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Therapy of Dermatology. l Systemic therapy l Topical therapy.

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Presentation on theme: "Therapy of Dermatology. l Systemic therapy l Topical therapy."— Presentation transcript:

1 Therapy of Dermatology

2 l Systemic therapy l Topical therapy

3 1.antihistaminies 2.corticosteroids 3.antibiotics 4.antivirals 5.antifungals 6.Vitamines 7.immunosuppressive agent 8.others Systemic therapy

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

5 1 . H1 antihitamines : CH2-CH2-N< 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-effects : dizziness 、 hypersomnia 、 hypodynamia 、 dryness of the mouth 、 seldom liver or kidney damage, allergic reaction 。

6 1.chlorpheniramine 4mg , tid po 10mg , qd-bid im hypersomnia 2.diphenhydramine 25-50mg , tid po hypersomnia, careful to glaucoma 20mg , qd-bid im anemia may be for 6 months 3. doxepin 25mg , qd po hypersomnia,dryness of mouth, not use to glaucome 、 pregnant women, children 4. cyproheptadine 2-4mg , tid po hypersomnia , Contraindications : glaucoma H1 antagonist dose(adult) route of administration side -effects First-generation H1 antihistamines

7 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 肝肾功能减退者 7.ketotifen 1mg , bid po sedative 、 hypersomnia dizziness, dryness of the mouth

8 astemizole 24h 3mg,tid po nearly no hypersomnia , careful to pregnant women, must not be 10mg,qd coadministered with macrolidantibiotics,imidazole antifungals terfenadine 12-24h 60mg , bid po nearly no hypersomnia , avoid to be coadministered with erythromycin and imidazole untifungals loratadine 18-24h 10mg , qd po nearly no hypersomnia H1 antagonist time dose route of administration side-effects Second-generation H1 antihistamines

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

10 2 . H2 antihistamines : contract vessel 、 ↓inflammation 、 inhibit gastric juice excretion cimetidine 0.2 qid ranitidine 150mg bid

11 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 。 glucocorticoids

12 2 immunosuppressive : l l inhibit factors release after Ag-Ab combination l l make lymphoid tissue atrophy 、 accelerate lymphocyte destruction l l reduce the reaction of hypersensitive lymphocytes and Ag 3 antitoxic : alleviate cell injury of toxic 4 anti-shock : alleviate angiospasm , improve microcirculation

13 low Hydrocortisone 1 20 /25—100 iv 100—400 Medium Prednisone 3.5 5 5 po 10—60 prednisolone 4 5 5 /5—25 ( Suspension ) po 10—60 Methyprednisone 5 4 4 /20—40 po 16—40 Triamcinolone 5 4 4 /50 ( Suspension ) po 8—40 high Dexamethasone 30 0.75 0.75 /2.5—10 po 1.5—9 iv 5—10 Betamethasone 30 0.6 0.5 po 1—6 name anti-inflammation equivalent dose troche/injection dose mg mg mg/d name anti-inflammation equivalent dose troche/injection dose mg mg mg/d Glucocorticoid in common use

14 Therapeutic principles : use ample dose at the begin , after control symptom , to reduce according with the state of illness acute allergic disease : reduce dose quickly stop self-immunologic disease : reduce slowly→sustain long term and excessive dose Glucocorticoids side effects ( infection 、 gastric and duodenal ulcer 、 osteoporosis 、 diabetes 、 hypertension 、 psychiatric disturbance 、 cataract )

15 antibiotics : staphylococcus ﹑ streptococcus ﹑ spirochete infection: penicillins ﹑ cephalosporins ﹑ erythromycin Mycobacterium and G - bacilli infection : streptomycin ﹑ aminoglycosides Propionibacterium acnes infection : tetracyclines ﹑ chloramphenicol or lincosamides

16 antivirals: acyclovir 200mg , q4h×5 , 7 ~ 10d valaciclovir 300mg , Bid ×7 ~ 10d ribavirin 10~15 mg/kg/d , im or iv gtt interferon Interferon inducer : Polyinosinic-polytidylin Acid

17 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 suspension : nystatin1,000,000unit, 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

18 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

19 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

20 immunosuppressive agent 1 . m ethotrexate,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 0.03~o.4%cream ext eczema

21 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/d×3 ~ 5d

22 Topical Therapy 1 topical agents 2 formulation 3 therapy principle

23 Topical agents Ⅰ 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 5—10 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

24 Topical agents Ⅱ 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

25 Topical agents Ⅲ 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 >30 salicylic acid >20 trichloroaceticacid >30 sunscreen agents absorb or prevent Titanium dioxide 5 ultraviolet radiation depigment agents reduce pigmentation Hydroquinone 3 Azelaic Acid 20

26 Formulation Ⅰ 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

27 Formulation Ⅰ Gel Propanediol gelatin same as cream same as cream of organic polymer + drug Dosage form component action indications

28 dosage form component action indications Fomulation Ⅱ 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

29 Plastics organic menstruum protection chronic and aqueous solution strong percutaneous inflammation contain macromolecule strong percutaneous compound or film agent action Fomulation Ⅱ dosage form component action indications

30 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

31 3.attentions: a.concentration b.peri-oral cavity c.make right use of drug d.irritation and allergic reaction

32 Physical Therapy(1) Electrosurgery Electrosurgery electrodesiccation electrodesiccation coagulation coagulation electrocautery electrocautery l phototherapy infrared infrared ultraviolet ultraviolet PUVA PUVA laser treatment laser treatment

33 Physical Therapy(2) l cryosurgery l hydrotherapy l radiotherapy

34 Dermatological Surgery l Dermabrasion(surgical skin planing) l Excision l Hair transplantation l epidermal transplantation: vitiligo


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