SURYOSUTANTO Depart.

of Pharmacology & Therapy Medical Faculty Padjadjaran University

DERMATOLOGICAL PHARMACOLOGY The essensial function of skin : protection thermoregulation immune responsiveness biochemical synthesis sensory detection social and sexual communication

Therapy to correct dysfunction in any of these activities may be delivered:

systemically. intralesionally topically depend on understanding the barrier function of the skin, primarily within the stratum corneum. ultraviolet radiation

Corticosteroids and retinoids are important

systemic and topical therapeutic agents for skin disease. Antibacterial, antiviral and antifungal agents are employed widely both oral antimalarial, chemotherapeutic and immunosupressive agents, dapsone, and antihistamine, frequently are used for treatment of dermatological diseases.

Calcipotrien, a vitamine D analog, and anthraline are mayor topical agents for psoriasis. Ultraviolet radiation therapy is frequent mode Of treatment for psoriasis, independently or combination with drugs such as psoralens or coaltar The prophylactic use of sunscreens may reduce or prevent premalignant or malignant skin lesions induce by UV light.

General Guidelines for Topical Therapy

1. Regional Anatomic Variation
- Drug penetration higher on the face, intertriginous area, and especially in the perineum. - Sensitization, irritation, and atropy from steroidare more likely to develop in these regions.

2. Altered Barrier Function

- psoriasis Str. corneum is abnormal barrier function is lost topical absorption is increased systemic toxicity.

3. Hydration
- drug absorption is increased - produce by inhibiting transepidermal loss of water, (occlusion with an impermeable film, application of lipophilic oclusive vehicle such as oinment)

4. Vechicle
- acute inflamation aqueous drying preparation - chronic inflamation hydrating preparations. - soaks acute moist eruptions

- Lotions (powder in water suspension) and

solutions (medications dissolve in a solvent) for hairy and intertriginous areas. - Creams or oil inwater emulsions are absorbable and are the most cosmetically acceptable. - Ointments, water in oil emulsions are the most effective hydrating agents scally eruption. - Multiple creams and oinments without active drug are marketed as moisturizing agents.

5. Age 6. apllication frequency

Topical Glucocorticoids
Therapeutic Uses: inflamatory skin diseases twice a day application is sufficient hydrocortison is the most potent steroid used on the face or in occluded areas (axilla or groin) tachyphylaxis can occur. intralesional injection : triamcinolone scalp allopecia, panniculitis, psoriasis, discoid lupus and inflamed cysts.

Toxicity and Monitoring - skin atrophy, striae, teleangiectasias purpura, acneiform eruptions, perioral dermatitis, overgrowth of skm fungus and bacteria, hypopigmentation in pigmented skin, and rosacea. - factors that increase systemic absorption : the amount of the steroid applied, the extent of the area treated, the frequency of application, the length of treatment, the potency of the drug and the use of occlusion. - intralesional glucocorticoids can cause cutaneous atrophy and hypopigmentation

Systemic Glucocorticoids
Therapeutic uses: A. Require long-term therapy: - Bullous diseases:- pemphigus vulgaris - herpes gestationis. - Collagn Vascular Diseases : - S.L.E. - vasculitis - Sarcoidosis - Sweets disease - Pyoderma gangrenosum - Type l reactive leprosy

B. Respond to short-term therapy : - Contact dermatitis (acute) - Atopic dermatitis - Lichen planus - Exfoliative dermatitis - Erythema nodosum C. Respond to low-dose bedtime therapy : - Acne - Hirsuitisme D. Steroid therapy controversial - Toxic epidermal necrolysis - Erythema multiforme - Cutaneous T - Cell lymphoma - Discoid L.E.

Toxicity and Monitoring Short-term use: > psychiatric problems, cataracts,myopathy, avascular necrosis, hypertension. Withdrawl syndrome : - transient arthralgias, myalgias, joint effusions

- Isotretinoin ( I ) - Etetrinate ( E) - Tretinoin (T) Mayor Retinoid-Responsive Skin Diseasea Acne 1,(T) Disorders of keratinization I,E,(T) Skin cancer I,E Precancereous T,E,(I) Psoriass E Cutaneous aging T

TOPICAL ANTIPSORIASIS DRUGS - Calcipotriene

- Anthralin
PHOTOCHEMOTHERAPY 1. PROSALEN 2. BERGAPTEN 3. METHOXALEN 4. TRIOXALEN

Therapeutic Uses: vitiligo psoriasis PUVA also is employed in the treatment of: - cutaneous T-Cell lymphoma atopic dermatitis - alopecia areata - lichen planus

Sunscreens are topical agents that reduce the amount of ultraviolet radiation reaching the Skin or block it altogether.

I.

Physical 3 Sunscreen :

This sunscreen contain large particulate ingredients that reflect and scatter UVA, UVB, and visible light. These ingredients include :

- Titanium dioxide - Talc - magnesium oxide zinc oxide kaolin ferric chloride Ichthamnol

II. Chemical sunscreens.

Protection against UVB is more effective, than Protection against UVA. - p-ammobenzoic acid esters - cinnamates effective UVB - salicylates - benzophenones - anthranilates - avobenzone blocking

effective UVA blocking

- Minoxidil Stimulating hair growth.

- Keratolytic agent : - lactid acid - glycolic acid - salcylic acid. -Destructive agents: - Podophyllin
- Trichloroacetic acid

- Hydroquinone HYPERPIGMENTATION - Capsaicin relief of post herpetic neuralgia (R/ : ZOSTRIC, ZOSTRIC HP) - Masoprocol Th/ ACTINIC KERATOSIS - Colchicine PMN leukocytes are part of the pathogenesis of the disease - Gold Pemphigus vulgaris and cutaneous LE