FARMAKOLOGI OBATOBAT YANG BEKERJA

PADA KULIT

dr. Rohmania Setiarini

Definisi
Farmakokinetik
Nasib obat di dalam tubuh
Absorpsi
Distribusi
Metabolisme
Eliminasi

Farmakodinamik
Efek obat terhadap tubuh
Terapi
Toksik

Farmakokinetik & Farmakodinamik

McLeod, HL, et. al. Peds Rev. 1992;13:413-421

Basics of Dermatological Therapy

Medical therapy in Dermatology consists of:
topical
systemic
phototherapy and
surgical procedures

Topical Therapy
The advantage of direct delivery and reduced systemic
toxicity make topical treatment quite attractive. There is
often a vehicle which then contains an active ingredient.

Vehicles include:
Cream a semi-solid emulsion of oil-in-water; contains a

preservative to prevent overgrowth of micro-organisms. Stabilize

by an emulsifier. Mostly water so mostly evaporates; non-greasy so
easy application and removal.

Gel a semi-solid transparent non-greasy emulsion.

Lotion liquid vehicle, aqueous or alcohol based, which may
contain a salt in solution. Calamine lotion is a shake lotion which
contains an insoluble powder. Lotions evaporate to cool the
inflamed/exudative skin.

Ointment a semi-solid grease/oil, sometimes also

containing powder, but little or no water. The active
ingredient is suspended. Usually, no preservative
needed. Ointments are best suited for dry skin disorders
rehydrate and occlude. Because they are greasy, they
are difficult to remove.

Paste An ointment with a high proportion of powder

which gives a stiff consistency. Pastes can be applied to
well-demarcated lesions. Due to its ointment base, they
are difficult to remove.

Emollients
Emollients are useful in dry-skin disorders due to their
ability to re-establish the surface lipid layer and
enhancing rehydration of the epidermis. There are
several emollient ointments, creams and oils added to
baths.

Overview of Topical Medications

Drug

Pharmacology

Indications

Antibiotics

Resistance and sensitization are

potential problems. Bacitracin,
chlortetracycline, gramicidin,
mupirocin, neomycin, polymixin,
sodium fusidate. Metronidazole
is used for rosacea.

Acne, folliculitis,
impetigo, infected
eczema, rosacea.

Antifungals

Amorolfine, clotrimazole,
Fungal infection of the
econazole, ketoconazole,
skin, Candidiasis.
miconazole, nystatin, terbinafine,
sulconazole.

Antiseptics

Chlorhexidine, iodine
Skin sepsis, leg
compounds, potassium
ulcers.
permanganate, silver nitrate.

Antivirals

Idoxuridine, acyclovir.

Coal tar

Presumed anti-inflammatory Eczema, psoriasis.

and anti-proliferative effects.

Corticosteroids

Anti-inflammatory, antiproliferative,
vasoconstrictive; different
strengths available.

Herpes simplex and

zoster.

Eczema, discoid lupus

erythematosus, lichen
planus, lichen
sclerosus, mycosis
fungoides,
photodermatoses,
pityriasis rosea,
psoriasis.

Dithranol

Anti-proliferative

Psoriasis.

Vitamin D
analogues

Inhibit keratinocyte
Psoriasis.
proliferation and
promote differentiation.
Calcipotriol, tacalcitol.

Keratolytics

Salicylic acid, benzoyl

peroxide, tretinoin.

Parasiticidals

Malathion, permethrin, Lice, scabies.

carbaryl for lice. Benzyl
benzoate, lindane,
malathion, permethrin
for scabies.

Acne, scaly
eczemas.

Steroid Topical

Class 1
Very potent (up to 600 times as potent as hydrocortisone)
Clobetasol propionate
Betamethasone dipropionate

Class 2
Potent (I50-100 times as potent as hydrocortisone)
Betamethasone valerate
Betamethasone dipropionate
Diflucortolone valerate
Fluticasone valerate
Hydrocortisone 17-butyrate
Mometasone furoate
Methylprednisolone aceponate

Class 3
Moderate(2-25 times as potent as hydrocortisone)
Aclometasone dipropionate
Clobetasone butyrate
Fluocinolone acetonide
Triamcinolone acetonide

Class 4
Mild
Hydrocortisone 0.5-2.5%

Skin absorption of topical steroids

Steroids are absorbed at different rates from different parts
of the body. A steroid that works on the face may not work
on the palm. But a potent steroid may cause side effects on
the face.
For example:
Forearm absorbs 1%
Armpit absorbs 4%
Face absorbs 7%
Eyelids and genitals absorb 30%
Palm absorbs 0.1%
Sole absorbs 0.05%

Skin side effects

Local side effects of topical steroids include:
Skin thinning (atrophy) and stretch marks (striae).
Easy bruising and tearing of the skin.
Perioral dermatitis(rash around the mouth).
Enlarged blood vessels (telangiectasia).
Susceptibility to skin infections.
Infection e.g. tinea incognito.
Allergy to the steroid cream.

Bruising

Prominent capillaries

Skin thinning

Stretch marks

Systemic Therapy
Systemic therapy is reserved for more serious
condition and infections.

Overview of Systemic Therapy

Group

Drug

Indications

Antiandrogens

Cyproterone

Acne (only in females)

Antibiotics

Various

Acne, rosacea, skin

sepsis

Antifungals

Griseofulvin
Ketoconazole
Itraconazole
Terbinafine

Fungal Infection
Fungal Infect.,
Candidiasis
Fungal Infect.,
Candidiasis
Fungal Infection

Antihistamines

H1 Blockers

Eczema, urticaria

Antileprotic

Dapsone

Dermatitis
herpetiformis, leprosy,
vasculitis

Antimalarials

Hydroxychloroquine

Lupus erythematosus,
prophyria cutanea
tarda

Antivirals

Acyclovir
Famciclovir

Herpes simplex/zoster
Herpes zoster, genital
herpes simplex

Corticosteroids

Prednisolone usually

Bullous disorders,
connective tissue
disease, vasculitis

Cytotoxics

Methotrexate
Hydroxyurea
Azathioprine

Psoriasis, sarcoidosis
Psoriasis
Bullous disorders,
chronic actinic
dermatitis

Immunosuppressant

Cyclosporin
Gold

Psoriasis, atopic
eczema
Bullous
disorders, lupus
erythematosus

Retinoids

Acitretin
Isotretinoin

Keratinization
disorders
Acne

Phototherapy
UVA
UVB
PUVA
PUVB

Terima Kasih