Topical Medications

1. Composition:

Topical medications have two basic components:

• Active ingredient: It has therapeutic effects.

• Excipient: It does not have therapeutic effects, but it helps to deliver the active ingredient into the skin.

2. Excipients:

Some common types of excipients:

• Water

• Alcohol

• Vaseline

• Lanolin

• Glycerin

• Powder

Effects of excipients:

• Help the medication penetrate the skin easily.

• Create the consistency and viscosity of the medication.

3. Forms of topical medications:

• Powder:

• Effects:

• Absorbs moisture, increases water evaporation.

• Anti-congestion, reduces inflammation, itching, burning.

• Commonly used powders:

• Herbal powder: Absorbs moisture quickly but easily ferments.

• Mineral powder:

• Talc: Magnesium sulfate

• Bismuth powder

• Indications:

• Acute skin diseases with drainage.

• Acute skin redness.

• Urticaria.

• Abrasions.

• Common powder formula:

• Zinc oxide 30g + Talc 70g

• Solution:

• Excipients: Distilled water, 30-70% alcohol, glycerin.

• Effects of glycerin:

• Penetration agent.

• Dehydration, moisture absorption.

• Lubricant.

• Effect of boric acid: Antiseptic.

• Jarish solution:

• Composition:

• Boric acid 20g

• Glycerin 40g

• Distilled water 1000ml

• Effects:

• Absorb moisture.

• Antiseptic, clean pus.

• Reduce inflammation, swelling, and exudate.

• Anti-itching, exfoliation.

• Indications:

• Eczema.

• Acute dermatitis.

• Draining, pus-filled, scaly lesions.

• How to use:

• Apply gauze to the lesion, soak with Jarish solution through the gauze.

• Keep gauze moist continuously.

• Miliam solution:

• Composition:

• Gentian violet 0.25g

• Methylene blue 2.0g

• 70% Alcohol or distilled water 100ml

• Effects:

• Dry lesions.

• Antibacterial.

• Indications:

• Impetigo.

• Eczema.

• Intertrigo due to streptococcus.

• How to use: Apply to the lesion.

• ASA solution:

• Composition:

• Aspirin 10g

• Sodium salicylate 8.8g

• Alcohol 100ml

• Effects:

• Antifungal.

• Anti-itching.

• Descaling.

• Indications:

• Tinea.

• Neurodermatitis.

• How to use:

• Apply to the lesion.

• Do not rub when using.

• Castellani solution:

• Composition:

• Fushin

• Boric acid

• Phenic acid

• Acetone

• Resorcinol

• 70% Alcohol

• Distilled water

• Oil:

• Excipients: Vegetable oil (peanut).

• Active ingredients: Zinc oxide, sulfur.

• Effects:

• Soft, soothe skin, prevent dryness.

• Zinc oil:

• Composition: Zinc oxide + Peanut oil.

• Indications:

• Subacute atopic dermatitis.

• Contact dermatitis.

• How to use: Apply to the skin.

• Paste:

• Powder ratio: 20-50%.

• Types of pastes:

• Brocq paste:

• Composition:

• Zinc oxide

• Lanolin

• Vaseline

• Water paste.

• Effects:

• Reduce inflammation, congestion, absorb moisture.

• Indications:

• Subacute skin diseases.

• Minimal drainage.

• How to use: Shake well before applying.

• Cream:

• Composition: Similar to ointment + glycerin/ water.

• Does not penetrate as deep as ointment.

• Used to treat subacute stage of the disease.

• Sunscreen cream:

• Composition:

• Quinine hydrate

• Lanolin

• Vaseline

• Water

• Dalibour cream:

• Effects: Antiseptic.

• Composition:

• Zinc sulfate

• Copper sulfate

• Zinc oxide

• Lanolin

• Vaseline

• Water

• Gel:

• Excipients: Transparent high molecular weight polymers.

• Effects:

• Clean, non-greasy, does not clog pores.

• Penetrates deep into the skin, releases active ingredients quickly.

• Indications:

• Subacute stage of the disease.

• Ointment:

• Excipients: Fatty substances.

• Active ingredient (powder) ratio: < 20%.

• Effects:

• Increase absorption through the skin.

• Soft skin, exfoliate, prevent dryness.

• Disadvantages:

• Greasy skin.

• Limit evaporation.

• Cause congestion (due to vasodilation).

• Composition of Whitfield’s ointment:

• Salicylic

• Benzoic acid

• Lanolin

• Vaseline

• Indications of Whitfield’s ointment: Fungi.

• Composition of Salicylic ointment:

• Salicylic

• Lanolin

• Vaseline

• Effects of Salicylic ointment: Keratolytic, descaling.

• Indications of Salicylic ointment:

• Psoriasis.

• CHRONIC atopic dermatitis.

• Composition of Drier-vitch ointment:

• Lactic acid

• Salicylic acid

• Vaseline

• Effects of Drier-vitch ointment: Very strong keratolytic.

• Indications of Drier-vitch ointment: Hyperkeratosis (e.g., callus).

4. Principles of topical medication use:

• Closely monitor patients for side effects and drug tolerance.

• Use medication according to each stage: acute, subacute, chronic.

• Clean lesions before applying medication.

5. Precautions when using topical medications:

• Some topical medications can cause toxicity with prolonged use:

• Chrysophanic

• Goudron

• Psoralen

• 5% Chrysophanic should not be applied to:

• Thin skin.

• Face.

• Whole body.

• Yellow oxide, mercury, subline should not be used together with iodine.

6. Mechanism of action of topical medications:

• Increase/ reduce water evaporation through the skin.

• Penetrate shallow/ deep into the skin.

• Affect vasoconstriction/ vasodilation.

7. Effects of different forms of topical medications:

• Ointment:

• Prevent water evaporation.

• Penetrate deeply.

• Vasodilate.

• Solution:

• Increase water evaporation.

• Usually only on the surface.

8. Applications of topical medications in disease treatment:

• Acute lesions: Use powders, solutions.

• Chronic disease, thick skin, scaly: Use ointments.

• Subacute disease: Use oils, pastes, creams, gels.

9. Some commonly used topical medications:

• BSI solution:

• Composition:

• Benzoic

• Salicylic

• Iodine crystals

• 70% Alcohol

• Effects:

• Antiseptic

• Antifungal

• Anti-itching

• Mild exfoliation

• No moisture absorption effect.

10. Note:

• Acute eczema: Apply Jarish solution.

• Subacute eczema: Use paste.

• Chronic eczema: Apply ointment.

• Ointment should be limited to the folds.

Conclusion:

Topical medications are one of the common treatments for skin diseases. Understanding the forms of topical medications, their effects, indications, and how to use them will help you use them effectively and safely.