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Posts for tag: medicine

By Michael J. Visconti, BSc & David Fivenson, MD
September 30, 2019
Category: Uncategorized
Tags: Skin   dermatology   medicine   psoriasis   topicals   therapy   eczema  

Many skin conditions are treated with topical medications. Instead of applying active medicine directly onto the skin, “vehicles” are combined with the chosen medication to aid in its delivery. Vehicles are inactive creams, lotions, solutions and/or ointments that change the properties of the medicine mixed into them – assisting its application.

The primary components of vehicles include powders, oils, and liquids. The inherent properties of these three ingredients is translated to the vehicle, and thus how the medicine is delivered on the skin. For example, a vehicle with a prominent liquid component can assist with the drying of wet skin lesions through evaporation, whereas oils can provide an occluding coating to the skin and enhance the penetration of the active medicine.

When vehicles are combined with active medicines, you get “formulations”. Formulations can be creams, ointments, lotions, solutions, and foams embedded with active medicine. Different formulations have different potencies (i.e. triamcinolone ointment is more potent than triamcinolone cream) and different body region applications (i.e. solutions for the scalp instead of creams). The consideration of which formulation to use is crucial, as certain formulations are easier to use, therefore promoting adherence to a treatment regimen and overall improvement of a patient’s skin condition.

Outline of formulations:

  • Cream
  • Ointment
  • Lotion
  • Gel
  • Foam
  • Solution

Cream:
Creams are predominantly mixtures or emulsions of oils in water. Creams are usually white in color and easily rubbed in without leaving much of a residue. They are applicable to numerous body regions. For these reasons, they tend to be favored by patients and frequently prescribed by clinicians. Creams are particularly beneficial in the skin folds and offer a drying effect to help with wet or damp skin lesions. Additionally, certain creams can be “augmented”, meaning they are more potent and penetrate the skin deeper (i.e. betamethasone dipropionate vs. betamethasone dipropionate augmented). Because a cream is an oil in water emulsion, it requires added agents to keep the mixture stable. This is the same idea as the difference between oil and water salad dressings and a thicker one like ranch or thousand island.

Ointment:
Ointments are mainly composed of oils and greases with a small amount of water. Oils are translucent and greasy, with the latter characteristic making them cosmetically unfavorable for some patients. They provide great lubrication and can be used on dry skin lesions. Ointments are more occlusive, which allows for better penetration of medication through the skin and higher potency. Because of this effect, ointments may not always be indicated for certain regions of the skin that are naturally thinner than others (i.e. the face, armpits, groin folds, etc.). Ointments work best in smooth skin regions lacking hair and on thick and dry skin lesions.

Lotion:
Lotions are composed of powder and water. Lotions are easily spread but only slightly occlusive, making them the least potent topical vehicle. However, lotions are useful in the treatment of moist or exudative skin lesions, as they provide a drying effect through evaporation after application. Lotions can be useful in hairy areas of the skin, as well as large areas due to their ease of application.

Gel:
Gels may appear similar to ointments, except they are composed of water, carboxymethylcellulose beads, propylene glycol, and occasionally alcohol. Gels are translucent, greaseless, and easy to apply. For comparison, think of the common surgical lubricant or K-Y Jelly. Gels dry and form a thin film, which does not stain or leave behind greasy texture. These features make gels cosmetically favorable, but they are poorly occlusive and do not provide hydration. Gels are particularly applicable for acne and hair-bearing areas, since they do not mat down the hair after drying.

Foam:
Foams are composed of liquid film and gas bubbles. Foams easily spread and absorb into the skin while leaving behind little residue. Because of this, they are cosmetically appealing and more expensive formulations. Foams provide little to no hydration or occlusion. However, certain types of foams called emollient foams can provide skin hydration and build up the skin barrier - making them advantageous over traditional foams. Because of their easy application, foams are often utilized on the scalp or other hair-bearing areas.

Solution:
Solutions are very thin and light. They are made from water, alcohol, and other liquids. Solutions come in a clear or hazy, thin-textured, liquid phase. As a result of this, they can be drying from evaporation, easy to spread, and messy to apply. Solutions are most useful for the scalp, as they can penetrate the skin through hair. Due to the presence of alcohols, they are more prone to stinging sensations when applied to inflamed skin.

By Sultan Qiblawi
June 16, 2019
Category: Uncategorized
Tags: Skin   dermatology   pemphigus   autoimmune   medicine   skincare  

 

There are a subset of dermatological diseases that are not very well known to the general public that can be painful, and potentially life threatening. In today’s post, I want to shed some light on one of these diseases: pemphigus vulgaris.

First off, I would like to give you some stats about how frequently this disease occurs in the general population. Pemphigus vulgaris affects about 0.7-5 people per 1,000,000 per year in the general population. This is not a very common disease, but its affects can be debilitating and missing this diagnosis can pose serious problem for the person who actually has it.

Dr. Fivenson is a nationally recognized leader in bullous diseases, like pemphigus, and he sees hundreds of these patients. He, and his team, are here to make sure you get the most accurate distilled information about rare dermatological disorders, and what you should look out for.

So what is pemphigus?

Pemphigus is a rare chronic blistering skin condition that is caused by the immune system attacking the body. These types of diseases are called autoimmune diseases, and in this case, your immune cells are making antibodies against your skin, specifically the epidermis. This means that the disease is not contagious, and cannot be transferred to people by any mode of transmission (i.e. blood, fluids).  It can happen to people at any age, but it tends to happen to middle aged adults or older adults.

Pemphigus vulgaris: this subtype of pemphigus creates blisters that generally start in the mouth and then appear on the skin or the genital mucous membranes (i.e. vagina, urethra, and underside of the foreskin). There can also be nail loss, alteration of the skin pigment, and severe disability if it is not taken care of quickly. Pemphigus vulgaris is not a disease that will go away by itself. It needs active treatment to control the flares and reduce downstream complications.

What should you look out for?

Pemphigus causes severe blistering in the mouth and other parts of the skin. Sometimes your skin can readily peel off and this can lead to increased infection, dehydration, and disfigurement. The blistering can be very painful, can have severe itching, and can even burn. 

The type of blister you get is also characteristic of the disease: big, flaccid bullae that burst easily. This means that the blisters will rarely form because they rupture almost immediately after they form. The rupturing blisters lead to multiple, superficial, ulcerated sores throughout the mouth. These painful sores are the more common sign that people initially see. 

What should you do if you suspect you have this?

If you suspect that you have this type of dermatological disease or any other concerns with your skin, contact your dermatologist. They will be able to guide you and work with you to see exactly what you have. There are also fantastic resources on our website about pemphigus and other blistering skin diseases that you can read about on Patient Resources page.

Dr. Fivenson is a nationally recognized specialist in autoimmune skin disorders, like pemphigus. He is board certified in dermatology and immunodermatology, and has published over 125 peer reviewed articles in dermatology. 

 

Resources:

https://rarediseases.org/rare-diseases/pemphigus/

https://www.mayoclinic.org/diseases-conditions/pemphigus/symptoms-causes/syc-20350404

http://www.pemphigus.org/living-with-pemphigus-pemphigoid/understanding-pemphigus-pemphigoid/

 



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