skin disorders
Treatment of Skin Disorders
Types of Topical Drugs
Topical drugs can be divided into several overlapping categories: Cleansing agents None Protective agents None Moisturizing agents (emollients) (emollients) Drying agents None Anti-itch agents None Anti-inflammatory agents None Anti-infective agents None Keratolytics None The principal cleansing agents are soaps, detergents, and solvents (a liquid substance capable of dissolving other substances). Soap is the most popular cleanser, but detergents are used as well. Soaps are cleansing and emulsifying agents containing some type of fat or lye, while detergents are made from petroleum products. Certain soaps dry the skin, but others have a creamy base that is less drying. Because baby shampoos are excellent cleansing agents and are usually gentle to the skin, they are good for cleansing wounds, cuts, abrasions, and areas around the eyes. Also, people who have Psoriasis , Many chemicals are added to cleansing agents. For example, some soaps have antibacterial substances added to them. In general, antibacterial soap does not improve hygiene or prevent disease, and routine use may disrupt the normal balance of bacteria on the skin. Antidandruff shampoos and lotions may contain other antibacterial substances, such as zinc pyrithione,selenium sulfide, or tar extracts, to help treat flaking skin, eczema, and psoriasis of the scalp. Water is the main solvent for cleansing. Other solvents include petroleum jelly, which can cleanse the skin of material that cannot be dissolved with soap and water, such as tar. Small amounts of alcohol can safely be used to cleanse the skin before injections or blood drawing. Alcohol gels are useful as hand sanitizers for routine hand hygiene when handwashing is not possible. Other solvents, such as acetone (nail polish remover), gasoline, and paint thinner, are rarely used for skin cleansing. These solvents dissolve the skin's natural oils, causing significant drying and irritation. They may also be absorbed through the skin, resulting in poisoning. Many different kinds of preparations help protect the skin. Oils and ointments supply an oil-based barrier that can help protect scraped or irritated skin and retain moisture. Powders may protect skin that rubs against skin or clothing. Synthetic hydrocolloid dressings protect Pressure Sores (bedsores, decubitus ulcers) and other areas of raw skin. Moisturizers restore and help maintain water and oils in the skin. The best time to apply a moisturizer is when the skin is already moistened—immediately after a bath or shower, for instance. Moisturizers typically containglycerin,mineral oil, or petrolatum and are available as lotions, creams, ointments, and bath oils. Some stronger moisturizers contain compounds such asurea, lactic acid, and glycolic acid. Cold creams are over-the-counter (OTC) moisturizing emulsions of fats (for example, beeswax) and water. Excessive moisture in areas where skin rubs against skin can cause irritation and skin breakdown (maceration), particularly in body folds where the environment tends to be warmer and moister. The areas most commonly affected are between the toes or buttocks, in the armpits or groin, and under the breasts and abdominal skin folds. These warm moist areas also provide fertile breeding grounds for infections, especially with fungi and bacteria. Cornstarch and talcum powderare the most commonly used drying agents. These powders absorb moisture from the skin surface. Most of the many talcum preparations vary only in their scents and packaging. Talcum powder is more effective than cornstarch but is no longer used in baby powders, because it can cause granulomas (a type of chronic inflammation) in the lungs when inhaled. Using talcum powder in the female genital area is not recommended because of concerns of possible risk of cancer. Cornstarch is a good drying agent but can sometimes lead to fungal infections. Superabsorbent powders (extremely absorbent powders) are occasionally required to dry very moist areas, such as in the groin or armpits. are drying agents commonly found in OTC antiperspirants. Prescription doses of aluminum salts are available to treat Treatment . solution. Usually applied with dressings or as soaks, astringents are used to treat infectious Atopic Dermatitis (Eczema) , oozing skin lesions, and Skin disease is often accompanied by itching. Itching and mild pain can sometimes be controlled with OTC agents such as camphor,menthol,pramoxine,zinc oxide, or (by prescription in the United States) alidocaineandprilocainemixture. Calamine is a common soothing agent that helps relieve itching somewhat and can also help dry out the skin. Antihistamines,which block certain types of allergic reactions, are sometimes included in topical preparations to relieve the itching associated with allergic reactions.Doxepinis an effective topical antihistamine for many conditions. Because the antihistaminediphenhydramine(common in many nonprescription topical preparations) can trigger an allergic reaction when applied to the skin, doctors do not usually recommend it. Taking antihistamines by mouth (orally) does not seem to produce this type of skin reaction, so oral rather than topical antihistamines are preferred to relieve itching.Benzocaine, an anesthetic that had been used to relieve itching, can also trigger allergic reactions and so is not recommended. are the main topical drugs used to relieve inflammation (swelling, itching, and redness) of the skin. Corticosteroids are most effective for rashes caused by allergic or inflammatory reactions to things such as Moderately Poisonous Plants , metals, cloth, Topical corticosteroids are sold as lotions, creams, ointments, solutions, foams, oils, gels, and tape products. Creams are most effective if rubbed in gently until they vanish. In general, ointments have the most potent effect. The type and concentration of corticosteroid in the preparation determines the overall effect.Hydrocortisoneis available in concentrations of up to 1% without a prescription (however, concentrations of 0.5% or less offer little benefit). Stronger corticosteroid preparations require a prescription. Doctors usually prescribe potent corticosteroids first, then less potent corticosteroids as the disorder abates. Generally, topical corticosteroids are applied 2 to 3 times a day in a thin layer, but high-potency formulations may be applied only once a day. Corticosteroids should be used with caution on areas where the skin is thin, such as the face, armpits, and genitals, and on areas of natural skin-to-skin contact, such as the armpits and groin. Doctors usually use low-potency Corticosteroids: Uses and Side Effects on these sensitive areas for no more than a few days to a week. Prolonged use (more than 1 month) in any area can cause skin breakdown, stretch marks, acne-like eruptions, and sometimes an allergic skin reaction ( When a stronger dose of topical corticosteroid is needed for one spot or a small area that does not respond to treatment, a doctor may inject the corticosteroid just under the skin or occasionally apply plastic tape infused with the corticosteroidflurandrenolide. Another way to deliver a strong dose is to apply a thin plastic film, such as household plastic wrap, over the topical corticosteroid (occlusive dressing). The plastic wrap increases the drug's absorption and effectiveness and is usually left on overnight. Such dressings are usually reserved for disorders such as severe Psoriasis and Other topical drugs that are not corticosteroids, such astacrolimus,pimecrolimus, andcrisaborole, can also be used to relieve inflammation, particularly in people with eczema. Several allegedly anti-inflammatory herbal products—among the most popular are chamomile and calendula—are commonly used in commercial products, but their effectiveness has not been well established. Herbal and "natural" products are often not standardized and commonly cause allergic and irritant reactions of the skin. are noncorticosteroid anti-inflammatory agents, which are byproducts of coal manufacturing. They slow skin cell division and are useful in treating disorders that cause excessive skin production (scaling) such as Psoriasis . Side effects include irritation, inflammation of follicles ( Viruses, bacteria, fungi, and parasites can all infect the skin. By far, the best way to prevent such infections is by carefully washing the skin with soap and water. Stronger disinfecting agents are commonly used by nurses and doctors to disinfect their hands to prevent spreading infections to patients. Antibacterial preparations or "preps" are used on the skin before surgery to lower the number of bacteria on the skin and thereby prevent postoperative infections. Once a skin infection has occurred, it may be treated with topical or systemic drugs depending on the severity and type of infection diagnosed or suspected. Topical anti-infective agents include antibiotics, antifungal drugs, and insecticides. are best used as an additional treatment for Acne . Topical ) in postoperative care of a Biopsy site and to prevent infection in scrapes, minor burns, and abrasions. These over-the-counter antibiotics, and especially work quite well for treating a wide variety of fungal infections of the skin (such as Dermatophytid Reaction and ) are used to treat Treatment and Nonantibiotic topical antisepticsstop or slow the growth of microbes (such as viruses, fungi, and bacteria) on the skin and are therefore considered to be anti-infective (antimicrobial). They include iodine solutions (such as povidone iodine and clioquinol),gentian violet, silver preparations (such assilver nitrateandsilver sulfadiazine),sodium hypochlorite, and zinc pyrithione. has antiseptic properties and is used in some disinfectant sprays and body washes. Zinc pyrithione is also an antifungal and a common ingredient in shampoos that treat dandruff caused by Psoriasis or Healing wounds should usually not be treated with topical antiseptics other than silver because they are irritating and tend to kill fragile regrowth (granulation tissue). Keratolytics are agents that soften and loosen skin cells and ease the flaking and peeling process (exfoliation) of the top layer of skin. Examples includesalicylic acidandurea. in varying concentrations is used to treat Psoriasis , can be used to moisturize, soothe itching, and reduce scaling. It is commonly used to treat excessive skin buildup on the soles of the feet (plantar keratodermas and calluses), Keratosis Pilaris (dry bumps on thighs and back of arms in people with allergies), and other dry skin conditions such as 