Transcript Topical therapy

Topical therapy
Prepared by :
SIG, Dermatological nursing,
IADVL
Topical therapy
• What is a topical therapy?
Medications applied on the surface of skin,
hair / nail and mucous membrane, which are
absorbed percutaneously to exert therapeutic
action at the site.
Commonly used topical drugs….
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Antibacterials
Antifungals
Antiparasitic (scabies & lice)
Topical corticosteroids
Anti-acne preparations
Sunscreen
Emollients
Soothing agents
Cleansing agents
Why nurses should have knowledge
regarding topical therapy?
• In out patient department;
explanation regarding topical therapy is
necessary for each dermatology patient
Why nurses should have knowledge
regarding topical therapy?
• In hospitalized patients;
-Nurses can provide topical therapy in a more scientific
way than the relatives.
- Oozy / painful lesions may need topical therapy in the
form of compress / fomentation.
- In patients with ‘widespread skin loss’ due to
dermatological diseases, various topical therapy may be
required along with skin care.
Advantages of topical therapy
• Act and metabolized locally in skin
• Systemic metabolism and side effects are
mostly avoided.
• Easy to use in children.
• Risk of over dosage is low as compared to
systemic therapy
Various topical preparations..site
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Cream (acute lesions of short duration)
Ointment (Chronic lesions of some duration)
Gel (Oily face or hairy areas)
Lotion (Hairy areas)
Powder (Flexural area)
Paint (Large surface area)
Shampoo (Scalp)
Foam formulation (Hairy scalp)
Various ways of application & local
therapy…..
• Topical application
• Paint
• Compress
• Fomentation
• Soaks
• Massage
Specific methods of application of
certain topical drugs
Topical steroid
• Use sparingly
• Over large body surface area; use ‘Finger tip
unit’ and ‘rule of hand’
• Not to rub over involved area
• Should be used only for prescribed period
• Effect can be enhanced by occlusion with
bandage (should be practiced only with
doctor’s advice)
Finger tip unit
Antibacterials….
• Twice / thrice daily application
• Crusts must be removed by compress before
applying topical antibacterials as some
antibiotics (mupirocin) are inactivated in
presence of proteinaceous materials.
Antiparasitic agents:
Scabies: Permethrin cream
• Single thorough application of 30 g container
from neck to toe, specially to all flexures, at
night.
• Contact period of 8-10 hours, followed by
bath
• All family members to be treated together
Pediculosis…
Pediculosis: Permethrin crème rinse
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Shampoo and dry hair
Apply on dry hair and keep for 10 min.
Wash off with water
Nits to be removed with a special comb.
Sunscreen
• To be applied on photoexposed body parts at
3 hourly intervals during daytime
(9am-12pm-3pm)
• The applied layer should be thin and uniform
• Mild stinging following application may occur
• Should preferably be used in combination
with physical sun-protection
Emollients
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Latin verb ‘Mollire’ (to soften)
Moisturizing cream / lotion,
Liquid paraffin / soft paraffin,
Bath oil (added to bath water),
Cream-based soap substitutes,
Coconut oil
Emollients
• Indications:
-Dry skin
-Ichthyosis
-Atopic dermatitis
-Asteatotic eczema
- During care of anesthetic hands and feet
(leprosy, diabetes)
Emollients
• Liberal application immediately after bath in
patients with xerosis.
• In leprosy patients routine oil application
following soaking of hands & feet.
• Addition of bath oil in atopic children.
Paint..
• Over intact skin or mucous membrane
• Gentian violet paint (0.5-1% aqueous solution)
• Mild antibacterial + drying effect
• Castellani’s paint (magenta color): Chronic
paronychia, finger / toe-web candidiasis
Compress
• Indications: Infected wound, eczema with
secondary infection, Pyoderma
• Agents used:
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Normal saline
Potassium permanganate + tap water
Sodium bicarbonate + tap water
Ice / ice-cold water compress
How do compresses help?
• Purpose: Removal of crusts, dirts, pus, dried
blood, etc.
• Warm compress helps to increase local
circulation.
• Improves local nutrition and immunity,
because of enhanced circulation.
Potassium permanganate (PP)
compress
• Tap water + PP crystal (1:10,000 dil. / 0.01%)
light magenta color, correct concentration.
(available as sugar-like crystals, few crystals
are enough)
• During compress the color gradually changes
to brownish (discard the water at this point).
• Too high concentration: caustic burn
Normal saline compress
• Commercially available normal saline
• Half –one level teaspoonful of common salt
added to 250ml of tap water (approx. 0.9%)
• Should not be used over raw areas of skin
Ice compress
• Ice / ice cold water
• Indication: inflammatory edema, acute neuritis of
leprosy
• Reduces chance of local edema by
vasoconstriction
• Alternate hot and cold compresses can be given.
Sodium bicarbonate compress
• Bucketful of tap water + 5 teaspoonful of baking
soda
• Keratolytic effect
• Removes foul odor
• Useful in patients with scaling, e.g. erythroderma,
ichthyosis, etc.
Fomentation
• Therapeutic application of warmth and
moisture, so as to relieve pain (acutely
inflamed areas)
• If a substance / material is used as a warm,
moist medicinal compresses, the term
‘poultice’ is used, (e.g. boric powder).
Soaks..
• Used for hyperkeratotic areas over hands and
feet.
• Warm water / water with normal
temperature, taken in a shallow bucket.
• In presence of oozy lesions over these areas,
potassium permanganate soaks may be used.
• Medications applied after soaking (e.g.
corticosteroids) have better penetration.
Massage
• Oil / moisturizing lotion may be massaged.
• Massaging helps uniform application of the
moisturizing agent and softening
• Improved blood circulation in dependent body
parts.
• Helps to improve inflammatory edema.
• In children, facilitate bondage between
nursing staff and the child.
The very fist step towards success
in any occupation is to become
interested in it.
SIR WILLIAM OSLER