Articles Index - Hydrolats
 
Local Skin Treatments
 
Emollients soothe, smooth and hydrate the skin and are indicated for all dry or scaling disorders. Their effects are short-lived and they should be applied frequently even after improvement occurs. They are useful in dry and eczematous disorders, and to a lesser extent in psoriasis. Light emollients, such as aqueous cream, are suitable for many patients with dry skin but a wide range of greasy preparations including white soft paraffin, emulsifying ointment and a mixture of white soft paraffin and liquid paraffin are available. None of these are any more effective or any healthier than the naturally occurring oils, which cover the spectrum from light to greasy, from heavy and highly nutritious to light and soothing.
 
Barrier preparations
Often contain water-repellent substances such as dimeticone or other silicones. They are used for areas around stomas, pressure areas in the elderly, bedsores, etc. It is doubtful that they are any more effective than the traditional compound zinc ointments. Never forget, of course, that natural oil is water-repellent!
 
Pruritis
May be caused by systemic disease (such as drug sensitivities, endocrine diseases and certain malignancies) as well as by skin diseases (psoriasis, eczema, urticaria, scabies). An emollient may be of value where the pruritis is associated with dry skin. Pruritis that occurs in otherwise healthy people can also be treated with an emollient. Preparations containing crotamiton are sometimes used but are of uncertain value. Preparations containing calamine are often ineffective, unlike the natural calamine. A topical preparation containing doxepin 5% causes drowsiness and there is a risk of sensitisation. Topical antihistamine and local anaesthetics are only marginally effective and may cause sensitisation.
 
Topical corticosteroids
Are used for the treatment of inflammatory conditions of the skin other than those due to an infection, in particular the eczematous disorders. Corticosteroids suppress the inflammatory reaction while in use; they are in no sense curative, and when treatment is discontinued a rebound exacerbation of the condition may occur. They are of no value in the treatment of urticaria and are contraindicated in rosacea. They may worsen ulcerated or secondarily infected lesions. They should not be used indiscriminately in pruritis and are not recommended in acne.
Side-effects can be systemic via absorption through the skin. Local side-effects include the spread and worsening of infections, the thinning of the skin, the irreversible striae formations and telangiectasia (bunch of dilated capillaries), contact dermatitis, dermatitis of the face, acne at the site of application, depigmentation of the skin.
 
Salicylic acid
May be used in all hyperkeratotic and scaling conditions to enhance the rate of loss of surface scale. Side-effects include irritation and toxicity.
 
Coal tar
Is more active than salicylic acid and has anti-inflammatory and anti-scaling properties. The use is limited by its unpleasant appearance and smell and it cannot be used on the face.
 
Topical retinoids
Used in the treatment for acne, causes redness and skin peeling. These preparations are known not be effective within several months of using them. They should never be used when large areas are involved. Contact with eyes, nostrils, mouth and mucous membranes, eczematous, broken or sunburned skin should be avoided. They should be used with great caution on areas such as the neck, and accumulation in angles of the nose should be avoided. Exposure to UV light (including sunlight, solariums) should be avoided. Topical retinoids are contraindicated in pregnancy and breas-feeding. Local reactions include burning, erythema, stinging, pruritis, dry or peeling skin, increased sensitivity to UVB light or sunlight, eye irritation and oedema, and blistering or crusting of the skin.
 
Sunscreen preparations
Stop your system being penetrated by the sunlight's spectrum. It is this penetration that is responsible for many natural processes from the making of vitamin D, the production of 'happy chemicals' and the uptake of extra energy by the system. The feel-good factor the sun brings is translated into biochemical processes of the body by means of the penetration of the sun's rays into the skin. Interfering with this process is detrimental to our health. During sensible sun exposure we can protect the skin by applying natural oils which will both protect against the drying out effect and will deliver essential nutrients to the cells. It is the combined effect of the sunlight and the application of chemicals on the skin that is responsible for local as well as several systemic breakdowns of the body's function.
 
Antifungal preparations
Used for the treatment of local fungal infections but have disappointing results, and very often a switch is made to the use of systemic preparations over a long period of time
 
© By Patrick Quanten MD
 
May June 07
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