Dermatologist Mind : Practical Advice on Topical Treatments 27-30
Emollients/moisturisers and complete emollient therapy
Emollients are a key element in controlling and managing dry skin conditions. These products may be prescribed alone or be used as an adjuvant to other topical treatments such as topical steroids.
Causes of dry skin include: environmental factors (dry air, exposure to wind); reduction in production of sebum (usually in old age); underactive thyroid; inherited factors; and skin conditions (eczema, psoriasis).
Complete emollient therapy
This is the term given to a regime which includes soap substitutes, bath oil and moisturiser.
Soap substitutes – soap can have a drying effect on the skin so should be avoided in dry skin conditions. Soap substitutes, when applied prior to contact with water, help prevent stinging and act as a moisturiser. antipruritic and antistaphylococcal agents. These should only be used if indicated and for the prescribed period (usually 4–6 weeks). Patients should be advised not to purchase bath oils containing fragrance as it is a known sensitiser.
Advise the patient that bath additives can make the bath slippery.
Moisturisers
Come as lotion, cream, gels, ointment and spray canisters.
Lotions
Are used for scalps or other hairy areas and for mild dryness on the face, trunk and limbs.
Creams
Cream-based products are the most commonly used moisturisers for dry skin conditions as they can be applied to the entire body, are cosmetically acceptable and have cooling properties.
Gels
Similar to creams.
Ointments
Are prescribed for drier, thicker, more scaly areas, but patients may find them too greasy.
Spray canisters
Quick to use.
Application
Patients should be advised to apply moisturiser directly to the skin in a downward motion in the direction of hair growth. This will reduce the risk of blocking the hair follicles (folliculitis). Moisturiser should be applied at least twice daily.
It is important to prescribe the right amount of moisturiser. Prescribe 250g per week for a child under 10 years, and 600g for adults and children over 10 years.
It is important to advise the patient, parent or carer not to stop complete emollient therapy once the condition is controlled as this will help to prevent future exacerbations.
Topical steroid therapy
Topical steroids are extremely useful in inflammatory skin conditions such as eczema. In the UK, they are divided into four groups according to their potency.
There are large numbers to choose from, but it is best to become familiar with a few, perhaps one or two from each group. The steroid ladder (below) identifies some of the steroids available and their potency. It also demonstrates the importance of titration of topical steroids: if the patient has been treated with a potent steroid and is improving, it is important to gradually reduce the potency, not discontinue treatment, to avoid a flare up of the condition.
As a general rule, use the weakest possible steroid that is effective. For the face, 1% hydrocortisone or equivalent (weak) should be prescribed. Start with this elsewhere and only prescribe something stronger if this does not work. In general practice, it is rarely necessary to use anything stronger than a moderately potent steroid for extensive eczema. For localised persistent eczema, a potent steroid can be useful. Very potent steroids should rarely be used.
30g of ointment or cream is enough to cover the adult body once. To cover the whole body for a week if applied twice daily will require 200g. If a patient has widespread eczema, adequate amounts of topical steroid should be prescribed to avoid relapse. A useful guide to using the correct amount of topical steroid is the finger-tip unit guide, which is the amount of cream/ointment squeezed onto the index finger from tip to the first joint. This amount will cover the area of two palms.
The potency of a steroid can be enhanced by the base used: for example, an ointment base makes a steroid more potent than a cream or lotion. Additionally, the ability of a topical steroid to be absorbed varies according to the site and the condition of the skin. The diagram below demonstrates these differences.
It is important to prescribe complete emollient therapy along with topical steroid therapy as this will help to reduce inflammation and dryness.
Caution
Topical steroids are contraindicated in some skin conditions, including: acne; rosacea; bacterial infections; infestation; leg ulcers; and viral infections.
DO NOT apply steroids to the eyelids.
Thanks For Visiting ! Keep Your Healthy !
0 comments:
Post a Comment