Therapy
Seborrheic diseases. Role of local therapy in dermatology. Dr.med.habil. István Juhász Univ. of Debrecen, Med. and Health. Sci. Ctr., Burn Dermatosurgery Unit, Dept. of Dermatology Dentistry Branch, Department of Human Surgery and Operative Techniques Pilosebaceus unit • Glicerid – free fatty acids, wax, sterol esther, squalens,colesterolesther, cholesterol Infundibulum • Bacterial lipases- free fatty acids • Asteatosis = sebostasis • Seborrhoea • Scalp skin, face, ears, skin of chest and back • Hormonal influences Sebaceus gland – holocrine – sebum production Seborrhoea • Post adolescent period, bw 18-25 yrs of age, elderly • Genetic factors • Oily, shiny, greasy facial skin • Oily, flaky desquamation • Greasy, sweating, wet hair • Hairy scalp – pityriasis simplex • Testosterone () – estrogen /hypophysis () • Emotional factors, role of diet (±) Comedo • Horny plug obstructing the opening of sebaceus gland • Blackhead (Open comedo) • Whitehead (Closed comedo, retention cyst) • Giant comedo Comedo • Comedo extractor • Scar after removed comedones: atrophodermia vermiculata Seborrhoea • • • • Therapy: Alcohol containing lotions, detergents - adstringents Benzoyl- peroxide Local retinoid treatment (Adapalene, Retinoic acid derivates) • 13-cis-retinoic acid (Roaccutane) • Antiandrogenic th: progesterone (ciproteron-acetate/CPA –- Diane 35) with or without etidinilestradiol (Androcur) Seborrhoea capitis Hairy scalp: Regular use of medicated shampoo: Adstringents: Triclosan, Zn-pirithion, Coal tar derivates, Most severe cases: Salicylic acid-steroid containing lotions (Diprosalic, Locoid crelo) Nizoral (local antimykotic) Rosacea • Centrofacial • papules, • pustules, • teleangiectasias • • • • • • • Bw 40-50 years of age Genetic factors Gastrointestinal problems, cholecystopathy, alcohol abuse I.) Persistant erythema – erythrosis faciei II.) Papulopustulous rosacea III.) Plaques, nodi, hypertrophy Blepharitis, iritis, iridocyclitis Rosacea • Therapy • • • • • Oral Tetracyclin (Doxycyclin) or Metronidazol (Klion) Isotretinoin (Roaccutan) p.os Stop irritating local therapy (cleansing w. distilled water) Local Klion, Erythromycine Sun protection Rosacea - Rhinophyma • Diffuse connective tissue and sebaceous gland hyperplasia (extreme grade) • Overgrowing sebaceous glands • Chin – gnathophyma • Th: dermabrasion Perioral dermatitis • Chronic rosacea-like dermatosis • Common recurrences • Perioral localisation, may extend to glabellar region • Young female pts. • Unknown ethiology • Intolerance towards cosmetics • UV provocation • Halogen dermatosis (toothpaste, mouthwash, fluorinated steroids) • Follicular papules, without comedones Acne vulgaris • • • • Very common, adolescence , adulthood Both sexes are involved, boys more often, Seborrhoeic diathesis Sebum – free fatty acids – chemotaxis – inflammation – closure of follicle openings – pus retention • Propionobacterium acnes, staphylococcus epidermidis • Androgen receptors on the cells of the sebaceous gland Acne comedonica Acne papulopustulosa Acne cystica Acne conglobata • Infiltrated painful nodules, cysts • Liquification • Formation of trabecules • Acne indurata • Therapy • Skin cleansing, comedo extraction, • Roaccutane 12-16 weeks (0,2- 1 mg / tskg) • Antiandrogenic th. Acne therapy Acne inversa • Acne tetrad, acne triad • Acne conglobata • Hidradenitis suppurativa • Perifolliculitis: neck, scalp • Sinus pilonidalis Acne keloidica Dermatological therapy Local therapy • • • • • • • • • • • paste warm compress film cold (wet) pack patch powder water base lotion alcohol base lotion shake lotion cream ointment Systhemic therapy Depth of effect Shake lotion liquid powder (air ) foam emulsion paste cream ointment Basic principles of dermatologic local therapy • Testing tolerability: apply first only vehicle, next step: add active ingredient • Least sensitizing local agents, in low number of combinations • External agents according to greasiness of skin • Promoting penetration with detergents: DMSO (disulphide bonds, reorganization of str. corneum and collagen fibers) • Comparative treatment of bilateral body parts • Oozing skin lesions: compress / cream • Squama, crust: compress , fatty cream • Acute inflammation: closed bandage, lotion – magistral (prepared in pharmacy) – FoNo (collection of standard recipes) – drug company manufactured Important active agents used in dermatological local therapy • Anti-inflammatory: protein inactivation, adstringent, desinfectant – – – – metallic salts, Al, Pb, Zn, Hg, albumin binds metal denaturation, Ung. Refrigerans FoNo; Ung alum. Acetici tart. FoNo; Tabl Burofix Ac. Tannicum (tannic acid ) Coal tar derivates (2 - 3% in cream) • Steroid anti inflammatory drugs – – – – – corticosteroids - sterane scaffold enhancing its effect: butyrate - pivalate - acetonide - etc. chains 10-fold increase: halogenating (fluoride, chloride) vehicle format: lotion, cream, ointment side-effects: pyogenic and mycotic infections, skin atrophy, purpuras, absorption: general symptoms (pediatry!) – Hydrocortison, Locoid, Dermovate, Synalar, Flucinar, Ftorocort, Locacorten, Cutivate,...
© Copyright 2024