DERMATOTHERAPY

DR. Endang Sutedja, dr. SpKK(K)

DERMATOTHERAPY

Science concerning theraphy of skin diseases

TYPE OF THERAPY

1. Medicamentous : topical, systemic2. Skin surgery: scalpei surgery,electrosurgery, chemical surgery, cryosurgery3. Radiation: radiotherapy, UV light, laser4. Psycotherapy

MEDICATION

1. Nature2. Treat the patiet holystic3. Attention for physiology, pathology, biochemical,

anatomy4. Medical material5. Attention pharmacy & pharmacology of drugs

MEDIKAMENTOUS THERAPY

6. Causal therapy7. Simplest drug8. Individualization9. 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 concentration3. Explain usage & cleansing4. Avoid sensitizer5. Restrict unstable drugs

Topical therapy: type of Vehiculum

1. V.monophasic : a. powder b. solution c. ointment2. V. biphasic : powder + solution powder + ointment solution + ointment3. V. triphasic : powder + solution + paste

Solution Oint.

Powder

Lotion Paste

Cream

Cold paste

O/W W/O

POWDER

* Inert, used`of physical effectA. Effect : cover adhesion slipping power

absorption cooling powerB. Indication : dry lesion superficial lesion

acute vesicobulousC. contraindication : dermatoses wet & eksudativeD. 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 dermatitisC. Contraindication : dry lesionD. 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

W / O O / WWATER IN OIL OIL IN WATER

OIL >> WATER >>

LESION

MORE DRY MORE WET

CREAM

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.

c

Tabel. VEHICULUM CHOICE ACCORDING DISTRIBUTION / LOCALISATION

Localisation Powder Water Alco- hol

Oint. Liquid powder

Paste Cream

Generalisata + -* - - + - +Scalp - + + - - - +

Face + + +# + + + +trunk,

extremity + + + + + + +Genitalia + + - - + - +Fold area + + + +@ + - +

EFFECTS OF DRUG

1. Protective : powder, paste, cold paste, cream2. Absorption : powder, liquid powder 3. Drying : solution, liquid powder 4. Good penetration : ointment, cream, tinctura5. 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