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 Cold paste

Paste

Solution
O/W

Cream
W/O

Oint.

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 MORE WET

SUBACUTE

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

SUBACUTE

CHRONIC DRY

dressing

Cream O/W

Cream W/O

Oint.

Tabel. VEHICULUM CHOICE ACCORDING DISTRIBUTION / LOCALISATION

Localisation
Generalisata Scalp Face trunk, extremity Genitalia

Powder

Water

Alcohol

Oint.

Liquid powder

Paste

Cream

+
+

-*
+ + +

+ +#

+
+

+
+ +

+
+

+
+

+
-

+
-

+
+

+
-

+
+

Fold area

+@

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