• Dissolve intercellular substance in horny layer of skin

• Epidermal cells swell, soften & desquamate

SALICYLIC ACID

10-20% sol in alcohol or propylene glycol for dissolving corns.

Polypylene glycol?

RESORCINOL

Antiseptic,antifungal,keratolytic

3-10% for eczema,seborrheicdermatitis, ringworm

UREA

5-20% in cream & ointment base

Ichthyosis,lichen planus

Concurrently with topical steroid?

SALICYLIC ACID 10-20%

RESORCINOL 3-10%

UREA 5-20%

Seborrheic dermatitis-face ,trunk, scalp(dandruff)

Pityrosporum ovale

Emotional ,genetic,local factors

SELENIUM SULFIDE

ZINC PYRITHIONE

CORTICOSTEROIDS

IMIDAZOLE ANTIFUNGALSSULFUR, COAL TAR,AMMONIATED MERCURY

RESORCINOL

SALICYLIC ACID

SELENIUM SULFIDE2.5% lotion or shampoo

Antiproliferative,antikeratolytic,fungicidal

More than 50% -relapse on discontinuation.

ZINC PYRITHIONE

Weekly shampoo-1%

‘Reduce’ epidermal turnover, dandruff

With ketoconazole

CORTICOSTEROIDS

Lotion-massage in scalp

Relapse rates high

Atopy ,poor healing, purpura...

IMIDAZOLE ANTIFUNGALS

KETACONAZOLE(KTZ)-200mg/day for 4 weeks

2% shampoo/cream/scalp gel

Good – excellant results without much S/E

SELENIUM SULFIDE 2.5%

ZINC PYRITHIONE 1%

CORTICOSTEROIDS

IMIDAZOLE ANTIFUNGALSSULFUR, COAL TAR,AMMONIATED MERCURY

RESORCINOL

SALICYLIC ACID

Increase sensitivity to solar radiation

Repigmentation of vitiliginous areas

Stimulate melanocytes & induce proliferation

Ammi majus

Furocoumarins – photoactivation stimulate melanocytes & induce proliferation

METHOXSALEN & TRIOXSALENSynthetic psoralens

Sensitize skin

Topical & oral

Short plasma t1/2 ; max skin sensitization 1-2 hrs ;lasts for 8 hrs.

TOPICAL ORAL

TOPICAL

Solution or ointment

On well defined vitiliginous lesion

1 min exposure to sunlight

Occluded by bandage or sunscreen ointment

Under supervision of physician.

ORAL THERAPY

“In alternate days after 2 hrs of 0.3-0.6mg/kg

15 min exposure to sunlight gradually

increasing to 30 min.”

Normally pigmented areas should be protected

Keratolyticssalicylic acid,resorcinol, urea

Anti-seborrheicsselenium sulfide,

zinc pyrithione, corticosteroids

imidazole antifungals.

Melanizing agents-

Psoralen,

methoxsalen ,trioxalen