Dermatotherapy modalities used in dermatology

The presentation summarizes the different types of treatment modalities used in dermatology.

1. DERMATOTHERAPY DR : Esam H. Imam

2. General principles for topical formulations There are reduced side effects and toxicity to other organs compared to systemic medications .

3. Quantity of topical formulations How much topical medication to prescribe can challenge the most experienced dermatologist. It depends on: The vehicle act physically as bases to carry the active drug The thickness of the application The total area to be treated The frequency of the application The duration of the treatment course .

4. Vehicles 

5. How does the nature of the dermatosis influence choice of topical formulation? For wet or oozy skin conditions — creams , lotions, and drying pastes are most suitable. For dry, scaly skin conditions — ointments and oils are appropriate. For inflamed skin — use wet compresses and soaks followed by creams or ointments. Cracks and sores — treat with bland applications; avoid alcohol and acidic preparations.

6. How does the site of the skin problem influence choice of topical formulation? Palms and soles — an ointment or cream may be preferred. Skin folds — use a cream or a lotion (ointments are too occlusive for these sites) . Hairy areas — a lotion, solution, gel, or foam is usually best. Mucosal surfaces — take care ---you have to prescribe non-irritating formulations to avoid irritating eroded surfaces.

7. How does a topical steroid work ? The effects of topical steroid on various cells in the skin are: Anti-inflammatory . Immunosuppressive Anti-proliferative Vasoconstrictive .

8. The potency of topical steroid The potency of a topical steroid depends on: The specific molecule The amount that reaches the target cell Absorption through the skin (0.25%–3%) Vehicles.

9. WHEN WE USE SUPER HIGH AND LOW CORTICOSTEROID Low-potency steroids are the safest agents for long-term use, on large surface areas, on the face or areas of the body with thinner skin, and on children . More potent agents are beneficial for severe diseases and for areas of the body where the skin is thicker, such as the palms and bottoms of the feet.

10. Side effects of topical steroid ? Cutaneous side effects Local side effects may arise when a potent topical steroid is applied daily for long periods of time (months). Most reports of side effects describe prolonged use of an unnecessarily potent topical steroid for inappropriate indications. Skin atrophy Stretch marks ( striae ) in armpits or groin Easy bruising ( senile/solar purpura ) and tearing of the skin Enlarged blood vessels( telangiectasia ) Hypertrichosis Hypopigmentation. Systemic side effect not common (cuhing syndrome, hypertension , hyperglycemia ) .

11. How much topical steroid we use 1 One finger tip unit(1 Ftu )

12. Estimating topical steroid

13. CON -ESTMITIN G TOPICAL STEROID One Finger tip unit (0.5 grams) = 2% BSA ( 2palmar surfaces) 0.5 grams x 2 times per day = 1 gram (30g per month) 2%BSA=30g

14. Rule of nine

15. What is phototherapy? Phototherapy , also known as light therapy, is a common form of treatment that uses bright, ultraviolet ( UV-A or UV-B) lights on your exposed  skin . Phototherapy can treat several types of skin conditions, including psoriasis and eczema.

16. What are the types of ultraviolet light? There are different types of ultraviolet light for medical procedures based on the type of ultraviolet and the size of the wavelength: UV-B : Ultraviolet light B (UVB) has a medium wavelength that reaches the top layer of your skin. Overexposure to UVB light can cause  sunburns . Narrow band ( UV-B) UV-A : Ultraviolet light A has a long wavelength that reaches the first two layers of your skin and treats conditions that affect these deeper regions of the skin. Overexposure to UVA light can cause sunburn and wrinkles . PUVA is an acronym for  psoralen plus ultraviolet-A radiation

17. side effects of phototherapy:  Skin redness that fades within 24 hours ,  Burns or blisters similar to a sunburn ,  Dry skin , eye damage, skin aging and cancer.

18. mohs micrographic surgery : What is the process of Mohs surgery? This surgery involves cutting away thin layers of skin. Each thin layer is looked at closely for signs of cancer( eg . melanomas,SCCs and BCCs). The process keeps going until there are no signs of cancer. The goal of Mohs surgery is to remove all of the skin cancer without hurting the healthy skin around it. For maximum cosmetic result(facial cancers) .

19. Cryotherapy Cryotherapy is a treatment where your healthcare provider applies extreme cold to freeze and destroy abnormal tissue. To create this severe cold, your provider will use a substance like liquid nitrogen or argon gas . Indication : warts , Seborrheic keratosis , Actinic keratosis . Side effect of Cryotherapy : Pain . Nerve damage resulting in loss of feeling. Swelling, scarring and skin infection.

20. thanks