : dry or chronic dermatoses

• C. Contraindication: wet lesion, hairy area, fold

• D. Usage : spread with finger, spatula

• E. Cleansing: 1 x / day with cotton moist with oil

LIQUID POWDER

• ≈ powder + solution (+ suspending agent)

• More adhesive than powder

• Usage < 40% body surface

• A. effect : 1. drying

2. Anti pruritic

LIQUID POWDER

• B. Indication : wide and generalisata dermatoses

• C. Contraindication : - productive dermatoses

- hairy area

- dry dermatoses

• D. Usage: shake and spread

• E. Cleansing : 1 x / day, bathing,wash with water

CREAM

• ≈ fat + water (+ emulgator)

• Cream O/W (oil/ointment in water)

• Cream W/O (water in oil/ointment)

• A. Effect : 1. Protektive

2. Drying

CREAM

• B. Indication : subacute dermatoses

wide dermatoses

for hairy area : O/W

dry lesion : W/O

• C. Contraindication : productive and wet dermatoses

• D. Usage : like ointment

W / O O / WWATER IN OIL OIL IN WATER

OIL >> WATER >>

LESION

MORE DRY MORE WET

CREAM

SUBACUTE

PASTE AND COLD PASTE

• Paste: mixed of ointment + powder

• Cold paste: ointment + powder + solution

• 1. Effect : 1. Protective

2. drying

• 2. Indication: subacute dermatoses

non productive

PASTE AND COLD PASTE

• C. Contraindication: productive dermatoses, hairy area

• D. Usage: spread with spatula, then close with gauze

(gauze changed 1 x 1-2 day)

• E. Cleasing: bath or with cotton moist with oil

CHOICE OF DRUG ACCORDING : CLINICAL APPEARANCE / LESION / STAGE

ACUTE WET SUBACUTE

CHRONIC

DRY

dressing Cream O/W Cream W/O Oint.

c

Tabel. VEHICULUM CHOICE ACCORDING DISTRIBUTION / LOCALISATION

Localisation Powder Water Alco- hol

Oint. Liquid powder

Paste Cream

Generalisata + -* - - + - +Scalp - + + - - - +

Face + + +# + + + +trunk,

extremity+ + + + + + +

Genitalia + + - - + - +Fold area + + + +@ + - +

EFFECTS OF DRUG

1. Protective : powder, paste, cold paste, cream2. Absorption : powder, liquid powder 3. Drying : solution, liquid powder 4. Good penetration : ointment, cream, tinctura5. Moisturizing (dry skin) : ointment, cream W/O 6. Cleansing : solution 7. Cooling : solution, liquid powder

8. Protection from UV : powder (Ti02) 9. Warming : close dressing