Transcript داروها در پوست و بیماریهای شایع:

‫مصرف داروها در پوست ‪:‬‬
‫دکتر گیتا فقیهی‬
‫دانشیار بیماریهای پوست‬
‫دانشگاه علوم پزشکی اصفهان‬
‫مصارف موضعی داروها در‬
‫پوست‬
What are the common ingredients in a
topical formulation?
Active drug(s)
Vehicle (cream, ointment, lotion etc.)
+/- preservatives
+/- penetration enhancers (e.g. azone, DMSO)
Others (e.g. antioxidants, fragrances, coloring
agents)
Common topical dose forms includes:
creams, lotions, ointments and powders.
• Creams: A cream is a semi-solid emulsion
containing a drug. The cream is usually nongreasy.
Creams are removed with water.
• Lotions: A lotion is a watery preparation
containing suspended particles. Shake all lotions
before application. Gently but firmly pat the lotion
on the skin. Do not rub into the skin.
Rubbing increases circulation and itching. Rubbing also causes
friction, which can irritate the skin. Lotions are used to:
Soothe and protect the skin
Relieve rashes and itching
Cleanse the skin
• Ointments: An ointment is a semi-solid
preparation containing a drug in an oily
base.
Ointments are not easily removed with water.
The drug has longer contact with the skin.
Why Apply Topical Drugs:
•
•
•
•
•
•
Clean and debride (remove) a wound
Hydrate (add water) to the skin
Reduce inflammation
Relieve itching or a rash
Provide a protection barrier to the skin
Reduce thickening of skin
‫یکی از پرمصرفترین داروهای‬
‫موضعی و یا به عبارتی فراورده های‬
‫بهداشتی توپیکال ضدافتابها هستند‪.‬‬
sunscreens
Sunscreens:
Physical agents
Chemical absorbing agents
Sun protection at any age is
important
to prevent the short-term as
well as long-term
damaging effects of
sunlight
How do “ Sunscreens “ work ?
by
absorbing,
reflecting,
the sun's rays on the skin.
They are available in many forms, including
ointments,
creams,
gels,
lotions,
sprays, and
wax sticks.
Physical blockers
effective at protecting
against both UVA and UVB radiation.
The two most common physical blockers are:
titanium dioxide
zinc oxide.
‫ضدآفتابهای ایده ال‬
‫• به نوعی در واقع همین گروه فیزیکی ها هستند‬
‫• احتمال آلرژی آنها کمتر و ایمنی بیشتری برای سالمت‬
‫دارند و اشعه را بطور موثرتری میگیرند‬
zinc oxide and
titanium dioxide ,
act as a physical barrier
‫معایب ضدافتابهای فیزیکی‪:‬‬
‫• تحمل بیمار از نظر زیبایی نسبت به آنها کمتر‬
‫است مگر با کاربرد جدید ترکیبات میکرونیزه که‬
‫از نظر پذبیرش بیمار بهترند‪.‬‬
ZNO
TIO2
Zinc oxide is less whitening than
titanium dioxide
and
provides better UV-A protection.
Iron oxides
are mineral pigments to give a tint and
better protection to sunblockers
Chemical absorbers
• Have a less active wavelength
• Higher side effects
• May harm babies and sensitive
persons
‫نمونه ای از آلرژیک فتو کنتاکت درماتیت‬
‫به ضدافتابهای شیمیایی‬
:‫طرز استعمال صحیح ضدافتاب‬
• 20-30 minutes
sunscreen to be
absorbed by the skin
• apply it at least half an hour before going
out in the sun.
• Reapply after half an hour
• Then,,,,Re-apply sunscreen every 2 hours
Sunscreens are not
recommended
for infants
less than 6 months
of age.
Are sunscreens really
safe??
Side effects reported during clinical
studies from sunscreens were
infrequent and non-serious.
The most common side effects in patients were
acne,
dermatitis,
dry skin,
eczema,
abnormal redness,
itching,
skin discomfort
and sunburn
Dermatitis is a
common skin disorder
in every age
When you have
eczema, you should
avoid soaps, especially
bar soaps, even
‘moisturizing soaps’ as
they will cause dry skin
and may damage the
skin barrier. Only
mild soap-free
cleansers, preferably
liquid, should be used
Baths may be better than
showers.
The water temperature
should be luke warm.
Long hot showers are not
recommended
Management points
• Try not to scratch
the irritated area on
your skin even if it
itches.
• Scratching can
break the skin.
Bacteria can enter
these breaks and
cause infection
OTC acne drugs:
•
•
•
•
•
•
benzoyl peroxide,
sulfur,
resorcinol,
salicylic acid or
lactic acid
Azelaic acid
Azelaic acid
This medication is used for the treatment of
mild to moderate acne.
Azelaic acid belongs to a class of drugs
known as dicarboxylic acids. It works by
stopping the growth of bacteria on the skin
and by reducing the amount of a natural
skin substance (keratin) that can cause acne.
Benzoyl peroxide
Benzoyl peroxide
• is available in almost all forms of skin carecreams, gels, liquids, lotions, soap etc.
• Benzoyl peroxide acts in three ways.
• It kills the bacteria in acne. It opens closed
acne pores and it removes excess oiliness
from the skin.
Acne drugs by prescription
• Tretinoin
• Adapalene(differin)
• Clindamycin
• erythromycin
During the first few weeks of
using tretinoin,
acne might appear worse because the
medication is working on pimples
forming inside the skin. It may take up
to 8-12 weeks to notice results from
this medication.
®
Differin
• Lotion 0.1%, Gel 0.1%, Cream 0.1% and
Differin® Gel, 0.3% are indicated for the acne
vulgaris in patients 12 years and older. Apply
Differin® products to affected skin (face, trunk
and other areas of the body affected by acne) once
per day avoiding the eyes, lips and mucous
membranes.
• The most common side effects reported with
use of Differin® products include skin dryness,
redness, scaling, stinging and burning.
Melasma
Melasma
• Melasma is an acquired
hypermelanosis of sunexposed areas.
• It presents as symmetric
hyperpigmented macules,
which can be confluent or
punctate. The cheeks, the
upper lip, the chin, and
the forehead are the
most common locations.
etiology
• In some cases, a direct relationship
with female hormonal activity
appears to be present because it occurs
with pregnancy and with the use of oral
contraceptive pills.
• Other factors implicated in the
etiopathogenesis of melasma are
photosensitizing medications, mild
ovarian or thyroid dysfunction, and
certain cosmetics
Important note/
• The most important factor in the
development of melasma is exposure
to sunlight.
• Without sunscreen any try to
treatment fails.
Race, age
• it is much more common in darker skin
types than in lighter skin ,, especially
Asians, from areas of the world with
intense sun exposure.
• Melasma is rare before puberty and
most commonly occurs in women during
their reproductive years.
Endocrine /emotional
factors
• a 4-fold increase in thyroid disease
in patients with melasma when compared
with matched controls.
• A case report of 2 women who developed
melasma after sudden and profound
emotional stress implicated the release
of MSH by the hypothalamus as a cause/
Diff.Diagnosis
• Addison Disease
• Drug-Induced Photosensitivity
• Lupus Erythematosus, Discoid
• Mastocytosis
• lichen planus
treatment
• The mainstay of treatment remains
• topical depigmenting agents.
• Hydroquinone (HQ) is most commonly
used.
a chemical that inhibits tyrosinase,
leading to the decreased production of
melanin.
• HQ can be applied in cream form or as
an alcohol-based solution
treatment
The use of tretinoin can be
effective as monotherapy. However,
the response to treatment is less
than with HQ and can be slow, with
improvement taking 6 months or
longer
Scrub creams and melasma
• Microdermabrasion
creams help to remove
dead skin and debris on
the surface of the skin.
•
These dead skin flakes
and particles can
interfere with the
penetration of skin care
products
‫کورتون موضعی‬
‫کشف آنها از ‪ 1950‬انقالب بزرگی در‬
‫درماتولوژی ایجاد نمود‪.‬‬
Corticosteroids are mainly used for their
effect in
controlling inflammation,
and topical corticosteroids are applied to the
skin
for the
localised treatment of various inflammatory
skin disorders.
Because of side effects
of topical steroids
• Classification is important to know by physicians
‫نکته مهم آنکه هر چه کورتون قویتر و موئثرتر‬
.‫پتانسیل عوارض سوئ نیز بیشتر است‬
Groups of topical steroids from
point of Potency:
Very Potent (Clobetasol propionate Betamethasone
dipropionate )
Potent (Desoximetasone, Fluocinonide,Halcinonide)
Moderate
)Fluocinolone‫و‬Triamcinolone,Betamethasone
valerate ,Mometasone furoate)
Mild ) Hydrocortisone(
Risks of topical steroids:
•
•
•
•
•
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•
•
Atrophy, striae
Telangiectasia, purpura
Perioral dermatitis, rosacea
Masking of initial lesion
Tachyphylaxis or rebound
Pigmentation abnormalities
Systemic absorption (uncommon)
Susceptibility to infection
‫ترک خوردگی یا استریای ناشی از‬
‫کورتن‬
‫اتساع مویرگها(تالنژیکتازی)‬
‫ناشی از کورتن‬
‫نازکی اپیدرم و خونمردگی به دلیل‬
‫شکنندگی عروق درم‬
Steroid atrophy
‫عوامل خطرسازدر افزایش عوارض سوئ‬
‫کورتن‬
• Potent topical steroids over large
areas of body.
• use plastic to cover treated areas
(occlusion).
• skin condition persists for more than
two or three weeks.
• In a child.
‫پزشک بایستی به بیمار هشدار دهد که‬
‫کورتون موضعی را بیش از ‪ 2‬نوبت در‬
‫روز به کار نبرد‬
‫و‬
‫از آن به عنوان نرم کننده صرف استفاده‬
‫نکند‪.‬‬
•Minimizing risks:
Avoid high potency steroids on flexures,
face or genitals
Avoid high potency steroids in children
Avoid use of occlusion for long periods
:‫آنتی هیستامینها‬
• Antihistamines are available for
oral use as tablets and elixirs.
They take about 15 to 30 minutes to be
effective
‫به فرم تزریقی اغلب نیازی نخواهد بود‬
‫مگر در‬
‫اورژانسها و یا شوک آنافیالکسی‬
Topical preparations (ointments
and creams)
are often applied to insect bites
‫هرچند متاسفانه ‪:‬‬
‫کرمهای آنتی هیستامین میتوانند آلرژیک‬
‫کنتاکت درماتیت ایجاد کنند‪.‬‬
:‫هیستامینها‬
‫گروه بندی آنتی‬
• Conventional antihistamines
• Non-sedating antihistamines
:‫معمول‬
•
•
•
•
•
•
•
•
‫آنتی هیستامینهای‬
Chlorpheniramine
Promethazine
Trimeprazine
Diphenhydramine
Cyclizine
Azatadine
Hydroxyzine
Cyproheptadine
Side effects of them include:
Drowsiness
Dry mouth,
blurring of vision,
difficulty passing urine and
impotence
Paradoxical stimulant effect (and even
agitation).
Non-sedating antihistamines
• Loratidine and desloratadine
• Cetirizine
• Fexofenadine
‫قابل ذکر است که‪:‬‬
‫آستمیزول و ترفنادین در استرالیا و‬
‫آمریکا از بازار دارویی حذف شدند‬
‫به دلیل تداخالت داروییشان‪/‬‬
:‫تداخالت مهم ترفنادین و آستمیزول شامل‬
Erythromycin
Ketoconazole
Itraconazole
Ciclosporin