Therapy

Seborrheic diseases.
Role of local therapy in
dermatology.
Dr.med.habil. István Juhász
Univ. of Debrecen, Med. and Health. Sci. Ctr., Burn Dermatosurgery Unit, Dept. of Dermatology
Dentistry Branch, Department of Human Surgery and Operative
Techniques
Pilosebaceus unit
• Glicerid – free fatty
acids, wax, sterol esther,
squalens,colesterolesther, cholesterol
Infundibulum
• Bacterial lipases- free
fatty acids
• Asteatosis = sebostasis
• Seborrhoea
• Scalp skin, face, ears,
skin of chest and back
• Hormonal influences
Sebaceus gland – holocrine – sebum production
Seborrhoea
• Post adolescent period,
bw 18-25 yrs of age,
elderly
• Genetic factors
• Oily, shiny, greasy facial
skin
• Oily, flaky desquamation
• Greasy, sweating, wet hair
• Hairy scalp – pityriasis simplex
• Testosterone () – estrogen /hypophysis ()
• Emotional factors, role of diet (±)
Comedo
• Horny plug obstructing
the opening of sebaceus
gland
• Blackhead (Open
comedo)
• Whitehead (Closed
comedo, retention cyst)
• Giant comedo
Comedo
• Comedo extractor
• Scar after removed
comedones:
atrophodermia
vermiculata
Seborrhoea
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Therapy:
Alcohol containing lotions, detergents - adstringents
Benzoyl- peroxide
Local retinoid treatment (Adapalene, Retinoic acid
derivates)
• 13-cis-retinoic acid (Roaccutane)
• Antiandrogenic th: progesterone (ciproteron-acetate/CPA
–- Diane 35) with or without etidinilestradiol (Androcur)
Seborrhoea capitis
Hairy scalp:
Regular use of medicated
shampoo:
Adstringents:
Triclosan,
Zn-pirithion,
Coal tar derivates,
Most severe cases:
Salicylic acid-steroid
containing lotions
(Diprosalic, Locoid crelo)
Nizoral (local antimykotic)
Rosacea
• Centrofacial
• papules,
• pustules,
• teleangiectasias
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Bw 40-50 years of age
Genetic factors
Gastrointestinal problems, cholecystopathy, alcohol abuse
I.) Persistant erythema – erythrosis faciei
II.) Papulopustulous rosacea
III.) Plaques, nodi, hypertrophy
Blepharitis, iritis, iridocyclitis
Rosacea
• Therapy
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Oral Tetracyclin (Doxycyclin) or Metronidazol (Klion)
Isotretinoin (Roaccutan) p.os
Stop irritating local therapy (cleansing w. distilled water)
Local Klion, Erythromycine
Sun protection
Rosacea - Rhinophyma
• Diffuse connective
tissue and
sebaceous gland
hyperplasia
(extreme grade)
• Overgrowing
sebaceous glands
• Chin –
gnathophyma
• Th: dermabrasion
Perioral dermatitis
• Chronic rosacea-like dermatosis
• Common recurrences
• Perioral localisation, may extend to
glabellar region
• Young female pts.
• Unknown ethiology
• Intolerance towards cosmetics
• UV provocation
• Halogen dermatosis (toothpaste,
mouthwash, fluorinated steroids)
• Follicular papules, without comedones
Acne vulgaris
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Very common, adolescence , adulthood 
Both sexes are involved, boys more often,
Seborrhoeic diathesis
Sebum – free fatty acids – chemotaxis –
inflammation – closure of follicle openings – pus
retention
• Propionobacterium acnes, staphylococcus
epidermidis
• Androgen receptors on the cells of the
sebaceous gland
Acne comedonica
Acne papulopustulosa
Acne cystica
Acne conglobata
• Infiltrated painful nodules,
cysts
• Liquification
• Formation of trabecules
• Acne indurata
• Therapy
• Skin cleansing, comedo
extraction,
• Roaccutane 12-16 weeks
(0,2- 1 mg / tskg)
• Antiandrogenic th.
Acne therapy
Acne inversa
• Acne tetrad, acne triad
• Acne conglobata
• Hidradenitis suppurativa
• Perifolliculitis: neck, scalp
• Sinus pilonidalis
Acne keloidica
Dermatological therapy
Local therapy
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paste
warm compress
film
cold (wet) pack
patch
powder
water base lotion
alcohol base lotion
shake lotion
cream
ointment
Systhemic therapy
Depth
of
effect
Shake lotion
liquid
powder
(air ) foam
emulsion
paste
cream
ointment
Basic principles of dermatologic local therapy
• Testing tolerability: apply first only vehicle, next step: add active
ingredient
• Least sensitizing local agents, in low number of combinations
• External agents according to greasiness of skin
• Promoting penetration with detergents: DMSO (disulphide
bonds, reorganization of str. corneum and collagen fibers)
• Comparative treatment of bilateral body parts
• Oozing skin lesions: compress / cream
• Squama, crust: compress , fatty cream
• Acute inflammation: closed bandage, lotion
– magistral (prepared in pharmacy)
– FoNo (collection of standard recipes) – drug company manufactured
Important active agents used in dermatological
local therapy
• Anti-inflammatory: protein inactivation, adstringent, desinfectant
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metallic salts, Al, Pb, Zn, Hg, albumin binds metal  denaturation,
Ung. Refrigerans FoNo; Ung alum. Acetici tart. FoNo; Tabl Burofix
Ac. Tannicum (tannic acid )
Coal tar derivates (2 - 3% in cream)
• Steroid anti inflammatory drugs
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corticosteroids - sterane scaffold
enhancing its effect: butyrate - pivalate - acetonide - etc. chains
10-fold increase: halogenating (fluoride, chloride)
vehicle format: lotion, cream, ointment
side-effects: pyogenic and mycotic infections, skin atrophy,
purpuras, absorption: general symptoms (pediatry!)
– Hydrocortison, Locoid, Dermovate, Synalar, Flucinar, Ftorocort,
Locacorten, Cutivate,...