1 / 34

Therapy of Dermatology

Therapy of Dermatology. Systemic therapy Topical therapy. Systemic therapy. 1 . antihistaminies 2.corticosteroids 3.antibiotics 4.antivirals 5.antifungals 6.Vitamines 7.immunosuppressive agent 8.others. antihistaminies. histamine functions ：

chelsa
Download Presentation

Therapy of Dermatology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Therapy of Dermatology

  2. Systemic therapy • Topical therapy

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

  4. antihistaminies histamine functions： telangiectasis BP , shock increase in vascular permeability erythema、 wheal contraction of smooth muscles bellyache stimulation of gland secretion asthma actions of antihistamine: • 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 First-generation H1 antihistamines H1 antagonist dose(adult) route of administration side -effects

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

  9. Second-generation H1 antihistamines 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

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

  11. glucocorticoids • 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。

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

  13. Glucocorticoid in common use name anti-inflammationequivalent dose troche/injection dose mg mg mg/d 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

  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 acnesinfection： 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 nystatinused 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 • fluconazole150mg/w x12-16w(onychomycosis) • itroconazole0.2 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 cruris250mg,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． methotrexate,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 Acid5--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 permanganate1/2000-1/5000 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 promotenormal 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(%) keratolyticshyperkeratosissalicylic acid 6--15 makekeratinocytes looseresorcinol6--15 separateand fall offGlacial Acetic Acid 10-30 urea 20-40 Cansticremove granulation tissuecarbolic acid pure and neoplasm Glacial Acetic Acid>30 salicylic acid >20 trichloroaceticacid >30 sunscreen agentsabsorb or preventTitanium dioxide 5 ultraviolet radiation depigment agentsreducepigmentationHydroquinone 3 Azelaic Acid 20

  26. Formulation Ⅰ Dosage form component action indications powderdrug put intoprotection、coolingacute andsubacute zinc oxide , talc astringencyinflammation but no effusion solutionliquid and soluble drugcooling、reduceacute inflammation reduce inflammation clear raw surface with lots of effusion lotionpowder and liquid protection、coolingacute and subacute mixturereduce inflammation inflammation without astringency effusion creamconsisting of aqueousprotection、lubrication subacute or chronic and oily components intenerate crust O/Wemulsion beingreadiyreduce inflammationinflammation,pruritus diluted with water,W/O emulsion with oil

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

  28. Fomulation Ⅱ dosage form component action indications Paste cream includingprotection、astringencysubacute inflammation, 25%-50% powderintenerate crust scar,erosion diminish inflammation ointmentvehicle with vaseline strong action of chronic inflammation or lanolinlubrication、penetration ulcer intenerate crust tinctureresolve or steepdiminish inflammationchronic inflammation drug by alcohol sterilization antipruritic pruritus

  29. Fomulation Ⅱ Plastics organic menstruum protection chronic and aqueous solution strong percutaneous inflammation contain macromolecule strong percutaneous compound or film agent action 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 electrodesiccation coagulation electrocautery • phototherapy infrared ultraviolet PUVA laser treatment

  33. Physical Therapy(2) • cryosurgery • hydrotherapy • radiotherapy

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

More Related