Topical therapy Prepared by : SIG, Dermatological nursing, IADVL

Topical therapy What is a topical therapy? Medications applied on the surface of skin, hair / nail and mucous membrane, which are absorbed percutaneously to exert therapeutic action at the site.

Commonly used topical drugs…. Antibacterials Antifungals Antiparasitic (scabies & lice) Topical corticosteroids Anti-acne preparations Sunscreen Emollients Soothing agents Cleansing agents

Why nurses should have knowledge regarding topical therapy? In out patient department; explanation regarding topical therapy is necessary for each dermatology patient

Why nurses should have knowledge regarding topical therapy? In hospitalized patients; - Nurses can provide topical therapy in a more scientific way than the relatives. - Oozy / painful lesions may need topical therapy in the form of compress / fomentation. - In patients with ‘widespread skin loss’ due to dermatological diseases, various topical therapy may be required along with skin care.

Advantages of topical therapy Act and metabolized locally in skin Systemic metabolism and side effects are mostly avoided. Easy to use in children. Risk of over dosage is low as compared to systemic therapy

Various topical preparations..site specific Cream (acute lesions of short duration) Ointment (Chronic lesions of some duration) Gel (Oily face or hairy areas) Lotion (Hairy areas) Powder (Flexural area) Paint (Large surface area) Shampoo (Scalp) Foam formulation (Hairy scalp)

Various ways of application & local therapy….. Topical application Paint Compress Fomentation Soaks Massage

Specific methods of application of certain topical drugs

Topical steroid Use sparingly Over large body surface area; use ‘Finger tip unit’ and ‘rule of hand’ Not to rub over involved area Should be used only for prescribed period Effect can be enhanced by occlusion with bandage (should be practiced only with doctor’s advice)

Finger tip unit

Antibacterials…. Twice / thrice daily application Crusts must be removed by compress before applying topical antibacterials as some antibiotics (mupirocin) are inactivated in presence of proteinaceous materials.

Antiparasitic agents: Scabies: Permethrin cream Single thorough application of 30 g container from neck to toe, specially to all flexures, at night. Contact period of 8-10 hours, followed by bath All family members to be treated together

Pediculosis… Pediculosis: Permethrin crème rinse Shampoo and dry hair Apply on dry hair and keep for 10 min. Wash off with water Nits to be removed with a special comb.

Sunscreen To be applied on photoexposed body parts at 3 hourly intervals during daytime (9am-12pm-3pm) The applied layer should be thin and uniform Mild stinging following application may occur Should preferably be used in combination with physical sun-protection

Emollients Latin verb ‘Mollire’ (to soften) Moisturizing cream / lotion, Liquid paraffin / soft paraffin, Bath oil (added to bath water), Cream-based soap substitutes, Coconut oil

Emollients Indications: -Dry skin -Ichthyosis -Atopic dermatitis -Asteatotic eczema - During care of anesthetic hands and feet (leprosy, diabetes)

Emollients Liberal application immediately after bath in patients with xerosis. In leprosy patients routine oil application following soaking of hands & feet. Addition of bath oil in atopic children.

Paint.. Over intact skin or mucous membrane Gentian violet paint (0.5-1% aqueous solution) Mild antibacterial + drying effect Castellani’s paint (magenta color): Chronic paronychia, finger / toe-web candidiasis

Compress Indications: Infected wound, eczema with secondary infection, Pyoderma Agents used: -Normal saline -Potassium permanganate + tap water -Sodium bicarbonate + tap water -Ice / ice-cold water compress

How do compresses help? Purpose: Removal of crusts, dirts, pus, dried blood, etc. Warm compress helps to increase local circulation. Improves local nutrition and immunity, because of enhanced circulation.

Potassium permanganate (PP) compress Tap water + PP crystal (1:10,000 dil. / 0.01%) light magenta color, correct concentration. (available as sugar-like crystals, few crystals are enough) During compress the color gradually changes to brownish (discard the water at this point). Too high concentration: caustic burn

Normal saline compress Commercially available normal saline Half –one level teaspoonful of common salt added to 250ml of tap water (approx. 0.9%) Should not be used over raw areas of skin

Ice compress Ice / ice cold water Indication: inflammatory edema, acute neuritis of leprosy Reduces chance of local edema by vasoconstriction Alternate hot and cold compresses can be given.

Sodium bicarbonate compress Bucketful of tap water + 5 teaspoonful of baking soda Keratolytic effect Removes foul odor Useful in patients with scaling, e.g. erythroderma, ichthyosis, etc.

Fomentation Therapeutic application of warmth and moisture, so as to relieve pain (acutely inflamed areas) If a substance / material is used as a warm, moist medicinal compresses, the term ‘poultice’ is used, (e.g. boric powder).

Soaks.. Used for hyperkeratotic areas over hands and feet. Warm water / water with normal temperature, taken in a shallow bucket. In presence of oozy lesions over these areas, potassium permanganate soaks may be used. Medications applied after soaking (e.g. corticosteroids) have better penetration.

Massage Oil / moisturizing lotion may be massaged. Massaging helps uniform application of the moisturizing agent and softening Improved blood circulation in dependent body parts. Helps to improve inflammatory edema. In children, facilitate bondage between nursing staff and the child.

SIR WILLIAM OSLER The very fist step towards success in any occupation is to become interested in it.