DRUGS USED IN SKIN DISORDERS:MR. ABDOU MARAM PANNEH

(RM ,FWACN,NT, RN)

INTRODUCTION:The skin is subjected to a very wide range of lesions.Some may be characteristics of specific systemic diseases

which may fade as the disease regresses.Some are caused by specific local infections and are best

treated by appropriate antimicrobials.The skin is also subjected to damage from environmental

hazards.Skin disorders may occur as a result of side-effects of

therapeutic and other agents, ranging from mild hypersensitivity reaction to life-threatening toxic epidermal necrolysis.

There also remains a wide range of skin disorders whose aetiology is poorly understood.

The distribution and morphological description of skin lesions (shape, colour and surface characteristics) are important in the diagnosis of skin dosorders.

INTRODUCTIONGENERAL CHARACTERISTICS OF DRUGS USED

IN SKIN DISORDERS:Most of them are effective against one type of

parasite.Many are discovered by chanceSome are highly toxic to human beings.Treatment must be repeated in many cases

because of possible re-infection. Each type of parasite have a specific drug of choice and it might not be necessary to give two or if the diagnose is accurate.

Pregnancy and gastric PUD are contra-indicated for most of them.

TREMINOLOGIES USED IN SKIN DISORDERS:- .ABCESS:- a collection of pus in a cavityALOPECIA:- hair loss or baldness from hereditary, aging,

disease, thyroid, etcBULLA or BLISTER:_ a fluid-filled circumscribed lesionCOMELO:_ a plug of keratin and sebumERYTHEMA:_ a red coloration due to vascular dilatation.FISSURE:_ a slit through the whole thickness of the skin.KERATOSIS:_ a horny thickening of the skinHORN:_ thickening of the skin that is above the skin surfaceIMPETIGO:- isolated pustles that are ruptured.MACULE:- a texture with no elevation above the surface

area of the skin.NODULE:_ a dome-shaped solid lesion of more than 0.5cm in

diameter & shape.

TREMINOLOGIES USED IN SKIN DISORDERS:-FURUNCLOSIS:- is a boilCARBUNCLES:- is inflammation of the skin and

deeper tissue that may be painful and discharges pus

PAPULE:- a firm area like pimplesPAPILOMA- a nipple-like massPUSTLE:- a macule of pus in the skin. PLAQUE:- a raised, flat-topped circumscribed lesion

of more than 2cm in diameter.PURPURA:- a macule of blood in the skinSCALE:- a flat plate or flake of stratum corneum.VESSICLE:- a fluid-filled circumscribed lesion less

than 0.5cm in diameter.

TYPE OF DRUGS USED IN SKIN DISORDERS1. TOPICAL PREPARATIONS:These are medications that are applied on the

surface area of the skin. These include:-A. EMOLLIENTS:These are preparations that soothe, smoothen and

hydrate the skin. They are indicated for all skin types of scaling and dry skin disorders such as : Napkin Rash, Extra Dry skins,

Pressure Sores and ecezematous conditions.(eg;- dry or weeping ecezema)

COMMON DRUGS USED:-Zinc CreamZinc+Castor oil CreamSudocremE45 Cream

TYPE OF DRUGS USED IN SKIN DISORDERSB. DUSTING POWDERS:-These are used in the treatment of Heat Rash, Pruritis and Prickly HeatDRUGS USED:-

Talc dusting powdersSalvatis powderMentholated dusting powderDettol dusting powders

C. TOPICAL ANTIHISTAMINES:-These products are used in the treatment of Insect Bites which

are stings causing allergic reaction or nettle rash on the skin.DRUGS COMMONLY USED:-

Anthisan cream (mepyramine maleate 2%)Histergan (chloepheneramine maleate)Chlopheneramine (Piriton) 2mg, 4mg tabsPromethazine (Phenergan) 25mg, 59mg tabs.

TYPE OF DRUGS USED IN SKIN DISORDERSD. TOPICAL CORTICOSTERIODS:-

These preparations are used in the treatment of inflammatory skin disorders apart from those due to infections.

They only suppress the inflammatory reaction but are not necessarily for curative.

Therefore, when treatment is discontinued, a rebound recurrence may appear.

DRUGS COMMONLY USED:-I Hydrocortison Esters:- Canestern Cream

(hydrocortisone+Clotrimazole)- Daktacort (hydrocortisone+miconazole)- Fucidine++ (hydrocortisone+fusidic acid). 

TYPE OF DRUGS USED IN SKIN DISORDERSD. TOPICAL CORTICOSTERIODS Cont’d:-II. Betamethasone Esters:

Betnovate Cream (Betamethasone)Betnovate-N Cream

(betamethasone+neomycin)Diprosone Cream (betamethasone)Diprosalic Cream ( betamethasone)

III. Clobetasone Esters:-Dermovate Cream - Lemonvate

CreamMovate Cream - Top Tone creamCivic Cream

TYPE OF DRUGS USED IN SKIN DISORDERS2. PREPARATIONS FOR PRURITISPruritis is a systemic disease usually due to

drug hypersensitivity, obstructive jaundice or an endocrine disease. It can be as a result of skin disorders such as Acne, Psoriasis, Eczema, Scabies or Ring Worm.

DRUGS COMMONLY USED:-Calamine Lotion - DermidexCrotamiton (Eurax) Cream - Anthisan

plus

TYPE OF DRUGS USED IN SKIN DISORDERS3. PREPARATIONS FOR ACNEAcne are small raised multiple deposits of fat on the body and

appearing more commonly on the face. This can be Mild, Moderate or Severe.

DRUGS COMMONLY USED:-i. Topical application.- Benzyl Benzoate lotion - Salicyclic acid ointment

(Medisalic)- Benzyl Peroxide lotion - Sulphur ointmentII. topical Antibiotics:-

Tetracycline Ointment - Dalacin-T lotion

Clindamycin (Dalacin) ointment - Gentamycin ointment

Neomycin ointment

TYPE OF DRUGS USED IN SKIN DISORDERS

3. PREPARATIONS FOR ACNE Cont’d…III. Topical Antibiotics

Tetracycline caps 250mg, 500mgCotrmoxazole tabs/ syrup 120/40mg,

240/80mgErythromycin tabs/syrup 125mg, 250mg,

500mgDoxycycline tabs/caps 50mg, 100mgOxytetracycline caps, Sebomin

(Minocycline)caps, Dalacin-C caps, etc.

TYPE OF DRUGS USED IN SKIN DISORDERS

4. PREPARATIONS FOR ECZEMA AND PSORIASIS.ECZEMA is a subcutaneous reaction characterized by

inflammation and itching.Types of Eczema:

Dry eczema- fissured, scaly lesionsWeeping – discharging and itchy

Eczema can also be classified as Mild, Moderate or Severe. PSORIASIS is a condition characterized by epidermal

thickening or scaling. It commonly affects the scalp. DRUGS COMMONLY USED:The treatment is usually a combination of a topical steroid

and an antibiotic agent. EXAMPLES:-

Betnovate-C cream (Betamethasone 1% + Clioquinol 3%) Betnovate-N (Betamethasone+Neomycin) Ketocanazole cream + tabs (Nizoral, Micozal, Nizole) Coal Tar , Potassium Permanganate, Salicylic Acid, Sulphur OintmentB-tex Lotion (Salicyclic Acid), Zinc Paste.

TYPE OF DRUGS USED IN SKIN DISORDERS

5. PREPARATIONS FOR WARTS & CALLUSES: Warts and Calluses are sort of lesions present in several

forms and can affect all skin sites but more frequently on the hands, feet and anogenital areas.

Warts on the soles of feet are called VARRUCAS.Anogenital warts are called CONDYLOMATA ACUMINATA.Warts are usually self-limiting and therefore, there is no

specific treatment for human papiloma virus yet.The treatment relies on some form of local tissue

destruction. DRUGS COMMONLY USED:-

Salicyclic acid cream or lotion - ImiquimodPodophyllum resin lotion - Bazuka

lotion (salicylic acid 40%)Plouracil

TYPE OF DRUGS USED IN SKIN DISORDERS

6. PREPARATIONS FOR MINOR CUTS:These are substances used for dressing of wounds. EXAMPLES

Magnesium Sulphate paste or solution Sodium chlorideBetadine ointment or solution Dettol liquidBenzyl peroxide Savlon solutionHydrogen peroxide -Iodine tinctureSurgical Spirit

TYPE OF DRUGS USED IN SKIN DISORDERS7. MYCOSIS ( Fungal infection ).Many common mycotic infections are superficial and

only involve skin (cutaneous mycosis), but fungi may also penetrate the skin, causing subcutaneous infections, the fungal infections that are most difficult to treat are the systemic mycosis.

They are usually found in the soil, human and animals.

They are active in hot, humid and unhygienic conditions.

Fungi may be classified as Yeast or Moulds according to the appearance and means of growth.

Yeast-like fungi causes infections such as Candida and Hisplasma capsulatum.

Pathogenic moulds fungi cause infections such as Aspergillus.

TYPE OF DRUGS USED IN SKIN DISORDERSFungal infection may be classified into two:-

Superficial :- affecting nails, skin, hair or mucous membrane

Systemic: - affecting the whole body which may be related to immunocompromised individuals as those with AIDS.

They can also be classified according to the body site affected commonly called TINEA.

Examples:-Tinea Capitis (scalp)Tinea Barbea (beard)Tinea Corporis (body)Tinea Cruris (groin)Tinea Manuum (hand)Tinea Pedis / Athletes Foot (feet)Tinea Unguium (nail)

TYPE OF DRUGS USED IN SKIN DISORDERSANTI-FUNGAL DRUGS COMMONLY USED:i) DRUGS FOR SUBCUTANEOUS AND SYSTEMIC MYCOSES:

Amphotericin B Caspofungin Fluconazole 50mg, 150mg tabs /Cream Flucytosine Itraconazole tabs/cream Voriconazole

 II) DRUGS FOR CUTANEOUS MYCOSIS:

Clotrimazole cream Econazole cream Griseofulvin 125mg, 250mg, 500mg tabs Miconazole cream Nystatin 100,000iu pessaries, drop, tabs Ketoconazole 200mg tabs, Cream.

TYPE OF DRUGS USED IN SKIN DISORDERSIII) AMPHOTERICIN BIs either fungicidal or fungistatic, depending on the organism

and the concentration of the drug.Administration: IV, Intrathecal.ADR: Fever, chills, renal impairment, hypotension, anemia,

neurologic problems (intrathecal), thromboflevitis. IV) THE AZOLESAzoles are predominantly fungistatic.Inhibition of ergosterol synthesis disrupts membrane function

and increases permeability.Itraconazole has largely replaced to ketoconazole.Only administered orally, requires gastric acid for dissolution.Effective in histoplasmosis in lung, bone, skin anf soft tissues.The drug does not enter the CSF.ADR: Nausea, anorexia, diarrhea, gynecomastia, decreased

libido, impotence, menstrual irregularities, hepatitis, can cause fatal hepatotoxicity.

TYPE OF DRUGS USED IN SKIN DISORDERS

Fluconazole 50mg, 150mg tabs, pessaries or tabsDrug of choice in cryptococcus neoformans, for

candidemia and coccidioidomycosis.Administered orally or IV.Azole family, Mechanism of action=ketoconazol.Lack of the endocrine side effects of

ketoconazole, excellent penetrability into the CSF.

Nystatin 100,000iu drops, tabsIts use is restricted to topical treatment of

candida infections (oral agent)Its use is restricted to topical treatment of

candida infections (oral agent)

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