Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
مصرف داروها در پوست : دکتر گیتا فقیهی دانشیار بیماریهای پوست دانشگاه علوم پزشکی اصفهان مصارف موضعی داروها در پوست What are the common ingredients in a topical formulation? Active drug(s) Vehicle (cream, ointment, lotion etc.) +/- preservatives +/- penetration enhancers (e.g. azone, DMSO) Others (e.g. antioxidants, fragrances, coloring agents) Common topical dose forms includes: creams, lotions, ointments and powders. • Creams: A cream is a semi-solid emulsion containing a drug. The cream is usually nongreasy. Creams are removed with water. • Lotions: A lotion is a watery preparation containing suspended particles. Shake all lotions before application. Gently but firmly pat the lotion on the skin. Do not rub into the skin. Rubbing increases circulation and itching. Rubbing also causes friction, which can irritate the skin. Lotions are used to: Soothe and protect the skin Relieve rashes and itching Cleanse the skin • Ointments: An ointment is a semi-solid preparation containing a drug in an oily base. Ointments are not easily removed with water. The drug has longer contact with the skin. Why Apply Topical Drugs: • • • • • • Clean and debride (remove) a wound Hydrate (add water) to the skin Reduce inflammation Relieve itching or a rash Provide a protection barrier to the skin Reduce thickening of skin یکی از پرمصرفترین داروهای موضعی و یا به عبارتی فراورده های بهداشتی توپیکال ضدافتابها هستند. sunscreens Sunscreens: Physical agents Chemical absorbing agents Sun protection at any age is important to prevent the short-term as well as long-term damaging effects of sunlight How do “ Sunscreens “ work ? by absorbing, reflecting, the sun's rays on the skin. They are available in many forms, including ointments, creams, gels, lotions, sprays, and wax sticks. Physical blockers effective at protecting against both UVA and UVB radiation. The two most common physical blockers are: titanium dioxide zinc oxide. ضدآفتابهای ایده ال • به نوعی در واقع همین گروه فیزیکی ها هستند • احتمال آلرژی آنها کمتر و ایمنی بیشتری برای سالمت دارند و اشعه را بطور موثرتری میگیرند zinc oxide and titanium dioxide , act as a physical barrier معایب ضدافتابهای فیزیکی: • تحمل بیمار از نظر زیبایی نسبت به آنها کمتر است مگر با کاربرد جدید ترکیبات میکرونیزه که از نظر پذبیرش بیمار بهترند. ZNO TIO2 Zinc oxide is less whitening than titanium dioxide and provides better UV-A protection. Iron oxides are mineral pigments to give a tint and better protection to sunblockers Chemical absorbers • Have a less active wavelength • Higher side effects • May harm babies and sensitive persons نمونه ای از آلرژیک فتو کنتاکت درماتیت به ضدافتابهای شیمیایی :طرز استعمال صحیح ضدافتاب • 20-30 minutes sunscreen to be absorbed by the skin • apply it at least half an hour before going out in the sun. • Reapply after half an hour • Then,,,,Re-apply sunscreen every 2 hours Sunscreens are not recommended for infants less than 6 months of age. Are sunscreens really safe?? Side effects reported during clinical studies from sunscreens were infrequent and non-serious. The most common side effects in patients were acne, dermatitis, dry skin, eczema, abnormal redness, itching, skin discomfort and sunburn Dermatitis is a common skin disorder in every age When you have eczema, you should avoid soaps, especially bar soaps, even ‘moisturizing soaps’ as they will cause dry skin and may damage the skin barrier. Only mild soap-free cleansers, preferably liquid, should be used Baths may be better than showers. The water temperature should be luke warm. Long hot showers are not recommended Management points • Try not to scratch the irritated area on your skin even if it itches. • Scratching can break the skin. Bacteria can enter these breaks and cause infection OTC acne drugs: • • • • • • benzoyl peroxide, sulfur, resorcinol, salicylic acid or lactic acid Azelaic acid Azelaic acid This medication is used for the treatment of mild to moderate acne. Azelaic acid belongs to a class of drugs known as dicarboxylic acids. It works by stopping the growth of bacteria on the skin and by reducing the amount of a natural skin substance (keratin) that can cause acne. Benzoyl peroxide Benzoyl peroxide • is available in almost all forms of skin carecreams, gels, liquids, lotions, soap etc. • Benzoyl peroxide acts in three ways. • It kills the bacteria in acne. It opens closed acne pores and it removes excess oiliness from the skin. Acne drugs by prescription • Tretinoin • Adapalene(differin) • Clindamycin • erythromycin During the first few weeks of using tretinoin, acne might appear worse because the medication is working on pimples forming inside the skin. It may take up to 8-12 weeks to notice results from this medication. ® Differin • Lotion 0.1%, Gel 0.1%, Cream 0.1% and Differin® Gel, 0.3% are indicated for the acne vulgaris in patients 12 years and older. Apply Differin® products to affected skin (face, trunk and other areas of the body affected by acne) once per day avoiding the eyes, lips and mucous membranes. • The most common side effects reported with use of Differin® products include skin dryness, redness, scaling, stinging and burning. Melasma Melasma • Melasma is an acquired hypermelanosis of sunexposed areas. • It presents as symmetric hyperpigmented macules, which can be confluent or punctate. The cheeks, the upper lip, the chin, and the forehead are the most common locations. etiology • In some cases, a direct relationship with female hormonal activity appears to be present because it occurs with pregnancy and with the use of oral contraceptive pills. • Other factors implicated in the etiopathogenesis of melasma are photosensitizing medications, mild ovarian or thyroid dysfunction, and certain cosmetics Important note/ • The most important factor in the development of melasma is exposure to sunlight. • Without sunscreen any try to treatment fails. Race, age • it is much more common in darker skin types than in lighter skin ,, especially Asians, from areas of the world with intense sun exposure. • Melasma is rare before puberty and most commonly occurs in women during their reproductive years. Endocrine /emotional factors • a 4-fold increase in thyroid disease in patients with melasma when compared with matched controls. • A case report of 2 women who developed melasma after sudden and profound emotional stress implicated the release of MSH by the hypothalamus as a cause/ Diff.Diagnosis • Addison Disease • Drug-Induced Photosensitivity • Lupus Erythematosus, Discoid • Mastocytosis • lichen planus treatment • The mainstay of treatment remains • topical depigmenting agents. • Hydroquinone (HQ) is most commonly used. a chemical that inhibits tyrosinase, leading to the decreased production of melanin. • HQ can be applied in cream form or as an alcohol-based solution treatment The use of tretinoin can be effective as monotherapy. However, the response to treatment is less than with HQ and can be slow, with improvement taking 6 months or longer Scrub creams and melasma • Microdermabrasion creams help to remove dead skin and debris on the surface of the skin. • These dead skin flakes and particles can interfere with the penetration of skin care products کورتون موضعی کشف آنها از 1950انقالب بزرگی در درماتولوژی ایجاد نمود. Corticosteroids are mainly used for their effect in controlling inflammation, and topical corticosteroids are applied to the skin for the localised treatment of various inflammatory skin disorders. Because of side effects of topical steroids • Classification is important to know by physicians نکته مهم آنکه هر چه کورتون قویتر و موئثرتر .پتانسیل عوارض سوئ نیز بیشتر است Groups of topical steroids from point of Potency: Very Potent (Clobetasol propionate Betamethasone dipropionate ) Potent (Desoximetasone, Fluocinonide,Halcinonide) Moderate )FluocinoloneوTriamcinolone,Betamethasone valerate ,Mometasone furoate) Mild ) Hydrocortisone( Risks of topical steroids: • • • • • • • • Atrophy, striae Telangiectasia, purpura Perioral dermatitis, rosacea Masking of initial lesion Tachyphylaxis or rebound Pigmentation abnormalities Systemic absorption (uncommon) Susceptibility to infection ترک خوردگی یا استریای ناشی از کورتن اتساع مویرگها(تالنژیکتازی) ناشی از کورتن نازکی اپیدرم و خونمردگی به دلیل شکنندگی عروق درم Steroid atrophy عوامل خطرسازدر افزایش عوارض سوئ کورتن • Potent topical steroids over large areas of body. • use plastic to cover treated areas (occlusion). • skin condition persists for more than two or three weeks. • In a child. پزشک بایستی به بیمار هشدار دهد که کورتون موضعی را بیش از 2نوبت در روز به کار نبرد و از آن به عنوان نرم کننده صرف استفاده نکند. •Minimizing risks: Avoid high potency steroids on flexures, face or genitals Avoid high potency steroids in children Avoid use of occlusion for long periods :آنتی هیستامینها • Antihistamines are available for oral use as tablets and elixirs. They take about 15 to 30 minutes to be effective به فرم تزریقی اغلب نیازی نخواهد بود مگر در اورژانسها و یا شوک آنافیالکسی Topical preparations (ointments and creams) are often applied to insect bites هرچند متاسفانه : کرمهای آنتی هیستامین میتوانند آلرژیک کنتاکت درماتیت ایجاد کنند. :هیستامینها گروه بندی آنتی • Conventional antihistamines • Non-sedating antihistamines :معمول • • • • • • • • آنتی هیستامینهای Chlorpheniramine Promethazine Trimeprazine Diphenhydramine Cyclizine Azatadine Hydroxyzine Cyproheptadine Side effects of them include: Drowsiness Dry mouth, blurring of vision, difficulty passing urine and impotence Paradoxical stimulant effect (and even agitation). Non-sedating antihistamines • Loratidine and desloratadine • Cetirizine • Fexofenadine قابل ذکر است که: آستمیزول و ترفنادین در استرالیا و آمریکا از بازار دارویی حذف شدند به دلیل تداخالت داروییشان/ :تداخالت مهم ترفنادین و آستمیزول شامل Erythromycin Ketoconazole Itraconazole Ciclosporin