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Posts for tag: psoriasis

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 H Qiblawi
September 04, 2019
Category: Uncategorized
Tags: Skin   dermatology   psoriasis   trigger   strep   stress   beta blocker  

Plain Field in Front of Mountain Peak

 

Psoriasis is a disease that many of us have encountered in our daily lives. Chances are you know someone who has it, or you may even have it yourself. Psoriasis is a disease that causes flaking of the skin with inflammation and thick white, silvery, or red patches of the skin. The scaly patches can be anywhere on the body, but tends to effect the elbow, knees, face, hands and feet, nails, and skin folds (e.g. armpits).

So what causes psoriasis?

Psoriasis is an autoimmune skin condition that speeds up the life cycle of skin cells and causes them to build up on the surface of the skin. The patches and scales that are seen on the affected areas are from this process. There are common things that can trigger a psoriasis flare that are important to know about if you or a loved one has psoriasis.

Triggers of Psoriasis:

1. Strep infections:

Strep throat infections have been linked to causing flares of psoriasis in some people. When you get a strep throat, your immune system responds by sending many immune cells to the tonsils to fight the infection. It is believed that some of these immune cells go to the skin and can trigger a psoriasis flare up. According to a study that looked at the relationship between psoriasis and strep throat, 42% of plaque psoriasis patients reported that their psoriasis got worse when they had a sore throat. Interestingly, 48% of patients who had their tonsils out after getting psoriasis reported that their psoriasis got better.  

 

shallow focus photography of prescription bottle with capsules

 

2. Beta blockers:

Beta blockers are a very common drug class that is used for controlling arrythmias, high blood pressure, and many other conditions. This class of drugs has been reported to induce and exacerbate psoriasis in many people. The latency period between taking a beta blockers like propranolol, atenolol, and metoprolol, and a drug eruption can range from several days to 48 weeks. It was also found that eruptions were usually resistant to psoriasis medications until the Beta-blocker was discontinued.

3. Anti malarial medications:

Medications that are used to treat malaria have been shown to exacerbate psoriasis in many patients. Antimalarials are commonly used to treat psoriatic arthritis, which is an arthritis that can be caused coexist with psoriasis, but can commonly precipitate eruptions and flares of psoriasis. Because of this, some authorities say that antimalarials are contraindicated in patients with psoriasis.

4. Stress:

Stress is commonplace in many of our lives, and it can have negative effects on many parts our life. Unfortunately, this is also the case for psoriasis and flareups. Stress is a very common trigger for psoriasis and it is important to reduce stress to lower your chances of having a psoriasis flare due to stress. Exercise and meditation have been shown to help patients reduce their stress and thus reduce the amount of psoriasis flares that can occur due to stress that compounds throughout a long period of time.

Check out the National Psoriasis Foundation website: https://www.psoriasis.org  for more information about psoriasis.



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