LECTURE No. 15. Principles of external therapy

1. External therapy

External therapy is a very important (sometimes the only or main), but most often auxiliary method of treating dermatological diseases.

1. The doctor's knowledge of pathomorphological changes in skin lesions allows you to choose etiotropic or pathogenetically substantiated treatment.

2. A clear understanding of the pharmacological properties of the active substance and the basis of its action is a prerequisite for successful treatment.

3. The choice of dosage forms and drugs depends on the phase of the pathological process (acute or chronic stages, the stage of progression, stabilization or regression), the existing primary and secondary elements of skin lesions (spots, papules, tubercles, nodes, blisters, pustules, vesicles, erosions, ulcers or scars), i.e. from the clinical picture of the lesion.

4. The prescription of drugs should be dynamic (careful monitoring of the patient is necessary).

5. When prescribing, individual intolerance must be taken into account. Starting treatment, you should use lower concentrations of drugs, gradually increasing them.

6. A new drug and the same drug, but in a new form, should be applied only after the removal of the previous one.

7. External treatment should be carried out until complete clinical recovery.

8. When prescribing external agents simultaneously with general therapy, it is necessary to take into account the possibility of synergism or antagonism of their effects.

9. When starting external treatment, it is necessary to first clean the affected skin and remove secondary layers: scales, crusts, fragments of blisters. It is necessary to clean the skin carefully, using a staged, rather than forcible removal of scales, crusts, necrotic masses.

10. A doctor who does not specifically deal with dermatological problems should not dilute or mix forms in order to avoid obtaining a form with incompatible components.

2. Forms of external medicines

1. Solutions (lotions). The main component of this dosage form is water. Any soluble medicinal substances of various mechanisms of action are added depending on the purpose of therapy. Solutions can be alcoholic (with the addition of alcohol) or soapy (shampoo). Used as lotions, compresses, washes, cauterizations.

2. Chatterboxes - shaken solutions. The main component is water, but insoluble, powdery substances (talc, zinc oxide, starch) are also added. They dry out the skin very much, so oils (glycerin, vaseline or olive oil) are often added to them.

3. Powders - fine powders (talc, zinc starch, dermatol, xeroform).

4. Pastes - the composition includes solid nutrients in powder form in an amount of at least 50%, which are evenly mixed with the ointment base (in an amount of 10-50%). Pastes may contain one or more medicinal substances. Ointment base - petroleum jelly, anhydrous lanolin, naphthalan, spermaceti, lard, cocoa butter, vaseline, sunflower, peach, olive, apricot, castor oil, fish oil.

5. Ointment - they differ from pastes in having a lower solids content (from 1% to 40%) and a higher content of bases (80-90%).

6. Crema - emulsions, which consist of a solution of oil in water or water in oil. You can enter any medicinal substances into them, as well as fragrances (cosmetic creams). There are creams in which medicinal substances are introduced in the form of liposomes. Liposomes are microcapsules with bilayer lipid membrane walls. They are made from plant seeds (sunflower), from lecithin, egg white, filled with biologically active substances, vitamins and moisture. They penetrate well into the skin, even into the deep layers, are well absorbed, reacting with the components of membranes and cells.

7. Gels (jelly) - semi-solid colloidal solutions or suspensions.

8. Bandages - the basis includes (except for fat) wax or rosin, often resins, rubber. The consistency of the patch is very thick and sticky. Before use, the patch is heated. Attaches tightly to the skin and holds firmly.

9. Laki Liquids that dry quickly on the surface of the skin to form a thin film. They are used for deep and limited effects on tissues (nails, calluses, warts). They contain various medicinal substances.

10. Aerosols - dispersed systems with a gaseous medium (freon, mixture of gases, nitrogen). Depending on the particle size of the dispersed phase, aerosols are divided into highly dispersed (0,5-5 microns), medium dispersed (5-20 microns) and low dispersed (20-100 microns). They allow for even distribution of medicinal substances, prevent their crystallization and are more stable than other forms. They are less adsorbed and have the greatest surface effect.

11. Drug carriers through the skin - dimexide, collagenase, hyaluronidase. They are used with an integral stratum corneum of the epidermis along with other drugs for the purpose of their deep penetration.

Author: Sitkalieva E.V.

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