G.M.

Aman
 Drug administration
(Cara Penggunaan Obat)
• Systemic (enteral, parenteral)

• Topical

• Transdermal
 Tujuan pemakaian obat untuk kulit

• Perawatan (sistemik, topikal)

• Pengobatan (sistemik, topikal)

 Bentuk Obat Topikal
• Powder
• Lotion
• Cair
• Krim
• Gel
• Patch
• Salep
 Skin Aging
(Penuaan Kulit)
• Natural/ chronological aging

• Environmental and photoaging

 Anti-aging treatment strategies
To prevent / pencegahan
• Dryness use Moisturizers
• Fine line & wrinkles use vitamin (Retinol,
Tocopherol, Ascorbic acid, Niacinamide, beta
Carotene), Antioxidant, AHA
• Photodamage use Sunscreen (tabir surya)
• Erythema and swelling caused by sunburn use
Thocopheryl phosphate Complex
• Age spots & hyperpigmentation use Arbutin,
Ascorbic acid, Niacinamide.
 Protect Skin From Radiation
• Topical (sunscreen cream)
. Zinc oxide, Titanium oxide
. PABA 5% in alcohol, Benzophenon 3%
• Systemic drug
. Beta carotene
. Antihistamin (pada Solar urticaria)
 Obat yang berefek pada kulit
• Antioxidant
• Vitamin
• Antiinfeksi:
 antibiotika
 antifungal
 antiviral (herpes, varicela)
• Antialergy
 OBAT SISTEMIK
(Anti-aging Benefit)
• Vitamin A (retinol)
• Alpha Hydroxy acid (AHA)
• Alpha lipoic acid (ALA)
• Vitamin C (ascorbic acid)
• Vitamin E (tocopherol)
• Niacinamide
• Beta carotene & carotenoid
• Coenzyme Q10
 Optimum Dose
Nutrient average daily optimum
intake level
----------------------------------------------------------------
Vit C 58 mg 500 mg
Vit E 9,3 mg 100 mg
B Carotene 1,9 mg 7 mg
Co-enyme Q10 10 mg 60 mg
Flavonoid 140 mg 250 mg
 Vitamin A (retinol)
• Antioksidan, menghambat lipid
peroxidation
• Stimulasi sintesis kolagen
• Photoprotection
• Mempercepat penyembuhan pada
photodamage
 Alpha Hydroxy acid
• Increase epidermal desquamation by
increase keratin synthesis
• Stimulate production of Collagen
• Improvement of the line and wrinkles
 Alpha lipoic acid (ALA)
• Dipecah di dalam sel menjadi dihydrofolic
acid, yang berfungsi sebagai antioksidan
• Membantu recycling antioksidan Vitamin E
dan vitamin C
• Antiinflamasi
• Bekerja pada mitochondria meningkatkan
pbt energi (ATP)
• Bayam, brokoli, kentang
 Vitamin C (Ascorbic Acid)
• Membrane antioxidant
• Stimulasi sintesis kolagen
• Menstimulasi pembentukan barrier lipid
• Regenerate vitamin E
• Memperbaiki keadaan hiperpigmentasi
• Photoprotection
 Vitamin E (tocopherol)
• Membrane antioxidant
• Bekerja memproteksi vitamin A,
Carotenoid dan Polyunsaturated Fatty
Acid (PUFA)
• Photoprotection terutama kalau
dikombinasi dengan vitamin C
 Niacinamide
• Memperbaiki keadaan hiperpigmentasi
• Mengurangi red spot
• Meningkatkan fungsi barrier kulit
 Beta Carotene & Carotenoid
• Antioxidant
• Lutein, Lycopene
• Free radical scavengers
 Coenzyme Q10
• Membrane antioxidant
• Memproteksi sel dari oxidative damage
yang disebabkan sinar ultra violet (UV)
• Regenerate tocopherol
• Sangat penting untuk Jantung & Otak
 Local Drug Administration
• Topically – outer layer of the skin
– Most act on the skin but are not absorbed (soften,
disinfect or lubricate).
– Few contain enzymes to remove superficial debris
(skin ulcerations)
– Others treat skin infections

• Transdermally – through a patch

– Readily absorbed with systemic effects
– Patches – gradual release, reducing toxicity effects
– Fewer adverse reactions
– Eg. Nitroglycerin (Cardiac Pts) and Scopolamine
(nausea)
 Skin Biology
• Epidermis:
– Outermost layer
• Dermis:
– Contains small capillaries,
glands, nerve fibres & hair
follicles
• Subcutaneous
(Hypodermia):
– Arterioles, fat, collagen,
fibroblasts
 Routes Of Drug
• Must have to penetrate cutaneous layer to exert
effects.
• Percutaneous absorption involves:
– Dissolution of drug in its vehicle
– Diffusion of drug from vehicle to surface of skin
– Penetration through skin layers

• NB: Passage is slowest in the stratum corneum

 Factors that
effect
cutaneous
Diffusion
Diffusion through absorption
through
channels between hair
epidermal cells follicles

Diffusion
through Diffusion
Transcellular
sebaceous through
Diffusion
ducts sweat ducts
 Factors affecting absorption
• Nature of skin:
– With a skin lesion 80% can penetrate, with intact skin only
1% (hydrocortisone)
– Hydration improves this rate (occulsive dressings)
– Thin layer of stratum corneum (infant & elderly)
• Nature of drug:
– Active drug concentration, composition, physiochemical
properties and base vehicle
– Lipid soluble more effective than water soluble (20% fat)
 Topical Anti-infectives
• Include antibiotic, antifungal and antiviral
drugs.
• Antibiotic:
– Exert a local bactericidal (killing) or bacteriostatic
(retarding growth) effect.
• Bacitracin, Gentamicin (G-myticin), Erythromycin
(Emgel) and neomycin are good examples
• Bacitracin (Baciguent) inhibits cell wall synthesis
– Prevention of superficial infections in wounds,
skin abrasions and minor burns
• Antifungal:
– Local inhibitory effect
• Amphotercin B (Fungizone) used for myotic infections
• Miconazole (Micatin), Ciclopirox (Loprox), econazole
(Spectazole) used for tinea pedis (athlete’s foot); tinea
corporis (ringworm)
• Clioquinol used for eczema and athletes' foot
• Antiviral:
– Acyclovir (Zovirax) and Penciclovir (Denavir) the
only available antiviral topical preparations
– Acyclovir used for initial presentation of genital
herpes and herpes simplex in immunocomprised
pts
– Penciclovir used for cold sores in adults
 Adverse reactions to Anti-infectives
• Usually mild but relatively common
• Present as skin rash, itching, dermatitis,
irritation and redness
• Hypersensitive reactions
• Prolong use may lead to a ‘Super-sized’
infection
 Contraindications
• Hypersensitive pts
• Be cautious in pts with extensive burns or
trophic ulceration
– Nephrotoxicity
 Penicilin, Streptomycin,
chloramphenicol, Sulphonamide

lebih baik jangan diberikan topical

 Antialergi/antihistamin
• Topical
• Sistemik

• First generation / konventional AH1

• Second generation
 First generation
• Diphenhydramine
• Promethazine
• Pheniramine
• Chlorpheniramine
• chlorcyclizine
 Second generation
• Astemizol
• Terfenadine
• Loratadine
• Cetirizine
• Levocobastin
• acrivastin
 First generation Second generation
• Sedasi Non sedasi
• Atropin like effect No atropin like effect
• Tolerance Rare
• Interaction with Interaction with
- alkohol - ketokonazol
- depresant - macrolide AB
 Antihistamine

Dianjurkan tidak memakai topical

 Topical Corticosteroids
• Potency dependant upon drug concentration, vehicle
and area of application
• Exert localised anti-inflammatory response
(reduction in oedema, irritation, vascular perfusion
and pain)
• Psoriasis, dermatitis, rashes, eczema, 1st & 2nd degree
burns
• Adverse reactions = irritation, dryness, secondary
infections
 Contraindications
• Pts with known hypersensitivity
• For use on face & groin (only high potency)
• Not for ophthalmic use (induce glaucoma)
• Category C for pregancy

• Eg: Hydrocortisone (Cort-Dome)

 Evidence base therapy

Pada severe eczema sistemik

corticosteroid lebih efektif
daripada topical
 Topical tidak efektif pada
• Severe Eczema.
Pemberian Corticosteroid tidak efektif dan
efek samping lebih besar
• Dermatosis Bulosa.
Pemberian Corticosteroid topical tidak efektif
o.k. penetrasi kurang baik
• Psoriasis.
Pemberian Metothrexate topical tidak efektif
o.k. penetrasi yang kurang, sehingga
pemberian sistemik lebih baik.
• Pemberian Antihistamin topical juga tidak
tidak efektif ok penetrasi sulit
• Pemberian Corticosteroid topical, sama
sulitnya dengan Antihistamin, ok sulit
penetrasi dan menyebabkan vasokonstriksi
 Efek Samping Pemberian Topical
• Contact dermatitis
* Antihistamin
* Local Anaesthetic (Kecuali Lignocaine)
* Antibiotic (Streptomycin, Penicillin)
* Corticosteroid
 Beberapa Disinfectant
• Disinfectant alat : Hipochlorite, Spiritus,
Alkohol, Povidine-Iodine
• Disinfectant tangan : Cuci dengan sabun,
Chlorhexidine, Alkohol+Chlorhexidine
• Disinfectant kulit sebelum operasi : Alkohol +
Povidone-Iodine, Alkohol + Chlorhexidine
• Disinfeksi kulit sebelum injeksi : 70% Ethyl
Alkohol, Isopropyl Alkohol
 Mekanisme Kerja Antiseptik
• Alkohol (Ethyl, Isopropyl) :
* presipitasi protein
*70% lebih efektif daripada 100%. Yang
100% presitasi protein lapisan luar mikro-
ba shg alkohol sukar masuk mikroba. Yang
70% menurunkan tahanan permukaan sel
mikroba shg mudah masuk dan mempresi-
pitasi protein sel mikroba
• Hexachlorophane :
*bakterisidal
*untuk profilaksis infeksi (dlm sabun,
emulsi atau powder
*hati-hati penggunaannya ok dapat
diabsorbsi oleh kulit dan toksik thd
CNS
• Hydrogen Peroksida (H2O2)
*antimikrobial yg digunakan membersihkan
luka. H2O2 akan mengeluarkan O2 waktu
membersihkan luka, mengeluarkan sisa
kotoran pada luka
• Chlorhexidine :
*broad spektrum disinfektan
*untuk kulit sebelum operasi, tindakan
obstetrik, dan juga untuk alat operasi
TERIMAKASIH