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Dermatology

Dermatology

Dermatology  –  Skin Disorders

Dermatology is the diagnosis, treatment and prevention of diseases of mainly the skin; but may also involve hair, nails, oral cavity, genitals and cosmetic care and enhancement.

The skin is the largest organ on/in the body and protects all the other organs from harmful micro-organisms, physical injury, temperature fluctuations and environmental changes. It is also susceptible to a wide variety of disorders and adverse conditions including - infection, infestation, inflammation, irritation/allergic reactions, dryness, scarring, sun-burn, sun-damage, hyperpigmentation.

Topical medication forms such as lotions, solutions, gels, creams, ointments, washes, shampoos, sprays and powders would be the conventional treatment options for skin disorders.

Eczema /Dermatitis

Eczema (and/or Dermatitis) is a disease pattern not a definite diagnosis. The type and cause of Eczema should be identified before starting treatment. Patient education on trigger factors and how to avoid them, ways to manage the condition and how to effectively and appropriately use their medications is crucial in improving quality of life.

Some treatment options include:-

·         Emollients – These help counteract skin dryness and maintain skin barrier integrity. Traditional ingredients e.g. sulfur, salicylic acid, menthol, phenol and coal tar solution may be added to emollient creams and ointments for better symptom control and/or relief.

 

·         Topical Steroids – Medications such as hydrocortisone, betamethasone and clobetasol can be used to treat (and stop) inflammation.  These can either be used alone (as a single ingredient) or in combination with antibacterial or antifungal medications.

 

·         Antibacterial/Antifungal – normal healthy skin is colonized by a variety of micro-organisms. In cases where skin integrity is compromised (as in eczema) these micro-organisms tend to further aggravate the inflammatory process. Products containing antifungals (Clotrimazole, miconazole,  Econazole, terbinafine) are readily available; however combinations with antibacterials like mupirocin, fucidin and erythromycin as well as topical steroids could offer a more efficient and convenient treatment option.

 

·         Topical Immunomodulators – these can only be initiated by a specialist physician (GP) and only after careful consultation with the patient. Tacrolimus has been used as a short-term treatment option in the form of an ointment or cream.

 

Acne

This is a chronic inflammatory condition associated with the sebaceous glands and involving the hair follicles. It can begin in the early teenage years and persist into later adult life. Acne treatments aim to reduce the intensity and duration of inflammation as well as prevent acne scar formation. 

Mild acne – Typical treatment may involve the use of benzoyl peroxide, retinoids and/or antibacterials. Benzoyl peroxide has antimicrobial and mild keratolytic properties, and both comedones and inflammation generally respond well. Azelaic acid is an good alternative that may cause less local irritation, but may be less effective. Topical retinoids are effective in both comedonal and inflammatory acne. Topical antibacterials - Tetracycline, clindamycin and erythromycin are generally used for inflammatory acne, with the addition of a topical retinoid or benzyl peroxide to increase efficacy and reduce the risk of developing resistance.  Nicotinamide has also been used topically in mild to moderate inflammatory acne.

Ingredients such as Salicylic Acid, Glycolic Acid, TCA (Trichloroacetic Acid), Resorcinol and Lactic Acid can be as chemical peels which help reverse the signs of skin aging and to treat skin lesions and acne scars.

Moderate acne - Best treatment option is with oral rather than topical antibacterials – tetracyclines (drugs of choice i.e. Tetracycline, doxycycline, lymecycline, oxytetracycline and minocycline). Alternatives to the tetracyclines include erythromycin, co-trimoxazole, and trimethoprim. A topical retinoid may also be used for additional comedolytic activity.

Severe acne – Various treatments include oral isotretinoin, high doses of oral antibacterials with a topical retinoid and benzoyl peroxide and the use of anti-androgenic cyproterone with ethinylestradiol (considered in females only).

 Psoriasis

Unlike Eczema, psoriasis is a chronic immune mediated inflammatory skin disease, characterized by clearly defined thickened/raised skin patches (scaly plaques).  Treatment depends on severity of te disease, location of the plaques and the type of psoriasis. Some topical treatment options include Emollient creams and ointments; Coal tar Preparations; Dithranol; Salicylic Acid; Tacrolimus; Calcipotriol and Potent topical steroids like betamethasone and Mometasone. Other treatment options include Phototherapy and systemic therapy (using medications such as methotrexate and cyclosporine).

 Viral Warts

As the name suggests, warts are caused by the Human papilloma virus and are more often than not self-limiting (will resolve without the need for treatment). The focus of treatment is to destroy the warts (locally) or to stimulate an inflammatory reaction. A good gauge for starting treatment is the severity of patient’s physical and/or psychological discomfort and whether the warts interfere with work or daily life. Although there is no specific treatment regimen, application of wart paints containing podophyllin, salicylic acid, formaldehyde, diphencyprone, and cryotherapy

  

References

1.       Dermatology Research and Practice volume 2010 – Acne Scars : Pathogenesis, Classification and Treatment.

2.       DermNet New Zealand - http://www.dermnetnz.org

3.       British Journal Of Dermatology 2001 – Guidelines for the management of cutaneous warts.

4.       Martindale The Complete Drug Reference 32nd Edition