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Principles of Prescribing in Dermatology
31 May, 2016
- Detailed history of allergy due to drugs taken in the past should be taken before prescribing any drug. Also history of ingestion of other drugs must be obtained to avoid drug interaction.
- Nature of treatment depends on the stage of the disease. More acute the condition less strong the local applications e.g. lotions for acute conditions, creams for subacute conditions , creams or ointment for chronic conditions.
- Vehicle in which the medication is incorporated requires careful consideration as does the manner of application.
Use of incorrect form of medicament will aggravate rather than improve the condition by causing sensitization.
- Areas near the eyes and genitals should be treated with mild remedies because of increased percutaneous absorption.
- Adhesive plaster should be used with caution and not close to an acute skin lesion.
- Patent or proprietary preparations should be used only after studying their composition, side effects and contraindications.
- Ultraviolet therapy should be used with discretion in local treatment as wrong use of it may aggravate the condition.
It should be avoided in cases with a history of photosensitivity and in lupus erythematosus or anti-fungal treatment.
- H/O previous application of corticosteroids can change the clinical picture of the disease.
- X-ray therapy in skin diseases should be left to the expert.
- If malignancy is suspected biopsy should be done before starting any treatment.
- Associated diseases like diabetes, hypertension, pepticulcer or pulmonary tuberculosis should be excluded before prescribing certain drugs such as corticosteroids.
- Avoid all drugs in the first trimester of pregnancy. Use minimum unavoidable drugs in later pregnancy. Strong steroid ointment should be avoided since if applied for a long time. They are absorbed into the blood. Ask for epilepsy as drugs given for the same may interact with some anti-fungal drugs.
- Additional drugs may have to be incorporated in the prescription to counteract the side-effects of main drug prescribed antacids when corticosteroids are used.
- Patient who has been fully treated should be re-examined at frequent intervals to observe and note untoward effects of drug prescribed and to check a release.
- In contagious skin disease, not only the patient but all the family members and contacts should be examined and if found infective, should be treated simultaneously for scabies.
- Treatment should be divided into two parts:
Topical therapy is the mainstay in dermatological practice. Understanding the principles of the therapy is important.
- Many topical agents penetrate the skin barrier and enter the blood circulation. Absorption is more in infants and children and this must be kept in mind with corticosteroids.
- Hydration of skin before topical application enhances absorption. If local application is not applied in correct strength it may give rise to side effects like irritation, burning.