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Chapter 6: Principles of Management

Carol Soutor

INTRODUCTION TO CHAPTER

Most common skin disorders can be treated with a formulary of cost-effective, widely available topical and oral products. Topical medications are effective for most common skin disorders and they have fewer serious adverse side effects when compared with their oral counterparts. Oral medications may be needed if a skin disease is widespread or more severe.

There are several things to consider before prescribing a topical product such as the active ingredient, the vehicle, and the quantity to dispense.

VEHICLE SELECTION

The vehicle of a topical product may be as important as the active ingredient. Table 6-1 lists commonly used vehicles. "If it's dry, wet it and if it is wet, dry it" is still a good general guideline for treatment of common dermatoses. Most skin disorders, especially the chronic dermatoses (eg, psoriasis, chronic contact dermatitis), are "dry"; therefore, ointments are preferred as they are more moisturizing. Also, ointments do not contain preservatives that can cause stinging and burning. The main problem with ointments, is that they are greasy and can stain clothing and bedding. Creams are a good option for the "wet" dermatoses, such as acute contact dermatitis, and other blistering or exudative dermatoses. They are also a good option for adults who do not want to use an ointment. However, some cream preparations are slightly drying and preservatives and other ingredients in the vehicle may sting or burn.

Table 6-1.Vehicles for topical products arranged from most moisturizing to most drying.
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Table 6-1. Vehicles for topical products arranged from most moisturizing to most drying.
Vehicle Formulation Indications
Ointment 80% oil and 20% or less water, petroleum jelly base, greasy, no preservatives, effective at moisturizing skin; may stain paper, clothing, and bedding Best vehicle for most "dry," thick, lichenified or fissured dermatoses (eg, atopic dermatitis and psoriasis), does not sting
Cream 50% oil and 50% water emulsion, moderate moisturizing effects, some residue, contains preservatives Best vehicle for acute dermatitis and in cases in which ointments are not tolerated, for example, hot, humid climate, intertriginous skin
Lotion Similar to cream with more water and lower viscosity, spreads easily, minimal residue, contains preservatives Used in many moisturizers and sunscreens, cosmetically acceptable
Gel Transparent base that liquefies on contact with skin, residue minimal, but may be shiny, drying Best vehicle for facial and hair-bearing areas, cosmetically acceptable
Solution Low viscosity, transparent, base of water and/or alcohol, very drying, evaporates quickly leaving no residue Best vehicle for scalp dermatoses, too drying and irritating for use on other body areas
Foam Leaves minimal residue, may be drying Usually used in hair-bearing areas
Powder Talc based, drying, decreases frictional forces in intertriginous areas Used in body fold areas and feet

QUANTITY TO DISPENSE

The quantity of medication to be dispensed and the amount of ...

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