What do dermatologists prescribe for pain

Treatment strategies in dermatology

Medicines for external use on the skin Externa (Local therapeutics) called.

Medicinal Basics

Decisive for the success of the treatment is not only the active ingredient contained in the drug, but also the mixture of carriers, auxiliaries and preservatives (i.e. the drug bases) with which it is applied to or into the skin. The basis defines the dosage form and the properties of the preparation perceived by the patient:

  • Greasy bases (anhydrous bases) such as petroleum jelly or fatty ointment smooth rough, rough skin, which is why they are the product of choice for extremely dry and flaky skin. The disadvantage, however, is that they hinder the release of water and heat and leave behind a pronounced greasy sheen.
  • Fluid foundations Like water or alcohol, it has a cooling effect and relieves itching, and alcohol also has a disinfectant effect. They make it easier to distribute the active ingredient over a large area on the skin and do not stick the hair together. With frequent use, however, they dry out the skin.
  • Solid foundations, z. B. Powders made from talc, starch or zinc oxide absorb secretions such as sweat. Because of their drying properties, they are not suitable for extremely dry skin.

The most common are combinations of the above-mentioned bases in the form of emulsions. In the case of an emulsion of the oil-in-water type (O / W emulsion), fat or oil is finely distributed in the water, as is the case with milk. An emulsion of the water-in-oil type (W / O emulsion), on the other hand, has the opposite composition.

  • O / W emulsions have a high proportion of water. Therefore, they are only slightly greasy, but provide plenty of moisture. In addition, the high water content leads to a cooling effect that z. B. Relieves itching. Last but not least, O / W emulsions are easy to apply, are quickly absorbed and do not leave a greasy film.
  • W / O emulsions, on the other hand, have a high proportion of fat or oil. They put a lot of fat on the skin B. for refatting, but only a little moisture. Compared to O / W emulsions, they are more difficult to spread on the skin, absorb more slowly and leave the skin with a slight oily sheen.

So that the emulsion does not break down again into its individual components, it needs an emulsifier as an auxiliary.

Emulsifiers and preservatives are stated on the label or on the package insert of a product.

In order to ensure an individual dermatological therapy, the doctor not only prescribes finished medicinal products as external agents, but also formulations specially tailored to the individual patient, which are based on in the pharmacy Basic preparations (e.g. base lotion, base cream or base ointment). By definition, basic preparations do not contain any medicinal products.

In the context of interval therapy, basic preparations are also used alternately as a pure basic preparation and as a basic preparation with an active ingredient. This is particularly useful for long-term cortisone therapy so that the skin areas affected by the side effects of cortisone can recover. In order to facilitate this interval therapy, many manufacturers therefore offer identical basic preparations for their cortisone preparations, e.g. B. Dermatop® ointment with cortisone and Dermatop® base ointment without active ingredient.

Basic preparations are also recommended for daily skin care in the case of relapsing skin diseases (e.g. neurodermatitis and psoriasis), for the follow-up treatment of a skin disease that has been overcome and, last but not least, for the daily care of healthy skin.

Active pharmaceutical ingredients

The most important externally applied groups of active ingredients in dermatology are:

  • Anti-inflammatory drugs used to treat mild inflammation, e.g. B. Bufexamac for a slight atopic dermatitis attack.
  • Cortisone suppresses all inflammatory processes in the skin (e.g. hydrocortisone in Ebenol® ointment). There are many different cortisone preparations that differ in their potency. The higher the effectiveness, the more likely it is that side effects will occur on the treated skin: enlarged veins, acne, permanent skin thinning or increased hair growth. With long-term or large-scale use, highly effective preparations also lead to general side effects, as are typical for the use of cortisone. Despite these disadvantages, cortisone is an indispensable active ingredient in selected cases that cannot be replaced by any other drug.
  • Immunosuppressants such as tacrolimus (Prograf®) have only recently become available active ingredients, e.g. B. against acute eczema flare-ups. Like cortisone, they intervene in the immune system and suppress inflammatory processes, but without its side effects.
  • Antibiotics used to treat bacterial infections, such as erythromycin for acne vulgaris.
  • Antimycotics for the treatment of fungal and yeast infections, for example Amorolfin in Loceryl® nail polish for nail fungus.
  • Antivirals for the treatment of viral infections, e.g. B. Aciclovir (Zovirax®) for cold sores.
  • In the case of allergies, antihistamines prevent the effects of histamine and thus relieve itching e.g. B. Dimetinden in Fenistil® gel or chlorophenoxamine in Systral® cream.
  • Local anesthetics have a local anesthetic effect, e.g. B. Benzocaine in Anaesthesin® ointment. You will v. a. used to relieve pain during medical interventions, e.g. B. with a skin biopsy.
  • Keratolytics are used to remove calluses or scales, such as salicylic acid from corns.

For some skin diseases, systemic, i.e. internally effective drugs are required, v. a. in the case of extensive skin changes, stubborn and severe forms of the disease or if an active ingredient cannot overcome the skin barrier due to its chemical-physical properties

Further therapy options

In addition to drug therapy, other treatment methods are available to the dermatologist:

In the light therapy (Phototherapy) one uses the fact that some skin conditions are improved by natural sunlight or artificial UVB or UVA light. The positive effect of UV light can be increased by bathing in brine or sea water, balneo-phototherapy and certain chemical substances (chemo-phototherapy). One example is PUVA therapy, which is very popular for treating psoriasis.

Laser therapy. Laser therapy, surgical measures and cold therapy are suitable for destroying or removing damaged tissue: the doctor uses laser beams to treat v. a. minor skin changes, e.g. B. the red veins in rosacea. Overgrown skin changes or malignant skin tumors, on the other hand, are usually removed surgically.

In the Cold therapy (Cryotherapy) the affected areas of the skin are cooled so much that ice crystals destroy the cells. So z. B. Remove plantar warts with carbonated snow. Since the connective tissue between the cells is preserved, the risk of scarring is low.

Authors

Dr. med. Arne Schäffler, Dr. med. Berthold Gehrke, Dr. Ute Koch in: Health Today, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 13:57