Dermatological Pharmacology, Suryosutanto,Dr

SURYOSUTANTO

Depart.of Pharmacology & Therapy

Medical Faculty – Padjadjaran University

DERMATOLOGICAL PHARMACOLOGY

The essensial function of skin : protection thermoregulation immune responsiveness biochemical synthesis sensory detection social and sexual communication

Therapy to correct dysfunction in any of these activities may be delivered: systemically. intralesionally topically depend on understanding the barrier function of the skin, primarily

within the stratum corneum. ultraviolet radiation

Corticosteroids and retinoids are importantsystemic and topical therapeutic agents for skin disease. Antibacterial, antiviral and antifungal agents are employed widely both oral antimalarial, chemotherapeutic and immunosupressive agents, dapsone, and antihistamine, frequently are used for treatment of dermatological diseases.

Calcipotrien, a vitamine D analog, and anthraline are mayor topical agents for psoriasis.Ultraviolet radiation therapy is frequent modeOf treatment for psoriasis, independently orcombination with drugs such as psoralens or coaltarThe prophylactic use of sunscreens may reduce or prevent premalignant or malignant skin lesions induce by UV light.

General Guidelines for Topical Therapy 1. Regional Anatomic Variation

- Drug penetration higher on the face, intertriginous area, and especially in the perineum. - Sensitization, irritation, and atropy from steroidare more likely to develop in these regions.

2. Altered Barrier Function - psoriasis Str. corneum is abnormal barrier function is lost topical absorption is increased systemic toxicity.

3. Hydration- drug absorption is increased- produce by inhibiting transepidermal loss of

water, (occlusion with an impermeable film,application of lipophilic oclusive vehicle such as oinment)

4. Vechicle- acute inflamation aqueous drying preparation- chronic inflamation hydrating preparations.- soaks acute moist eruptions

- Lotions (powder in water suspension) andsolutions (medications dissolve in a solvent) for hairy and intertriginous areas.

- Creams or oil inwater emulsions are absorbableand are the most cosmetically acceptable.

- Ointments, water in oil emulsions are the mosteffective hydrating agents scally eruption.

- Multiple creams and oinments without activedrug are marketed as moisturizing agents.

5. Age6. apllication frequency 

Topical Glucocorticoids Therapeutic Uses: inflamatory skin diseases twice a day application is sufficient hydrocortison is the most potent steroid used

on the face or in occluded areas (axilla or groin) tachyphylaxis can occur. intralesional injection : triamcinolone scalp

allopecia, panniculitis, psoriasis, discoid lupusand inflamed cysts.

Toxicity and Monitoring- skin atrophy, striae, teleangiectasias purpura,

acneiform eruptions, perioral dermatitis,overgrowth of skm fungus and bacteria,

hypopigmentation in pigmented skin, and rosacea.- factors that increase systemic absorption : the

amount of the steroid applied, the extent of thearea treated, the frequency of application, thelength of treatment, the potency of the drug andthe use of occlusion.

- intralesional glucocorticoids can cause cutaneous atrophy and hypopigmentation

Systemic GlucocorticoidsTherapeutic uses: A. Require long-term therapy: - Bullous diseases:- pemphigus vulgaris

- herpes gestationis.- Collagn Vascular Diseases : - S.L.E. - vasculitis- Sarcoidosis - Sweet’s disease - Pyoderma gangrenosum - Type l reactive leprosy

B. Respond to short-term therapy : - Contact dermatitis (acute)- Atopic dermatitis- Lichen planus- Exfoliative dermatitis - Erythema nodosumC. Respond to low-dose bedtime therapy :- Acne- HirsuitismeD. Steroid therapy controversial- Toxic epidermal necrolysis- Erythema multiforme- Cutaneous T - Cell lymphoma - Discoid L.E.

Toxicity and MonitoringShort-term use:> psychiatric problems, cataracts,myopathy,avascular necrosis, hypertension.

Withdrawl syndrome : - transient arthralgias, myalgias, joint effusions

- Isotretinoin ( I ) - Etetrinate ( E)- Tretinoin (T)Mayor Retinoid-Responsive Skin DiseaseaAcne 1,(T) Disorders of keratinization I,E,(T)Skin cancer I,EPrecancereous T,E,(I)Psoriass ECutaneous aging T

TOPICAL ANTIPSORIASIS DRUGS - Calcipotriene- Anthralin PHOTOCHEMOTHERAPY 1. PROSALEN2. BERGAPTEN3. METHOXALEN4. TRIOXALEN

Therapeutic Uses: vitiligo psoriasis PUVA also is employed in the treatment

of:- cutaneous T-Cell lymphoma

atopic dermatitis- alopecia areata- lichen planus

Sunscreens are topical agents that reduce theamount of ultraviolet radiation reaching the Skin or block it altogether.

I. Physical 3 Sunscreen :This sunscreen contain large particulate

ingredients that reflect and scatter UVA, UVB, andvisible light. These ingredients include :

- Titanium dioxide - Talc - magnesium oxide - zinc oxide  - kaolin     - ferric chloride - Ichthamnol

II. Chemical sunscreens. Protection against UVB is more effective, thanProtection against UVA.- p-ammobenzoic acid esters- cinnamates effective UVB - salicylates blocking - benzophenones - anthranilates effective UVA blocking- avobenzone

- Minoxidil Stimulating hair growth.- Keratolytic agent : - lactid acid

- glycolic acid - salcylic acid.-Destructive agents: - Podophyllin - Trichloroacetic acid

- Hydroquinone HYPERPIGMENTATION- Capsaicin relief of post herpetic neuralgia

(R/ : ZOSTRIC, ZOSTRIC HP)- Masoprocol Th/ ACTINIC KERATOSIS- Colchicine PMN leukocytes are part of the

pathogenesis of the disease- Gold Pemphigus vulgaris and cutaneous LE