Therapy of Dermatology

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Therapy of Dermatology
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• Systemic therapy
• Topical therapy

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Systemic therapy
1.antihistaminies 2.corticosteroids 3.antibiotic
s 4.antivirals 5.antifungals 6.Vitamines 7.immun
osuppressive agent 8.others
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antihistaminies

• histamine functions
• telangiectasis
  BP , shock
• increase in vascular permeability
  erythema?
• 
  wheal
• contraction of smooth muscles
  bellyache
• stimulation of gland secretion
  asthma
• actions of antihistamine
• Compete with histamine H1 and H2 receptors

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1. H1 antihitamines CH2-CH2-Nlt same
as histamine 1) compete H1
receptor?exudation??inflammation??relieving
smooth muscle convulsion, adapt to allergic
diseases (urticaria?eczema) 2)reduce
center nerve system excitement ,sedative
effects,antipruritic function adapt to all
pruritic disease (nervous dermatitis?prurigo)
3) side-effectsdizziness?hypersomnia?hypodyn
amia?dryness of the mouth ? seldom
liver or kidney damage, allergic reaction?
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First-generation H1 antihistamines
H1 antagonist dose(adult)
route of administration side -effects

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H1 antagonist dose(adult) route of
administration side -effects

• 4. cyproheptadine 2-4mg,tid
  po
  hypersomnia ,
• 
  
  Contraindications glaucoma
• 
  
  
  
• 5.decloxizine 25-50mg,tid
  po
  hypersomnia
• 
  
  can make monstrosity
• 6.promethazine 12.5-25mg,tid
  po
  hypersomnia ,careful to
• 
  25-50mg,qd im or iv
  glaocoma and liver and
• 
  
  kidney
• ???????
• 7.ketotifen 1mg,bid
  po
  sedative? hypersomnia
• 
  
  dizziness, dryness of the mouth
• 
  

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Second-generation H1 antihistamines
H1 antagonist time dose route of
administration side-effects

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H1 antagonist time dose route of
administration side-effects
Second-generation H1 antihistamines

• cetirizine 24h 10mg,qd po
  nearly no hypersomnia
• mequitazine 18h 5mg, bid po
  nearly no hypersomnia , not
• 
  use to glaucoma
  and
• 
  prostatauxe
• 
  
• 
  
• mizolastine 24h 10mg ,qd po
  nearly no hypersomnia

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• 2. H2 antihistamines
• contract vessel??inflammation?inhibit gastric
  juice excretion
• cimetidine 0.2 qid
• ranitidine 150mg bid

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glucocorticoids

• 1 anti-inflammatory actions
• stimulate monocytes and macrophages produce
  polypeptide ?inhibit activation of
  polymorphonuclear(chemiotaxis?adherability and
  lysosome excretion)?
• inhibit connective tissue hyperplasia and
  activation
• of fibrocyte?
• ?hyaluronidase and chondroitin sulfate
  synthesize?

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• 2 immunosuppressive
• inhibit factors release after Ag-Ab combination
  
• make lymphoid tissue atrophy ?accelerate
  lymphocyte destruction
• reduce the reaction of hypersensitive
  lymphocytes
• and Ag
• 3 antitoxicalleviate cell injury of toxic
• 4 anti-shockalleviate angiospasm,improve
  microcirculation

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name anti-inflammation equivalent dose
troche/injection dose

mg mg mg/d
Glucocorticoid in common use
low Hydrocortisone 1
20 /25100
iv 100400 Medium Prednisone
3.5 5
5 po 1060
prednisolone 4
5 5
/525(Suspension) po 1060

Methyprednisone 5 4
4 /2040 po 1640
Triamcinolone 5
4 4 /50(Suspension )
po 840 high Dexamethasone
30 0.75 0.75
/2.510 po 1.59


iv 510 Betamethasone
30 0.6
0.5 po 16
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Therapeutic principles use ample
dose at the begin,after control symptom,to
reduce according with the state of illness
acute allergic diseasereduce dose quickly
stop

self-immunologic diseasereduce slowly?sustain
long term and excessive dose Glucocorticoids
side effects (infection?gastric and duodenal
ulcer ? osteoporosis?diabetes?hypertension?psychia
tric disturbance? cataract)
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antibiotics
staphylococcus?streptococcus?spirochete
infection penicillins?cephalosporins?erythromy
cin Mycobacterium and G- bacilli
infection streptomycin?aminoglycoside
s Propionibacterium acnes infection
tetracyclines?chloramphenicol or lincosamides
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• antivirals
• acyclovir
• 200mg,q4h5,710d
• valaciclovir
• 300mg,Bid 7 10d
• ribavirin
• 1015 mg/kg/d,im or iv gtt
• interferon
• Interferon inducerPolyinosinic-polytidylin Acid

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antifungals 1. griseofulvin
adult 0.6-0.8 g/d griseofulvin
child 15-20mg/kg/d,tinea capitis 2. polyene
nystatin used for treatment of
intestinal candidiasis
2,000,000unit/d,tid-qid,
child 50,000-100,000unit/kg
nystatin
suspensionnystatin1,000,000unit,
glycerol 10ml,water adding
to 100ml amphotericinB systemic
mycoses,such as candidosis,
cryptococcosis, chromomycosis
3.5-fluorocytosine,5-Fc
candidosis, cryptococcosis, chromomycosis
sporotrichosis

50-150mg/kg/d,divided for 8 times
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• 4.Azoles
• ketoconazole 200-400mg,q.d
• fluconazole 150mg/w x12-16w(onychomycosis
  )
• itroconazole 0.2 Bid x7d,
• 1 week per month
  for 3-4m(onychomycosis)
• 5.Allylamines
• terbinafine onychomycosis
  250mg,q.d x7,q.o.d x7-11w
• tinea coporis or cruris 250mg,q.d x7

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• Vitamines
• 1. vitaminC
• 2. vitamineA
• 3. retinoic acid
• inhibit cell division and cebaceous gland
  excretion
• inhibit tumour growth?keratolytic action
• isotretinion(13-cis-retinoic acid?Isotretinoin
  Capsules)
• acne
• etretinate(Tigason,New -Tigason )
• psoriasis? Pityriasis rubra pilaris
• 4.VitE

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immunosuppressive agent 1.
methotrexate,MTX inhibit
lymphocyte and epithelium division
psopriasis?dermamycosis? Pityriasis rubra
pilaris, 2.5mg q12h x3 ,for
7-10 d 2. cyclophosphamide 3. azathioprine 4.
chloroquine,Hydroxychloroquine, 0.2Bid
SLE ?Polymorphous Light Eruption ?lichen
planus 5. cyclosporine 6. tacrolimus
0.03o.4cream ext eczema
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others 1. Ca and
hypo 2. procaine 3. diamino-diphenyl
Sulfone,D.D.S. 50mg
Bid-Tid 4. zine sulphate 5. Tripterygium
wilfordii Hook 6. intravenous immunoglobulin,IVIg
0.4g/kg/d35d
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Topical Therapy
1 topical agents
2 formulation
3 therapy principle
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Topical agents ?
classification action
drug concentration() smooth agents
reduce friction calamine
10-15 avoid
stimulation talc
10-70
zinc oxide
20-50 antimycotics kill or inhibition
sulphur 510

Glacial Acetic Acid 5--30

benzonic acid 6--12

salicylic acid 5--10

clotrimazole 2---3

Miconazole 2

Terbinafine 1 antiseptics
kill or inhibition boracic acid
3---4
potassium permanganate
1/2000-1/5000
Neomycin
0.5-1
revanol
0.1
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Topical agents ?
classification action
drug concentration()
antipruritics narcotism?cool
1---5
dimimish inflammation mint
0.2-3 stop itchness

carbolic acid 1---2

bendazolecain 3---5
dexamethasone
0.025
triamcinolone
0.025 keratoplastics promote normal keratosis
pityrol 3---5
shrink blood vessel coal tar
5--40 reduce
effusion and resorcinol 2---5
inflammatory infiltration
salicylic acid 3
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Topical agents ?
classification action drug
concentration()
keratolytics hyperkeratosis
salicylic acid 6--15
make keratinocytes loose
resorcinol 6--15
separate and fall off Glacial Acetic
Acid 10-30
urea
20-40 Canstic remove
granulation tissue carbolic acid
pure and neoplasm
Glacial Acetic Acid gt30

salicylic acid gt20

trichloroaceticacid gt30 sunscreen
agents absorb or prevent Titanium dioxide
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ultraviolet radiation depigment agents reduce
pigmentation Hydroquinone 3

Azelaic Acid 20
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Formulation ?
Dosage form component action
indications powder
drug put into
protection?cooling acute and subacute
zinc oxide , talc
astringency inflammation but
no

effusion solution liquid and
soluble drug cooling?reduce
acute inflammation
reduce
inflammation
clear
raw surface with lots of effusion
lotion powder and liquid
protection?cooling acute and subacute
mixture
reduce inflammation inflammation without

astringency
effusion cream consisting
of aqueous protection?lubrication
subacute or chronic and oily
components intenerate crust

O/W emulsion being readiy reduce inflammation
inflammation ,pruritus
diluted with water,W/O emulsion
with oil
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Formulation ?

• Gel Propanediol gelatin same as cream
  same as cream
• of organic polymer
• drug

Dosage form component action
indications
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Fomulation ?
dosage form component action
indications
Paste cream including
protection?astringency subacute
inflammation, 25-50 powder
intenerate crust scar,erosion

diminish inflammation ointment vehicle with
vaseline strong action of
chronic inflammation or lanolin
lubrication?penetration
ulcer
intenerate crust tincture resolve
or steep diminish inflammation
chronic inflammation drug by
alcohol
sterilization
antipruritic
pruritus
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Fomulation ?

• Plastics organic menstruum
  protection chronic
  
• and aqueous solution
  strong percutaneous inflammation
• contain macromolecule
  strong percutaneous
• compound or film agent
  action

dosage form component
action indications
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therapeutic principle
1.choice right drugs 2.Principles of
formulation acute lesion
more effusion--solution(hydropathic compress)
no
effusion--powder?lotion subacute
lesion effusion--paste
no effusion--power?lotion?cream
chronic lesion cream
?ointment?tincture?plastics
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3.attentions a.concentration
b.peri-oral cavity
c.make right use of
drug d.irritation and allergic
reaction
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Physical Therapy(1)

• Electrosurgery
• electrodesiccation
• coagulation
• electrocautery
• phototherapy
• infrared
• ultraviolet
• PUVA
• laser treatment

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Physical Therapy(2)

• cryosurgery
• hydrotherapy
• radiotherapy

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Dermatological Surgery

• Dermabrasion(surgical skin planing)
• Excision
• Hair transplantation
• epidermal transplantation vitiligo