Basics Of Topical Dermatological Therapy

Topical dermatological treatments include cleaning substances absorbent dressings (eg. B. hydrocolloid plasters or powder) and superabsorbent powder antiinfectives inflammatories astringents (drying up means, which precipitate the proteins, and thereby shrink the skin and contract) emollients (hydrating skin care agents and plasticizers) keratolytics (agents that soften the scale-like cells of the epidermis solve, and their desquamation) facilitate vehicle Topical therapies (excipients) can be supplied via various vehicles, z. B. Powder combinations of liquids and a liquid oil The vehicle influences the effectiveness of therapy and can cause side effects (eg. B. toxic contact eczema). General preparations to water and alcohol-based dehydration are (because the liquid vaporizes) and are used for acute inflammatory diseases. Powder also affect drying. Preparations based on oil are moisturizing and are preferred for chronic inflammation. The vehicles selected on the basis of the application location, cosmetic effects and comfort. Inert powder powder may be mixed with active substances (eg. As antifungals) to bring it to the site of action. You are in lesions in moist or intertriginous areas verordnet.Flüssigkeiten Liquid vehicles are bathrooms and envelopes foams solutions lotions gels baths and envelopes are used when large areas need to be treated like a extensive contact dermatitis or atopic eczema. Foams are alcohol or emolliency-based aerosol preparations. They tend to be absorbed quickly, and may be preferred for hairy areas of the body. For solutions, the ingredients are dissolved in a solvent, usually ethyl alcohol, propylene glycol, polyethylene glycol or water. Solutions are easy to apply (v. A. On the scalp in diseases such as psoriasis or seborrhea), dry the skin out though. Two commonly used solutions are the Burowsche solution and the Domeboro solution. Lotions are water-based emulsions. They are good to apply on hairy skin and cool and dry acutely inflamed and exudative lesions such. As contact dermatitis, tinea pedis and tinea cruris. In gels, the active compounds are dissolved in a thickened with polymer solvent. Gels set the topically active substances often controlled freely and frequently with acne, rosacea and psoriasis of the scalp eingesetzt.Kombinierte vehicle combinations are creams ointments Combined vehicles usually contain oil and water, but can also propylene or polyethylene glycol. Creams are semi-solid oil-water emulsions. They are used for humidification and cooling and used in exudates and can be rubbed into the skin. Ointments are oil-based (eg., Petrolatum) and contain little or no water. They are excellent moisturizers and increase by their occlusive properties, the penetration of the drug into the skin. Thus substances are independent of their concentration in ointments typically effective. They are v. a. applied at lichenified lesions as well as with thick crusts and accumulations of scale, such as in psoriasis and lichen simplex chronicus. Ointments are less irritating than creams for erosions and ulcers. They are usually best applied after bathing or wetting the skin with water. Associations Associations protect open lesions, promote improve the healing process, the absorption of drugs and protect the patient’s clothes. Non-occlusive dressings are most commonly applied gauze bandages. Let a lot of air to the wound, which promotes healing and helps in drying the lesion. Non-occlusive dressings which are soaked with liquid – mostly saline – are used for cleaning and debridement of thickened or crusted lesions. The dressings will be wet laid and removed again after the liquid has evaporated (Wet-to-dry dressings) with portions of the wound covering improve then adhered to the wound dressing bleiben.Okklusive associations Occlusive dressings the absorption and effectiveness of the topical treatment. Most, such as polyethylene (plastic household foil), or flexible, transparent, semi-permeable dressings used transparent films. Hydrocolloid dressings can be fixed with skin ulcers with a gauze pad. A zinc paste bandage (after Paul Gerson Unna) is in stasis and -ulzera effective occlusive dressing. In sporadic lesions or refractory impregnated with occlusive dressings come flurandrenolide, a corticosteroid used. Occlusive dressings are u. a. for the treatment of psoriasis, atopic dermatitis, skin lesions, lupus erythematosus and chronic hand eczema from about topical corticosteroids (also briefly: corticoids) result created in order to increase their absorption. Systemic absorption of topical corticosteroids may occur in adrenal suppression and lead to her. Other local side effects of topical corticosteroids include development of miliaria atrophy striae Bacterial or fungal infections acneiform rashes Other occlusive dressings are used to protect and promote the healing of open wounds, such as burns (burns). Categories and indications main categories of topical agents are cleaning substances emollients drying substances inflammatories Antimicrobials keratolytics astringents Antipruritic substances cleaning substances are the main cleaning agents are soaps, detergents and solvents. Soap is the most popular detergent, often synthetic detergents are used. Baby shampoos are generally well tolerated in the eye area as well as in the cleaning of wounds and abrasions. They help in the removal of crusts and scales in psoriasis, eczema and other forms of dermatitis. Acutely irritated, oozing lesions are preferably cleaned with water or isotonic saline. The most important solvents in the cleaning water. Organic solvents (eg. Acetone, petroleum products, propylene glycol) to dry out the skin strong, can irritate the skin and a toxic or, more rarely, cause allergic contact dermatitis. Dried tar preparations, and color are from the skin emollients entfernt.Emollienzien protect by means of a petroleum-based ointment or commercially available, anhydrous cleanser the skin from water and fat loss, thus stabilizing the fluid balance of the skin. They usually contain glycerin, mineral oil or petrolatum and are available as lotions, creams, ointments and bath oils available. More emollients containing 2% of urea, 5 to 12% lactic acid and 10% glycolic acid (in keratinolytics be higher concentrations of glycolic acid used, for. Example, in ichthyosis). they are most effective when they are applied to already damp skin (z. B. after a bath or a shower). Cold creams are moisturizing OTC emulsions of oil (such. As beeswax) and Wasser.Austrocknende substances Excessive moisture in intertriginous (d. E. Between toes, gluteal fold, axillae, groin and inframammal) causes skin irritation and maceration. Powder dry macerated skin and reduce the friction by absorption of the moisture. However, some powder clump together quickly and irritate the skin when they are wet. Most corn starch and talc are used. Talc is indeed effective, but can cause granulomas if inhaled and is therefore no longer used in baby powder. Cornstarch in turn promotes the growth of fungi. also aluminum chloride solutions (often with hyperhidrosis helpful) act as drying agents .Entzündungshemmende means Topical anti-inflammatory substances are either corticosteroids or NSAIDs. Corticosteroids are the cornerstone of treatment of most non-infectious inflammatory dermatoses. They are used in the form of lotions in intertriginous and face. Gels are v. a. helpful on the scalp and in the management of contact dermatitis. As creams they are applied on the face and intertriginous and for the treatment of inflammatory dermatoses. Ointments are helpful in dry, scaly areas and when higher powers are required. Corticosteroid impregnated medical adhesive tapes are useful to protect an area from abrasions. They also increase the absorption and thus the effect of corticosteroids. The potency of topical corticosteroids is of weak (class VII) to very strong (Class I) divided Relative potency of selected topical corticosteroids. Intrinsic differences in potency based on the fluorination or chlorination (halogenation) of the preparation. Relative potency of selected topical corticosteroids class I * drug betamethasone dipropionate 0.05% ointment clobetasol propionate 0.05% cream or ointment diflorasone diacetate 0.05% ointment 0.05% halobetasol propionate cream or ointment II Amcinonide 0.1% betamethasone dipropionate ointment 0.05% betamethasone dipropionate cream 0.05% desoximetasone ointment 0.25% cream, 0.05% gel, 0.25% ointment diflorasone diacetate 0.05% fluocinonide ointment 0.05% cream, gel , ointment or solution Halcinonide 0.1% Cream 0.1% mometasone furoate amcinonide ointment III 0.1% cream or lotion betamethasone dipropionate 0.05% cream betamethasone dipropionate 0.05% Betamethasone valerate 0.1% ointment lotion Desoximet ASON 0.05% cream diflorasone diacetate 0.05% fluocinonide cream Cream 0.05% fluticasone propionate 0.005% ointment halcinonide or 0.1% ointment solution triamcinolone 0.1% ointment IV fluocinolone acetonide 0.025% ointment Flurandrenolide 0.05% ointment mometasone furoate 0.1% triamcinolone acetonide cream or lotion 0.1% cream or ointment V betamethasone valerate 0.1% desonide cream ointment 0.05% Fluocinolone acetonide cream 0.025% Flurandrenolide 0.05% cream fluticasone propionate 0.05% cream Hydrokortisonbutyrat 0.1% cream, ointment or solution hydrocortisone valerate 0.2% triamcinolone acetonide cream or ointment lotion or 0.1% 0.025% ointment VI alclometasone dipropionate 0.05% cream or ointment0.1% betamethasone valerate lotion 0.05% desonide cream Flumethasone pivalate 0.03% Fluocinolone acetonide cream 0.01% cream, or solution triamcinolone acetonide 0.1% cream 0.025% triamcinolone acetonide cream or lotion VII Hydrocortisone 1% or 2.5% cream, 1% or 2.5% lotion, 1% or 2.5% hydrocortisone acetate ointment (1% or 2.5% cream, 1% or 2.5% lotion, 1% or 2.5% ointment) and pramoxine hydrochloride 1% * class I has the highest class VII the lowest potency. The effectiveness depends on many factors, including the properties and concentration of the drug and in which it is used the base material, decreases. Topical corticosteroids are applied daily to 3 times mostly 2-, preparations with high potency often only once a day or even less often. Most dermatoses are treated with preparations medium to high potency. Preparations with low potency, are more suitable for mild inflammatory reactions and how to apply on the face and intertriginous where systemic absorption and local adverse effects are likely. All substances can cause local skin atrophy, striae, and acneiform rashes, when applied over a month (> 1 month). This is v. a. problematic to the thinner skin of the face and genital area. In addition, corticosteroids favor the growth of fungi. With prolonged use, also contact dermatitis is often in response to the preservatives and additives. Also the corticosteroid itself can lead to contact dermatitis. The use of moderate to very strong preparations in the face leads to a perioral dermatitis. This is not the case with the use of weak preparations. Substances of very high potency may cause adrenal suppression, when administered in children, on very large skin areas or over time. Relative contraindications are diseases with infectious component and acneiform diseases. Among the NSAIDs include tar preparations. Tar is used in the form of untreated coal tar for the treatment of psoriasis. Side effects include irritation, folliculitis, staining of clothes and furniture, and photosensitivity. Contraindications are for. B. infected skin. In the commercial preparations plant extracts are often used, their effectiveness is not assured. Most popular are chamomile and Ringelblume.Antimikrobiotika Topical antimicrobials include antibiotics antifungal insecticides unspecific acting antiseptics Topical antibiotics are rarely indicated. Clindamycin and erythromycin are topically administered to primary or supportive therapy in acne vulgaris if the patient does not want to take oral antibiotics or tolerated. Topical metronidazole and occasionally topical sulfacetamide, clindamycin or erythromycin for acne rosacea used. Mupirocin works extremely well in the Gram positive (especially Staphylococcus aureus and Streptococcus) area and is used for the treatment of impetigo, if it is only superficial. Bacitracin and polymyxin are often used postoperatively skin biopsies as well as to infection prophylaxis in scratches, minor burns and abrasions. Topical neomycin caused more often than other antibiotics contact dermatitis. By applying topical antibiotics and the use of antiseptic soaps at-healing wounds, the healing process is often delayed. Antifungals are indicated for candidiasis, as well as in numerous dermatophytosis and other fungal infections (see table: treatment options superficial fungal infections *). Insecticides (. Eg permethrin, malathion) are used for scabies and lice infestation (see Table: Treatment options for lice and see Table: Treatment options for scabies). Nichtantibiotisch to the effective topical antiseptics include iodide solutions (eg. As povidone iodine, clioquinol), gentian violet, silver compounds (eg., Silver nitrate, silver sulfadiazine) and zinc pyrithione. Iodine is indicated for preoperative skin preparation. Gentian violet when a chemically and physically stable antiseptic / antimicrobial alternative that has to be inexpensive is required is used. Many wound dressings impregnated with silver. Silver preparations are effective in burns and ulcers and strong antimicrobial activity. Zinc pyrithione antimycotic effect and is often used in shampoos for the treatment of dandruff, which arise due psoriasis or seborrheic dermatitis, added. Healing wounds should not be treated with other topical antiseptics as silver, as they are irritating and often the delicate granulation tissue zerstören.Keratolytika keratolytics soft epidermal cells and facilitate their detachment. Examples are 3- to 6% salicylic acid and urea. Salicylic acid is used in psoriasis, seborrheic dermatitis, acne and warts. Side effects include burning and, if it is applied to large areas, systemic toxic effects. In children and infants should not possible be used. Urea is used in the treatment of plantar keratoses and ichthyosis. Side effects include skin irritation and not manageable burning. He should not werden.Adstringenzien applied to large areas of skin astringents dehydrating effects by precipitating proteins and thereby shrink the skin and contract. The most common astringents aluminum acetate are (Burowsche solution), aluminum sulfate and calcium acetate (Domeboro solution) applied. They are usually applied in the form of wound dressings or wraps. exudative skin lesions and pressure ulcers are dripping astringents with infected eczema, applied. Witch hazel is a popular OTC Adstringens.Antipruriginosa Doxepin is a topical antihistamine that is effective against the itching in atopic dermatitis, chronic dermatitis simplex in the lichen and the nummular eczema. Topical benzocaine and diphenhydramine (in many countries the-counter lotions) have a sensitizing effect and should not be used. More antipruritics are 0.5 to 3% camphor, 0.1 to 0.2% sodium menthol, pramoxine hydrochloride, and eutectic mixtures of local anesthetic (EMLA) containing equal parts of lidocaine and prilocaine in a oil-water vehicle , Unless small skin areas are affected and pruritus is controlled, topical Antipruritics to systemic substances (such as oral antihistamines) should be preferred. Although Calaminlotion relieves, but not specifically targets the itching.

Health Life Media Team

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