: تسوپ رد اهوراد فرصم

یهیقف اتیگ رتکد

تسوپ یاهیرامیب رایشناد ناهفصا یکشزپ مولع هاگشناد

رد اهوراد یعضوم فراصم تسوپ

What are the common ingredients in a topical formulation?

Active drug(s) Vehicle (cream, ointment, lotion etc.) +/- preservatives +/- penetration enhancers (e.g. azone, DMSO) Others (e.g. antioxidants, fragrances, coloring agents)

Common topical dose forms includes: creams, lotions, ointments and powders.

•

Creams:

A

cream

is a semi-solid emulsion containing a drug. The cream is usually non greasy. • Creams are removed with water.

Lotions:

A

lotion

is a watery preparation containing suspended particles. Shake all lotions before application. Gently but firmly pat the lotion on the skin. Do not rub into the skin.

Rubbing increases circulation and itching. Rubbing also causes friction, which can irritate the skin. Lotions are used to: Soothe and protect the skin Relieve rashes and itching Cleanse the skin •

Ointments:

An

ointment

is a semi-solid preparation containing a drug in an oily base. Ointments are not easily removed with water. The drug has longer contact with the skin.

Why Apply Topical Drugs:

• Clean and debride (remove) a wound • Hydrate (add water) to the skin • Reduce inflammation • Relieve itching or a rash • Provide a protection barrier to the skin • Reduce thickening of skin

یاه هدروارف یترابع هب ای و یعضوم

.

یاهوراد نیرتفرصمرپ زا یکی د نتسه اهباتفادض لاکیپوت یتشادهب

sunscreens

Sunscreens:

Physical agents Chemical absorbing agents

Sun protection at any age is important to prevent the short-term as well as long-term damaging effects of sunlight

How do “ Sunscreens “ work ?

by absorbing, reflecting, the sun's rays on the skin. They are available in many forms, including ointments, creams, gels, lotions, sprays, and wax sticks.

Physical blockers

effective at protecting

against both

UVA and UVB radiation.

The two most common physical blockers are:

titanium dioxide zinc oxide.

لا هدیا یاهباتفآدض

دنتسه اه یکیزیف هورگ نیمه عقاو رد یعون هب

•

تم لاس یارب یرتشیب ینمیا و رتمک اهنآ یژرلآ لامتحا دنریگیم یرترثوم روطب ار هعشا و دنراد

•

zinc oxide and titanium dioxide ,

act as a physical barrier

: یکیزیف یاهباتفادض بیاعم

ر تمک اهنآ هب تبسن ییابیز رظن زا رامیب لمحت هک هز ینورکیم تابیکرت دیدج دربراک اب رگم تسا .

دنرتهب رامیب شریبذپ رظن زا

•

ZNO TIO2

Zinc oxide is less whitening than titanium dioxide and provides better UV-A protection.

Iron oxides

are mineral pigments to give a tint and better protection to sunblockers

Chemical absorbers •

Have a less active wavelength

•

Higher side effects

•

May harm babies and sensitive persons

تیتامرد تکاتنک وتف کیژرلآ زا یا هنومن ییایمیش یاهباتفادض هب

: باتفادض حیحص لامعتسا زرط •

20-30 minutes sunscreen to be absorbed by the skin

•

apply it at least half an hour before going out in the sun.

•

Reapply after half an hour

•

Then,,,,Re-apply sunscreen every 2 hours

Sunscreens are not recommended for infants less than 6 months of age.

Are sunscreens really safe??

Side effects reported during clinical studies from sunscreens were infrequent and non-serious.

The most common side effects in patients were acne, dermatitis, dry skin, eczema, abnormal redness, itching, skin discomfort and sunburn

Dermatitis is a common skin disorder in every age

When you have eczema, you should avoid soaps they , especially bar soaps, even ‘moisturizing soaps’ as will cause dry skin and may damage the skin barrier . Only mild liquid soap-free cleansers, preferably , should be used

Baths may be better than showers.

The water temperature should be luke warm. Long hot showers are not recommended

Management points

• Try not to scratch the irritated area on your skin even if it itches.

• Scratching can break the skin. Bacteria can enter these breaks and cause infection

OTC acne drugs: • benzoyl peroxide, • sulfur, • resorcinol, • salicylic acid or • lactic acid • Azelaic acid

Azelaic acid

This medication is used for the treatment of mild to moderate acne.

Azelaic acid belongs to a class of drugs known as dicarboxylic acids. It works by stopping the growth of bacteria on the skin and by reducing the amount of a natural skin substance (keratin) that can cause acne.

Benzoyl peroxide

Benzoyl peroxide

• is available in almost all forms of skin care creams, gels, liquids, lotions, soap etc. • Benzoyl peroxide acts in three ways. • It kills the bacteria in acne. It opens closed acne pores and it removes excess oiliness from the skin.

Acne drugs by prescription

• Tretinoin • Adapalene(differin) • Clindamycin • erythromycin

During the first few weeks of using tretinoin,

acne might appear worse because the medication is working on pimples forming inside the skin. It may take up to 8-12 weeks to notice results from this medication.

Differin

®

• •

Lotion 0.1%, Gel 0.1%, Cream 0.1% and Differin ® Gel, 0.3%

are indicated for the acne vulgaris in patients 12 years and older. Apply Differin ® products to affected skin (face, trunk and other areas of the body affected by acne) once per day avoiding the eyes, lips and mucous membranes.

The most common side effects reported with use of Differin ® products include skin dryness, redness,

scaling, stinging and burning.

Melasma

Melasma

• Melasma

is an acquired hypermelanosis of sun exposed areas.

• It presents as symmetric

hyperpigmented macules, which can be confluent or punctate. The cheeks, the upper lip, the chin, and the forehead are the most common locations.

etiology

• In some cases, a

direct relationship with female hormonal activity

appears to be present because it occurs with pregnancy and with the use of oral contraceptive pills. • Other factors implicated in the etiopathogenesis of melasma are

photosensitizing medications, mild ovarian or thyroid dysfunction, and certain cosmetics

Important note/

• The most important factor in the

development of melasma is exposure to sunlight.

• Without sunscreen any try to

treatment fails .

Race, age

• it is

much more common in darker skin types than in lighter skin ,, especially Asians, from areas of the world with intense sun exposure.

• Melasma

is rare before puberty and most commonly occurs in women during their reproductive years.

Endocrine /emotional factors

• a 4-fold increase in thyroid disease

in patients with melasma when compared with matched controls.

• A case report of 2 women who developed

melasma after sudden and profound emotional stress implicated the release of MSH by the hypothalamus as a cause/

Diff.Diagnosis

• Addison Disease • Drug-Induced Photosensitivity • Lupus Erythematosus, Discoid • Mastocytosis • lichen planus

treatment

• The mainstay of treatment remains • topical depigmenting agents. •

Hydroquinone (HQ) is most commonly used. a chemical that inhibits tyrosinase, leading to the decreased production of melanin.

•

HQ can be applied in cream form or as an alcohol-based solution

treatment

The use of than with tretinoin can be effective as monotherapy. However, the response to treatment is less longer HQ and can be slow, with improvement taking 6 months or

Scrub creams and melasma

• Microdermabrasion

creams help to remove dead skin and debris on the surface of the skin.

• These dead skin flakes

and particles can interfere with the penetration of skin care products

یعضوم نوتروک

رد یگرزب بلاقنا .

1950 زا اهنآ فشک دومن داجیا یژولوتامرد

Corticosteroids are mainly used for their effect in

controlling inflammation,

and topical corticosteroids are applied to the skin for the localised treatment of

various inflammatory skin disorders .

Because of side effects of topical steroids

• Classification is important to know by physicians رترثئوم و رتیوق نوتروک هچ ره هکنآ مهم هتکن .

تسا رتشیب زین ئوس ضراوع لیسناتپ

Groups of topical steroids from point of Potency:

Very Potent

(Clobetasol propionate Betamethasone dipropionate )

Potent

(Desoximetasone, Fluocinonide,Halcinonide)

Moderate

)FluocinoloneوTriamcinolone,Betamethasone valerate ,Mometasone furoate)

Mild ) Hydrocortisone(

Risks of topical steroids:

• Atrophy, striae • Telangiectasia, purpura • Perioral dermatitis, rosacea • Masking of initial lesion • Tachyphylaxis or rebound • Pigmentation abnormalities • Systemic absorption (uncommon) • Susceptibility to infection

زا یشان یایرتسا ای یگدروخ کرت نتروک

) یزاتکیژنلات ( اهگریوم عاستا نتروک زا یشان

لیلد هب یگدرمنوخ و مردیپا یکزان مرد قورع یگدننکش

Steroid atrophy

ئوس ضراوع شیازفا ردزاسرطخ لماوع نتروک •

Potent topical steroids over large areas of body.

•

use plastic to cover treated areas (occlusion).

•

skin condition persists for more than two or three weeks.

•

In a child.

هک دهد رادشه رامیب هب یتسیاب کشزپ رد تبون 2 زا شیب ار یعضوم نوتروک دربن راک هب زور هدافتسا فرص هدننک مرن ناونع هب نآ زا .

و دنکن

•

Minimizing risks:

Avoid high potency steroids on flexures, face or genitals Avoid high potency steroids in children Avoid use of occlusion for long periods

: اهنیماتسیه یتنآ

• Antihistamines are available for oral use as

tablets and elixirs

. They take about

15 to 30 minutes

to be effective

دوب دهاوخن یزاین بلغا یقیرزت مرف هب رد رگم

یسکلایفانآ کوش ای و اهسناژروا

Topical preparations (ointments and creams) are often applied to insect bites

: هنافساتم دنچره کیژرلآ دنناوتیم نیماتسیه یتنآ یاهمرک .

دننک داجیا تیتامرد تکاتنک

:

ا هنیماتسیه یتنآ یدنب هورگ

•

Conventional antihistamines

•

Non-sedating antihistamines

:

لومعم یاهنیماتسیه یتنآ

• • • • • • • •

Chlorpheniramine Promethazine Trimeprazine Diphenhydramine Cyclizine Azatadine Hydroxyzine Cyproheptadine

Side effects of them include: Drowsiness Dry mouth, blurring of vision, difficulty passing urine and impotence Paradoxical stimulant effect (and even agitation).

Non-sedating antihistamines

•

Loratidine and desloratadine

•

Cetirizine

•

Fexofenadine

: هک تسا رکذ لباق و ایلارتسا رد نیدانفرت و لوزیمتسآ دندش فذح ییوراد رازاب زا اکیرمآ / ناشییوراد تلاخادت لیلد هب

: لماش لوزیمتسآ و نیدانفرت مهم تلاخادت

Erythromycin Ketoconazole Itraconazole Ciclosporin