An Introduction to Topical Therapies Enhancing phototherapy Jane emmonds/Andrea ward

What are they ?

In dermatology this means application to the skin Topical therapies are medications that are applied to a particular place on or in the body, as opposed to systemically. Topical derives from the Greek word topikos "of a place". In dermatology this means application to the skin

Advantages and disadvantages *Increased dose of medication where it is needed. *reduced side effects and toxicity *time consuming *can be complicated *can be messy

Topical therapies are made up of a base/vehicle and an active ingredient

Topical therapies are delivered in a vehicle or base Lotions Creams Ointments Gels Foams

Lotions Water or alcohol based, containing an oil. Higher content of water. Easier to apply/spread Less effective

Creams Thicker than a lotion. Emulsion of oil and water Cosmetically acceptable Requires preservative to extend shelf life

Ointments Greasy preparation. Semi solid, water free or 80% oil. Made up of paraffin, synthetic oils, vegetable oils, animal fats Protective and occlusive Produce fewer adverse reactions Folliculitus Difficult to apply Not cosmetically acceptable Encourage hydration often have mild anti inflammatory effects (NICE 2007)

Gels Water or alcohol based. Liquefies upon contact with the skin Often includes fragrances and preservatives

Foams Solution with pressurized propellant Easy to apply Time saving

Is the base important? Wet/weeping skin conditions: creams, lotions Dry/scaly skin conditions: ointments Inflamed skin: creams or ointments Cracked/fissured skin avoid alcohol Hairy skin: gels/lotions Patient preference

Anything else to consider? Site of application Condition of the skin Age The vehicle The patient

Active components Steroids (eumovate) Urea Salicylic acid (diprosalic) Tar (exorex) Vitamin D analogues (dovobet/dovonex) Anti-bacterials Anti-fungals (trimovate) Anti-virals (aciclovir) Calcineurin inhibitor (Tacrolimus)

Emollients and topical corticosteroids (TCS) are common therapies used in the management of skin conditions . The emollient counteracts dryness/hydrates the skin. TCS are anti inflammatory and immunosuppressive.

Emollients Increase the amount of water in the stratum corneum (Cork 1997) Constituent ingredients vary. Most are lipid based. Can be high lipid or low lipid If low lipid have humectants added to attract water around the corneocytes e.g. Urea Often underused (Loden 2005)

Which emollients should be used?

Topical corticosteroids 4 different potencies/strengths Very potent, Potent, Moderate, Mild Topical corticosteroids

Effects on the skin Anti inflammatory Immunosuppressive Anti proliferative Vasoconstrictive

Fingertip units guide the amount to be applied 1 FTU=0.5g. How to use?

Striae Bruising Telangiectasis Side effects Atrophy

Topical therapies and phototherapy Reduce side effects caused by phototherapy Enable treatment to continue Reduce number of exposures

Conclusion Topical therapies are still important in dermatology The base important to the patient Knowledge of topical therapies still relevant to the nurse Nurses should be allowed/trained to be involved in the administration of topical therapies

“Thank you.” –Andrea and Jane