Therapy of Therapy of DermatologyDermatology

Systemic Systemic therapytherapy

Topical Topical therapytherapy

1.antihistaminies

2.corticosteroids

3.antibiotics4.antivirals5.antifungals

6.Vitamines

7.immunosuppressive agent

8.others

Systemic therapy

antihistaminiesantihistaminieshistamine functionshistamine functions ： ： telangiectasis BP , shocktelangiectasis BP , shockincrease in vascular permeability erythemaincrease in vascular permeability erythema 、、 whealwhealcontraction of smooth muscles bellyache contraction of smooth muscles bellyache

stimulation of gland secretion asthmastimulation of gland secretion asthmaactions of antihistamine:actions of antihistamine: Compete with histamine H1 and H2 receptorsCompete with histamine H1 and H2 receptors

1 ． H1 antihitamines ： CH2-CH2-N< same as histamine 1 ） compete H1 receptor→exudation↓ 、 inflammation↓ 、 relieving smooth muscle convulsion ， adapt to allergic diseases （ urticaria 、 eczema ） 2 ） reduce center nerve system excitement ， sedative effects,antipruritic function ： adapt to all pruritic disease （ nervous dermatitis 、 prurigo ） 3 ） side-effects ： dizziness 、 hypersomnia 、 hypodynamia 、 dryness of the mouth 、 seldom liver or kidney damage, allergic reaction 。

1.chlorpheniramine 4mg ， tid po 10mg ， qd-bid im hypersomnia

2.diphenhydramine 25-50mg ， tid po hypersomnia, careful to glaucoma 20mg ， qd-bid im anemia may be for 6 months

3. doxepin 25mg ， qd po hypersomnia ,dryness of

mouth , not use to glaucome 、 pregnant women , children

4. cyproheptadine 2-4mg ， tid po hypersomnia ， Contraindications :

glaucoma

H1 antagonist dose(adult) route of administration side -effects

First-generation H1 antihistamines

H1 antagonist dose(adult) route of administration side -effects

4. cyproheptadine 2-4mg ， tid po hypersomnia ， Contraindications :glaucoma

5.decloxizine 25-50mg ， tid po hypersomnia can make monstrosity6.promethazine 12.5-25mg ， tid po hypersomnia ， careful to 25-50mg ， qd im or iv glaocoma and liver and kidney 肝肾功能减退者

7.ketotifen 1mg ， bid po sedative 、 hypersomnia dizziness, dryness of the mouth

astemizole 24h 3mg,tid po nearly no hypersomnia ， careful to pregnant women, must not be 10mg,qd coadministered with macrolidantibiotics,imidazole antifungals

terfenadine 12-24h 60mg ， bid po nearly no hypersomnia ， avoid to be coadministered with erythromycin and imidazole untifungalsloratadine 18-24h 10mg ， qd po nearly no hypersomnia

H1 antagonist time dose route of administration side-effects

Second-generation H1 antihistamines

H1 antagonist time dose route of administration side-effects

cetirizine 24h 10mg ， qd po nearly no hypersomnia

mequitazine 18h 5mg ， bid po nearly no hypersomnia , not use to glaucoma and prostatauxe mizolastine 24h 10mg ， qd po nearly no hypersomnia

Second-generation H1 antihistamines

2 ． H2 antihistamines ：

contract vessel 、↓ inflammation 、 inhibit gastric juice excretion • cimetidine 0.2 qid

• ranitidine 150mg bid

1 anti-inflammatory actions ：• stimulate monocytes and macrophages produce polypeptide →inhibit activation of polymorphonuclear （ chemiotaxis 、 adherability and lysosome excretion ）。• inhibit connective tissue hyperplasia and activation of fibrocyte 。• ↓hyaluronidase and chondroitin sulfate synthesize 。

glucocorticoids

2 immunosuppressive ： inhibit factors release after Ag-Ab combination make lymphoid tissue atrophy 、 accelerate lym

phocyte destruction reduce the reaction of hypersensitive lymphocyt

es and Ag

3 antitoxic ： alleviate cell injury of toxic4 anti-shock ： alleviate angiospasm ， improve mic

rocirculation

low Hydrocortisone 1 20 /25—100 iv 100—400 Medium Prednisone 3.5 5 5 po 10—60 prednisolone 4 5 5 /5—25 （ Suspension ） po 10—60

Methyprednisone 5 4 4 /20—40 po 16—40

Triamcinolone 5 4 4 /50 （ Suspension ） po 8—40 high Dexamethasone 30 0.75 0.75 /2.5—10 po 1.5—9 iv 5—10 Betamethasone 30 0.6 0.5 po 1—6

name name anti-inflammationanti-inflammation equivalent doseequivalent dose troche/injection troche/injection dose dose

mg mg mg/dmg mg mg/d

Glucocorticoid in common use

Therapeutic principles ： use ample dose at the begin ， after control symptom ， to reduce according with the state of illness acute allergic disease ： reduce dose quickly stop

self-immunologic disease ： reduce slowly→sustain long term and excessive dose Glucocorticoids side effects（ infection 、 gastric and duodenal ulcer 、osteoporosis 、 diabetes 、 hypertension 、 psychiatric disturbance 、cataract ）

antibiotics:

staphylococcus streptococcus spirochete ﹑ ﹑infection: penicillins cephalosporins erythromycin﹑ ﹑

Mycobacterium and G- bacilli infection ： streptomycin aminoglycosides﹑

Propionibacterium acnes infection ： tetracyclines chloramphenicol or lincosa﹑mides

antivirals:

•acyclovir 200mg ， q4h×5 ， 7 ～ 10d

valaciclovir 300mg ， Bid ×7 ～ 10d•ribavirin 10~15 mg/kg/d ， im or iv gtt•interferon•Interferon inducer ： Polyinosinic-polytidylin Acid

antifungals1 ． griseofulvin ： adult 0.6-0.8 g/d griseofulvin child 15-20mg/kg/d ， tinea capitis2 ． polyene nystatin used for treatment of intestinal candidiasis

2,000,000unit/d,tid-qid ， child 50,000-100,000unit/kg nystatin suspension ： nystatin1,000,000unit, glycerol 10ml,water adding to 100ml

amphotericinB systemic mycoses ， such as candidosis, cryptococcosis, chromomycosis 3 ． 5-fluorocytosine,5-Fc ： candidosis, cryptococcosis, chromomycosis sporotrichosis 50-150mg/kg/d ， divided for 8 times

4 ． Azoles ： • ketoconazole 200-400mg,q.d 　 • fluconazole 　 150mg/w x12-16w(onychomycosis)　　 • itroconazole 　 0.2 Bid x7d, 1 week per month for 3-4m （ onychomycosis ）5 ． Allylamines ：

• terbinafine onychomycosis 250mg,q.d x7,q.o.d x7-11w　　　　　　 tinea coporis or cruris 　 250mg,q.d x7

Vitamines1. vitaminC2. vitamineA3. retinoic acid inhibit cell division and cebaceous gland excretion inhibit tumour growth keratolytic action﹑• isotretinion （ 13-cis-retinoic acid﹑Isotretinoin Capsules ） acne• etretinate （ Tigason,New -Tigason ） psoriasis ﹑ Pityriasis rubra pilaris

4 ． VitE

immunosuppressive agent1 ． methotrexate,MTX inhibit lymphocyte and epithelium division psopriasis dermamycosis ﹑ ﹑ Pityriasis rubra pilaris ， 2.5mg q12h x3 ， for 7-10 d2 ． cyclophosphamide3 ． azathioprine4 ． chloroquine,Hydroxychloroquine, 0.2Bid SLE ﹑Polymorphous Light Eruption lichen planus﹑5 ． cyclosporine6 ． tacrolimus 0.03~o.4%cream ext eczema

others ：

1 ． Ca and hypo

2 ． procaine

3 ． diamino-diphenyl Sulfone,D.D.S. 50mg Bid-Tid

4 ． zine sulphate5 ． Tripterygium wilfordii Hook

6 ． intravenous immunoglobulin,IVIg 0.4g/kg/d×3 ～ 5d

Topical Therapy

1 topical agents

2 formulation

3 therapy principle

Topical agents Ⅰ classification action drug concentration(%)

smooth agents reduce friction calamine 10-15 avoid stimulation talc 10-70 zinc oxide 20-50antimycotics kill or inhibition sulphur 5—10 Glacial Acetic Acid 5--30 benzonic acid 6--12 salicylic acid 5--10 clotrimazole 2---3 Miconazole 2 Terbinafine 1antiseptics kill or inhibition boracic acid 3---4 potassium permanganate 1/2000-1/5000

Neomycin 0.5-1 revanol 0.1

Topical agents Ⅱ

classification action drug concentration(%)

antipruritics narcotism 、 cool 1---5 dimimish inflammation mint 0.2-3 stop itchness carbolic acid 1---2 bendazolecain 3---5 dexamethasone 0.025 triamcinolone 0.025keratoplastics promote normal keratosis pityrol 3---5 shrink blood vessel coal tar 5--40 reduce effusion and resorcinol 2---5 inflammatory infiltration salicylic acid 3

Topical agents Ⅲ

classification action drug concentration(%)

keratolytics hyperkeratosis salicylic acid 6--15 make keratinocytes loose resorcinol 6--15 separate and fall off Glacial Acetic Acid 10-30 urea 20-40Canstic remove granulation tissue carbolic acid pure and neoplasm Glacial Acetic Acid >30 salicylic acid >20 trichloroaceticacid >30sunscreen agents absorb or prevent Titanium dioxide 5 ultraviolet radiation

depigment agents reduce pigmentation Hydroquinone 3 Azelaic Acid 20

Formulation ⅠDosage form component action indications

powder drug put into protection 、 cooling acute and subacute

zinc oxide , talc astringency inflammation but no effusion solution liquid and soluble drug cooling 、 reduce acute inflammation reduce inflammation clear raw surface with lots of effusion lotion powder and liquid protection 、 cooling acute and subacute mixture reduce inflammation inflammation without astringency effusion cream consisting of aqueous protection 、 lubrication subacute or chronic and oily components intenerate crust O/W emulsion being readiy reduce inflammation inflammation ,pruritus diluted with water,W/O

emulsion with oil

Formulation Ⅰ

Gel Propanediol gelatin same as cream same as cream of organic polymer ＋ drug

Dosage form component action indications

dosage form component action indications

Fomulation Ⅱ

Paste cream including protection 、 astringency subacute inflammation,

25%-50% powder intenerate crust scar,erosion diminish inflammation

ointment vehicle with vaseline strong action of chronic inflammation

or lanolin lubrication 、 penetration ulcer intenerate crust

tincture resolve or steep diminish inflammation chronic inflammation

drug by alcohol sterilization antipruritic pruritus

Plastics organic menstruum protection chronic and aqueous solution strong percutaneous inflammation contain macromolecule strong percutaneous compound or film agent action

Fomulation Ⅱdosage form component action indications

therapeutic principle

1.choice right drugs:2.Principles of formulation: acute lesion: more effusion--solution(hydropathic compress) no effusion--powder 、 lotion subacute lesion: effusion--paste no effusion--power 、 lotion 、 cream chronic lesion: cream 、 ointment 、 tincture 、 plastics

3.attentions: a.concentration b.peri-oral cavity c.make right use of drug

d.irritation and allergic reaction

Physical Therapy(1) Physical Therapy(1) ElectrosurgeryElectrosurgery electrodesiccationelectrodesiccation coagulationcoagulation electrocauteryelectrocautery phototherapyphototherapy infraredinfrared ultravioletultraviolet PUVAPUVA laser treatmentlaser treatment

Physical Therapy(2)Physical Therapy(2)

cryosurgerycryosurgery hydrotherapyhydrotherapy radiotherapyradiotherapy

Dermatological SurgeryDermatological Surgery

Dermabrasion(surgical skin planing)Dermabrasion(surgical skin planing) ExcisionExcision Hair transplantationHair transplantation epidermal transplantation: vitiligo epidermal transplantation: vitiligo