Dermatological Pharmacology

DERMATOLOGICAL PHARMACOLOGY Darmawan,dr.,M.Kes

The Essensial Function of Skin : Protection Thermoregulation

Immune responsiveness Biochemical synthesis Sensory detection Social and sexual communication

Route of Drug Administrations: Systemically. Intralesionally Topically

Ultraviolet radiation

Corticosteroids

and retinoids are important systemic and topical therapeutic agents for skin disease

Antibacterial, antiviral and antifungal agents are employed widely both oral Chemotherapeutic

and immunosupressive agents, dapsone, and antihistamine, frequently are used for treatment of dermatological diseases

Calcipotrien, a vitamine D analog, and anthraline

are mayor topical agents for psoriasis

Ultraviolet radiation therapy is frequent mode of treatment for psoriasis, independently or combination with drugs such as psoralens or coaltar The prophylactic use of sunscreens may reduce

or prevent premalignant or malignant skin lesions induce by UV light.

General Guidelines for Topical Therapy

1. Regional Anatomic Variation -

Drug penetration higher on the face, intertriginous area, and especially in the perineum

-

Sensitization, irritation, and atropy from steroidare more likely to develop in these regions

2. Altered Barrier Function - Psoriasis:

Str. corneum is abnormal barrier function is lost topical absorption is increased systemic toxicity.

General Guidelines for Topical Therapy (2):

3. Hydration

- Drug absorption is increased - Produce by inhibiting transepidermal loss of water, (occlusion with an impermeable film, application of lipophilic cclusive vechicle such as oinment)

4. Vehicle - Acute inflamation p aqueous drying preparation - Chronic inflamation p hydrating preparations. - Soaks p acute moist eruptions

General Guidelines for Topical Therapy (3):

4. Vechicle Lotions (powder in water suspension) and solutions (medications dissolve in a solvent) p for hairy and intertriginous areas Creams or oil in water emulsions are absorbable and are the most cosmetically acceptable Ointments, water in oil emulsions are the most effective hydrating agents p scally eruption Multiple creams and oinments without active drug are marketed as moisturizing agents

. Age 6. Aplication Frequency

Topical Glucocorticoids Therapeutic Uses: Inflamatory skin diseases Twice a day application is sufficient Hydrocortison is the most potent steroid used on the face or in occluded areas (axilla or groin) Tachyphylaxis can occur Intralesional injection: triamcinolone p scalp allopecia, panniculitis, psoriasis, discoid lupus and inflamed cysts. ,

Topical Glucocorticoids (2): Toxicity and Monitoring:

Skin atrophy, striae, teleangiectasias purpura, acneiform eruptions, perioral dermatitis, overgrowth of skin fungus and bacteria, hypopigmentation in pigmented skin, and rosacea. Intralesional glucocorticoids can cause cutaneous atrophy and hypopigmentation

Topical Glucocorticoids (3): Toxicity and Monitoring:

Factors that increase systemic absorption: The amount of the steroid applied The extent of the area treated The frequency of application The length of treatment The potency of the drug The use of occlusion.

Systemic Glucocorticoids Therapeutic Uses:

A. Require Long-Term Therapy:

-

Bullousdiseases:-

Pemphigusvulgaris

- Herpes gestationis.

-

Collagen Vascular Diseases :

- S.L.E. - Vasculitis - Sarcoidosis - Sweet¶s disease - Pyodermagangrenosum -

Type

l reactive leprosy

Systemic Glucocorticoids (2)

B. Respond to short-term therapy : - Contact dermatitis (acute) -

Atopic dermatitis Lichen planus Exfoliative dermatitis Erythema nodosum

Systemic Glucocorticoids (3) C. Respond to low-dose bedtime therapy : - Acne - Hirsuitisme

D. Steroid therapy controversial - Toxic epidermal necrolysis - Erythemamultiforme - Cutaneous T - Cell lymphoma - Discoid L.E.

Systemic Glucocorticoids (4) Toxicity and Monitoring

Short-term use:

> psychiatric problems, cataracts,myopathy, avascular necrosis, hypertension. Withdrawl syndrome :

- transient arthralgias, myalgias, joint effusions

RETINOID

- Isotretinoin ( I ) - Etetrinate ( E) - Tretinoin (T)

RETINOID (2) Mayor Retinoid-Responsive Skin Diseases Acne 1,(T) Disorders of keratinization Skin cancer I,E Precancereous T,E,(I) Psoriass E T Cutaneousaging

I,E,(T)

ANTIPSORIASIS TOPICAL ANTIPSORIASIS DRUGS

- Calcipotriene - Anthralin

PHOTOCHEMOTHERAPY 1. PSORALEN 2. BERGAPTEN 3. METHOXALEN 4. TRIOXALEN

Therapeutic Uses:

Vitiligo Psoriasis PUVA also is employed in the treatment of: - Cutaneous T-Cell lymphoma atopic dermatitis - Alopecia areata - Lichen planus

SUNSCREEN Sunscreens are topical agents that reduce the amount of ultraviolet radiation reaching the Skin or block it altogether.

SUNSCREEN (2) I. Physical 3 Sunscreen : This sunscreen contain large particulate ingredients that reflect and scatter UVA, UVB, and visible light. These ingredients

include : -

Titanium

-

Talc

dioxide

- Magnesium oxide - Zinc oxide - Kaolin - Ferric chloride - Ichthamnol

SUNSCREEN (3) II. Chemical Sunscreen Protection against UVB is more effective, than Protection against UVA. - P-ammobenzoic acid esters - Cinnamates effective UVB blocking - Salicylates -

Benzophenones Anthranilates

-

Avobenzone

effective UVA blocking

MISCELLANEOUS DRUGS - Minoxidil p Stimulating hair growth. - Keratolytic agent: - Lactidacid

- Glycolic acid - Salcylicacid.

- Destructive agents: - Podophyllin -

Trichloroacetic

acid

MISCELLANEOUS DRUGS (2) Hydroquinone Capsaicin

HYPERPIGMENTATION

relief of post herpetic neuralgia

(R/ : ZOSTRIC, ZOSTRIC HP)

Masoprocol

Th/

ACTINIC KERATOSIS

Colchicine PMN leukocytes are part of the pathogenesis of the disease Gold

Pemphigus vulgaris and cutaneous LE

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