Download dermatotherapy

DERMATOTHERAPY
DR. Endang Sutedja, dr. SpKK(K)
DERMATOTHERAPY
Science concerning theraphy of skin
diseases
TYPE OF THERAPY
1.
2.
Medicamentous : topical, systemic
Skin surgery: scalpei surgery,electrosurgery,
chemical surgery, cryosurgery
3. Radiation: radiotherapy, UV light, laser
4. Psycotherapy
MEDICATION
1.
2.
3.
4.
5.
Nature
Treat the patiet holystic
Attention for physiology, pathology, biochemical,
anatomy
Medical material
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
Powder
Lotion
Paste
Cold paste
Solution
Oint.
Cream
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
CREAM
W/O
WATER IN OIL
OIL >>
O/W
OIL IN WATER
WATER >>
LESION
MORE DRY
SUBACUTE
MORE WET
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
dressing
c
SUBACUTE
Cream O/W
Cream W/O
CHRONIC
DRY
Oint.
Tabel. VEHICULUM CHOICE ACCORDING
DISTRIBUTION / LOCALISATION
Localisation
Powder
Water
Alcohol
Generalisata
+
Liquid
powder
Paste
Cream
+
-
+
Scalp
-
+
+
-
-
-
+
Face
+
+
+#
+
+
+
+
trunk,
extremity
+
+
+
+
+
+
+
Genitalia
+
+
-
-
+
-
+
Fold area
+
+
+
+@
+
-
+
-*
Oint.
-
-
EFFECTS OF DRUG
1. Protective
: powder, paste, cold paste, cream
2. Absorption: powder, liquid powder
3. Drying
: solution, liquid powder
4. Good penetration: ointment, cream, tinctura
5. 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