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Topical Keratolytics & Topical Keratolytics & Topical Steroids Topical Steroids Jignesh Patel, Jignesh Patel, IV BDS IV BDS Dept. of Oral Medicine Diagnosis & Dept. of Oral Medicine Diagnosis & Radiology Radiology K.M.Shah Dental College & Hospital K.M.Shah Dental College & Hospital Pipariya, Vadodara Pipariya, Vadodara

Topical keratolytics & topical steroids

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Page 1: Topical keratolytics & topical steroids

Topical Keratolytics &Topical Keratolytics &Topical SteroidsTopical Steroids

Jignesh Patel,Jignesh Patel, IV BDSIV BDS

Dept. of Oral Medicine Diagnosis & RadiologyDept. of Oral Medicine Diagnosis & RadiologyK.M.Shah Dental College & HospitalK.M.Shah Dental College & Hospital

Pipariya, VadodaraPipariya, Vadodara

Page 2: Topical keratolytics & topical steroids

Routes of drug Routes of drug administration?administration?

• There are ThreeThere are Three RoutesRoutes of of administrationadministration::

–Local Or TopicalLocal Or Topical–Oral or enteralOral or enteral–parenteralparenteral

Page 3: Topical keratolytics & topical steroids

Topical Applications:Topical Applications:

• Types ofTypes of topical applicationstopical applications include:include:

–PowderPowder–PastePaste–lotionslotions–DropsDrops–Ointments etc…Ointments etc…

Page 4: Topical keratolytics & topical steroids
Page 5: Topical keratolytics & topical steroids

DefinitionDefinition

• KeratolyticsKeratolytics are the drugs which,are the drugs which, when applied locally,when applied locally, cause a mildcause a mild peeling (Removal ofpeeling (Removal of epidermis or superficial layer of theepidermis or superficial layer of the epithelium)epithelium) of the skin or mucous of the skin or mucous membranemembrane

Page 6: Topical keratolytics & topical steroids

Pharmacological action:Pharmacological action:

• Keratolytics removes the Keratolytics removes the pathologic pathologic desquamated keratin layerdesquamated keratin layer from the from the superficial layer of the skin and superficial layer of the skin and mucous membrane by mucous membrane by its chemical its chemical mode of actionmode of action

• Keratolytics removes excessive Keratolytics removes excessive keratin layer formed by keratin layer formed by defective defective desquamationdesquamation of keratocytes of keratocytes

Page 7: Topical keratolytics & topical steroids

Keratolytic agents:Keratolytic agents:

• Salicylic acidSalicylic acid

• Propylene glycolPropylene glycol

• UreaUrea

• Benzoyl peroxideBenzoyl peroxide

• TretinoinTretinoin

• Podophyllin resinPodophyllin resin

Page 8: Topical keratolytics & topical steroids

Salicylic acidSalicylic acid

• Uses:Uses:– In concentration ofIn concentration of 0.5-2 %0.5-2 % to treatto treat

acneacne vulgarisvulgaris– In concentration ofIn concentration of 6%6% as anas an ointmentointment

used in the tretment of used in the tretment of psoriasispsoriasis and and seborrheic dermatitisseborrheic dermatitis

– AA 15-25% soln. in lactic acid15-25% soln. in lactic acid is used is used to treat to treat wartswarts

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Salicylic acid ointment

Page 10: Topical keratolytics & topical steroids

UreaUrea

• Urea is used in the form ofUrea is used in the form of cream &cream & ointmentointment to treatto treat psoriasispsoriasis & & atopicatopic dermatitisdermatitis

• Urea hasUrea has hydrating, keratolytichydrating, keratolytic && antipruritic actionsantipruritic actions

• ItIt increases absorption of increases absorption of hydrocortisonhydrocortison when used in when used in combinationcombination

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Urea Cream

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Benzoyl peroxideBenzoyl peroxide

• Used asUsed as 5-10% cream5-10% cream oror lotionlotion for for mild to moderate acnemild to moderate acne

• It is effective mainly due to itsIt is effective mainly due to its keratolytickeratolytic && bacteriostaticbacteriostatic activity activity against acne bacilliagainst acne bacilli

• Drug mayDrug may cause irritationcause irritation

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Benzoyl peroxide cream

Page 14: Topical keratolytics & topical steroids

Podophyllin resinPodophyllin resin

• Hairy tongue-Hairy tongue- results from theresults from the defectivedefective desqumationdesqumation of cells that make up of cells that make up secondarysecondary filliform papillae, this build up of filliform papillae, this build up of keratin resultskeratin results in the formation ofin the formation of elongated elongated hairshairs that isthat is hallmarkhallmark of this activityof this activity

• Podophyllin resin-Podophyllin resin- 1%soln.1%soln. andand

topical tretinointopical tretinoin is used in the is used in the treatment of treatment of Hairy tongueHairy tongue

Page 15: Topical keratolytics & topical steroids
Page 16: Topical keratolytics & topical steroids

DefinitionDefinition

• Topical steroidsTopical steroids are medicines in the form are medicines in the form ofof cream, ointment or lotion that are used cream, ointment or lotion that are used to treat certain skin problems such asto treat certain skin problems such as eczema, psoriasiseczema, psoriasis and otherand other dermatological conditionsdermatological conditions

butbut in Dentistryin Dentistry topical steroidstopical steroids are are used toused to treat treat severe erosive-bullous severe erosive-bullous diseasesdiseases, , aphathousaphathous ulcers and ulcers and herpatiform diseasesherpatiform diseases

Page 17: Topical keratolytics & topical steroids

Classification of topical steroid Classification of topical steroid preparationpreparation

• MildMild– Hydrocortison 1% Hydrocortison 1%

• Moderately PotentModerately Potent– Clobetasone butyrate 0.05%Clobetasone butyrate 0.05%

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• PotentPotent– Betamethasone valerate 0.1%Betamethasone valerate 0.1%– Hydrocortisone butyrate 0.1%Hydrocortisone butyrate 0.1%– Fluocinolone acetonide 0.025%Fluocinolone acetonide 0.025%– Trimecenolone acetonide 0.2%Trimecenolone acetonide 0.2%

• Very potentVery potent– Clobetasol propionate 0.05%Clobetasol propionate 0.05%

Page 19: Topical keratolytics & topical steroids

Pharmacological action ofPharmacological action oftopical steroidstopical steroids

• Anti-inflammatoryAnti-inflammatory

• Immunosuppresive and anti-allergicImmunosuppresive and anti-allergic

• Inhibit the function of macrophagesInhibit the function of macrophages

• InhibitInhibit the activaton of the activaton of cytotoxiccytotoxic

T lymphocyteT lymphocyte

• Complement system is inhibitedComplement system is inhibited

• Suppresses Suppresses cell mediated cell mediated hypersensitivityhypersensitivity

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Common indication of topical Common indication of topical steroidssteroids

• Severe recurrent aphthous ulcerSevere recurrent aphthous ulcer

• Behcet’s syndromeBehcet’s syndrome

• Pemphigus vulgarisPemphigus vulgaris

• Mucous membrane PamphigoidMucous membrane Pamphigoid

• Erythema multiformeErythema multiforme

• Erosive Lichen planusErosive Lichen planus

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Erosive Lichen planusErosive Lichen planus

Pemphigus vulgaris

Erythema multiforme

Page 22: Topical keratolytics & topical steroids

Topical corticosteroids used to treat Topical corticosteroids used to treat ulcerative and vesiculobullous oral ulcerative and vesiculobullous oral mucosal lesionsmucosal lesions

• BetamethasoneBetamethasone-- 0.1% cream0.1% cream oror 0.05%0.05% gelgel applied thinly b.i.d.applied thinly b.i.d.

• ClobetasolClobetasol-- 0.05% cream0.05% cream or gel or gel applied thinly b.i.d.applied thinly b.i.d.

• HalobetasolHalobetasol- - 0.05% cream0.05% cream or gel or gel applied thinly b.i.d.applied thinly b.i.d.

• FluocinoloneFluocinolone-- 0.05% cream0.05% cream or gel or gel applied thinly b.i.d.applied thinly b.i.d.

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Hydrocortisone 0.1% (mild)

Betamethasone 0.1% (potent)

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Intralesional steroidal inj. Of dexametahsone

Trimecenolone 0.1% (potent)

Clobetasol 0.05%

(very potent)

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How they are applied?How they are applied?

• Topical steroids should be Topical steroids should be spread thinlyspread thinlyon the affected area of skin.on the affected area of skin.

• One way of One way of measuring amountsmeasuring amounts of topical steroids of topical steroids is in is in ‘fingertip units’,‘fingertip units’, which is the distance from which is the distance from the tip of the index finger to the first crease.the tip of the index finger to the first crease.

• the topical steroid After you have applied the topical steroid After you have applied washwash your your hands thoroughly.hands thoroughly.

• With some of the more potent topical steroids, With some of the more potent topical steroids, you may be advised to you may be advised to apply the medicine using apply the medicine using a cotton buda cotton bud rather than your fingers. rather than your fingers.

Page 26: Topical keratolytics & topical steroids

Local side effects of topical Local side effects of topical steroids include:steroids include:

• Skin thinningSkin thinning (atrophy) and (atrophy) and stretch stretch marksmarks (striae). (striae).

• Easy bruisingEasy bruising and tearing of the skin. and tearing of the skin.• Perioral dermatitisPerioral dermatitis (rash around the (rash around the

mouth).mouth).• Enlarged blood vessels Enlarged blood vessels (telangiectasia).(telangiectasia).• Susceptibility to Susceptibility to skin infections.skin infections.• AllergyAllergy to the steroid cream. to the steroid cream.

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Commonest side effect of Commonest side effect of topical steroid in oral cavity is:topical steroid in oral cavity is:

• Oral candidiasisOral candidiasis due to decrease in due to decrease in immune cells including neutrophills, immune cells including neutrophills, monocytes, macrophages & plasma monocytes, macrophages & plasma cellscells

• Use of Use of chlorhexidine chlorhexidine before steroid before steroid application helps prevent fungal application helps prevent fungal infection infection

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Systemic adverse effects:Systemic adverse effects:

• Systemic adverse effects are rare with Systemic adverse effects are rare with topical steroidstopical steroids

• Some of them are:Some of them are:– Cushing's syndromeCushing's syndrome– Adrenal Gland SuppressionAdrenal Gland Suppression– Gastric irritationGastric irritation– Mood swing & insomniaMood swing & insomnia– Hyperglycemia & weight gainHyperglycemia & weight gain– Water retaintion and arterial hypertentionWater retaintion and arterial hypertention– osteoporosisosteoporosis

Page 29: Topical keratolytics & topical steroids

Therapeutic uses:Therapeutic uses:

• Oral lichen planusOral lichen planus: : 0.05%fluocinomide0.05%fluocinomide and and 0.05% clobetasol0.05% clobetasol is frequently used as a is frequently used as a cream or gelcream or gel

• Recurrent aphthous ulcerRecurrent aphthous ulcer: topical steroid: topical steroid

• Mucous membrane pemnphigoidMucous membrane pemnphigoid: : 0.1% 0.1% betamethasone or 0.05%clobetasolebetamethasone or 0.05%clobetasole– Intralesional inj. May be usedIntralesional inj. May be used

• erythema multiforme

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References:References:

• Burcket’s oral medicine, 10Burcket’s oral medicine, 10thth edition,pharmacology.edition,pharmacology.

• Gandolfo Sergio, oral medicine; Gandolfo Sergio, oral medicine; Churchill livingstone elsevier.Churchill livingstone elsevier.

• Satoskar R.S. ; pharmacology & Satoskar R.S. ; pharmacology & pharmacotherapeautics; twentieth pharmacotherapeautics; twentieth edition.edition.

• National institute of health & national National institute of health & national library of Medicine, pubmed, USAlibrary of Medicine, pubmed, USA

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