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

2. What are they ?

3. 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

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

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

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

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

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

9. 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)

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

11. Foams
Solution with pressurized propellant
Easy to apply
Time saving

12. 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

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

14. 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)

15. 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.

16. 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)

17. Which emollients should be used?

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

19. Effects on the skin Anti inflammatory Immunosuppressive
Anti proliferative
Vasoconstrictive

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

21. Striae
Bruising
Telangiectasis
Side effects
Atrophy

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

23. 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

24. “Thank you.”
–Andrea and Jane