DERMATOTHERAPY

DR. Endang Sutedja, dr. SpKK(K)

 DERMATOTHERAPY

Science concerning theraphy of skin

diseases
 TYPE OF THERAPY

1. Medicamentous : topical, systemic

2. Skin surgery: scalpei surgery,electrosurgery,
chemical surgery, cryosurgery
3. Radiation: radiotherapy, UV light, laser
4. Psycotherapy
 MEDICATION

1. Nature
2. Treat the patiet holystic
3. Attention for physiology, pathology, biochemical,
anatomy
4. Medical material
5. 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 Paste
Cold paste

Solution Cream Oint.

O/W W/O
 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 O/W
WATER IN OIL OIL IN WATER
OIL >> 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 CHRONIC
WET SUBACUTE DRY

dressing Cream O/W Cream W/O Oint.

c
 Tabel. VEHICULUM CHOICE ACCORDING
DISTRIBUTION / LOCALISATION

Localisation Powder Water Alco- Oint. Liquid Paste Cream

hol powder
Generalisata
+ -* - - + - +
Scalp
- + + - - - +
Face
+ + +# + + + +
trunk,
extremity
+ + + + + + +
Genitalia
+ + - - + - +
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