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Topicals

Topicals

Topical therapy is the most common treatment option utilized by dermatologists. Several categories of topical therapies are available that your Advanced Dermatology provider can take advantage of to treat your skin. Below is a list of several common classes of topical therapies and there uses.

Antibiotics: these are particles that either eliminate or inhibit the growth of microorganisms. Several classifications of microorganisms exist, with specific antibiotics targeting each class.

Antibacterials: these work by inhibiting several components of bacterial organisms, either directly killing them (bactericidal) or inhibiting their proliferation (bacteriostatic). Common medications used for skin infections or wound care include Bacitracin, Polymyxin B, Neomycin, Mupirocin, Retapamulin, Gentamicin, Silver sulfadiazine, and Iodoquinol. There are several other anti-bacterial agents use for acne and rosacea that include Benzoyl Peroxide, Clindamycin, Erythromycin, Metronidazole, Azelaic Acid, Dapsone and Sodium Sulfacetamide. Lastly, Triclosan, Chlorhexidine and Povidone-Iodine are a few agents used for hand hygiene and surgical sterilization.

Antifungals: most of these work by disrupting the cell wall either directly or its synthesis, with two exceptions. The commonly prescribed classes of anti-fungal medications include polyenes (Nystatin), azoles (Miconazole, Clotrimazole, Ketoconazole, Oxiconazole, Econazole, Sulconazole, Sertaconazole), allylamines (Naftifine, Terbinafine), and benzylamine (Butenafine). The two medications that work via other mechanisms include Ciclopirox and Selenium sulfide. These medications are prescribed for both yeast and fungal infections of the skin.

Antivirals: these work via three mechanisms – destroying virus (viricidal), stimulating the immune system (immune-enhancers) and destructive to cells (cytodestructive). Viricidal treatments include Acyclovir, Penciclovir, Cidofovir and Foscarnet. They are used mostly for herpes infections, with off-label use of Cidofovir for molluscum and warts (genital and non-genital). The only current immune-enhancer is Imiquimod, which is effective for warts, molluscum, and the non-infectious entities Actinic Keratoses and superficial Basal Cell skin cancer. Lastly, cytodestructive agents include Bleomycin, Podophyllin (and Podofilox), Trichloroacetic Acid, Cantharidin, Salicylic Acid, 5-Fluorouracil and Sinecatechin. These are all options for warts.

Antiparasitics: these work by several mechanisms, treating scabies, lice (pediculosis) and larva migrans. Common medications used for scabies include Permethrin, Ivermectin, Lindane, Crotamiton, Benzyl benzoate and Precipitated sulfur. Tea tree oil can also be recommended. Lice, both head and pubic, treatments include Permethrin, Ivermectin, Pyrethins, Lindane, Malathion and Spinosad. For head lice diluted vinegar or 8% formic acid can be tried. Larva migrans, also known as “Creeping Eruption”, is treated by Thiabendazole.

Steroids: topical corticosteroids (TCS) are an excellent therapeutic option for numerous inflammatory skin conditions like eczema, psoriasis, irritation, itching, amongst others. There are several TCS available and they all have different potencies, requiring a comprehensive knowledge to effectively prescribe these medications. Your Advanced Dermatology provider has extensive experience using TCS to appropriately treat the specific location(s) and severity of your skins ailment. Don’t let your skin continue to suffer, call for an appointment today.

Retinoids: retinoids are extremely effective topical forms of vitamin A. With the exception of Bexarotene, which is used for several inflammatory disorders, all retinoids are effective for acne, discoloration and skin changes related to photoaging. They work by normalizing how your skin functions and renews itself. Other conditions retinoids have shown efficacy include actinic keratoses (“pre-cancers”), early stretch marks, psoriasis, hand dermatitis and alopecia areata. Make an appointment today to ask your Advanced Dermatology provider about the benefits of topical retinoids.

Chemotherapeutics: pre-cancer (actinic keratoses) and certain cancers of the skin (some non-melanoma skin cancers and cutaneous T-cell lymphoma) are accessible to a topical treatment option, unlike internal cancer. There are a few topical therapies your advanced dermatology medical provider can use in a treatment regimen, so call and make an appointment today to discuss your options.

Contact Allergens: in certain skin conditions, in particular alopecia areata and warts, topical medications that stimulate the immune system in certain ways can lead to improvement. Currently there are three available products for your Advanced Dermatology medical provider to use for your condition including Diphenylcyclopropenone (DPC), Squaric Acid Dibutyl Ester (SADBE) and Dinitrochlorobenzene (DNCB). Experience with these treatments varies, so make sure to discuss these options at your appointment.

Calcineurin Inhibitors: these wonderful medications, tacrolimus and pimecrolimus, are FDA-approved for the treatment of tough-to-treat atopic dermatitis. Their major advantages over TCS are their ability to be used without the adverse effects of skin thinning and stretch marks. Due to their anti-inflammatory effects without significant side effects, they have been used for numerous conditions on all kinds of skin. Your Advanced Dermatology medical provider can further educate you about the benefits of these treatments, so call today for an appointment.

Vitamin D3: vitamin D is a hormone important in both the blood and skin. While it is important for maintaining normal calcium levels in the blood, in the skin it regulates normal growth and has immunosuppressive effects. There are currently two topical vitamin D analogues available for dermatologists to treat inflammatory skin conditions in the USA: Calcipotriene (Dovonex) and Calcitriol (Vectical). Calcipotriene has been combined with Betamethasone (a TCS) which is called Taclonex. While these are approved for psoriasis, they have been used off-label alone and in combination with other treatments for numerous skin ailments.

Sunscreens: sunscreens are the most effective option skin-care professionals recommend to encourage photoprotection and it’s deleterious effects, including photoaging, flaring of many skin conditions and skin cancer (including melanoma). With advanced knowledge of ultraviolet radiation and it’s effects on the skin, several new factors of sunscreens have been elicited to enhance protection. The better sunscreens are broad-spectrum (meaning they protect against both UVB and UVA) and non-comedogenic (so they won’t clog pores). Your Advanced Dermatology provider will provide you with excellent sunscreen products to maintain the health of your skin.

Therapeutic Shampoos: sometimes skin conditions effect the scalp, making standard topical therapies difficult to use. Dandruff (scaling), itching (pruritus) and infections (tinea capitis) can all be treated by prescription strength shampoos. The active ingredient(s) in the shampoo determine their function and include zinc pyrithione and selenium sulfide (cytostatic shampoos), salicylic acid with or without sulfur (keratolytic shampoos), tar (antimitotic shampoos), ketoconazole and ciclopirox (antimicrobial shampoos), and two topical TCS (Fluocinolone and clobetasol, both anti-inflammatory shampoos).

Cosmetics: as the endless quest for eternal youth and flawless skin continues to flourish in our society, your Advanced Dermatology skin specialists have several cosmetic therapies known to preserve the integrity of the hair, nails and skin along with enhancing their overall vitality.

Skin exfoliants are extensively used for skin rejuvenation, as well as for acne, dry skin, overgrowths and sun damage. Alpha-hxdroxy acids (including glycolic and lactic acid), Salicylic acid (β-hydroxy acid), Trichloroacetic acid (TCA) and Jessner’s solution are some of the more commonly utilized products. They have an excellent track record of successful results, which is why your Advanced Dermatology provider is likely to recommend one.

The level of pigment in one’s skin fluctuates, and sometimes there is a desire for less pigment while other times there is a desire to achieve more pigment. Hydroquinone is a skin lightening product used in the treatment of increased pigmentation from sun, inflammatory disorders and natural pigment. Newer formulations including skin exfoliants, retinoids and sunscreens. On the contrary, ‘sunless’ or ‘self’ tanner products are extremely popular amongst less pigmented caucasians who need or desire a quick tan appearance when they don’t have time (or have been educated against) developing a tan from the sun. The active ingredient is dihydroxyacetone and when applied appropriately provides a natural-appearing tan. It does not provide any sun protection, so it is still necessary to apply sunscreen.

Daily skin care involves several products including cleansers, moisturizers and for some make-up. Cleansers (soaps) are modified fats that have detergent properties. Many brands are commercially available with different additives and ingredients, which allow different claims owing to their individual properties. Moisturizers are mixtures of chemicals specially designed to perform three functions: prevent water loss, soothe irritated skin, and make the skin feel smoother and softer. They should always be applied after bathing and as often as needed to maintain optimal skin health. Lastly, facial foundations and camouflage cosmetics offer the advantage of adding color, blending pigmentary abnormalities and covering blemishes. There are several formulations and types, so an appointment with your Advanced Dermatology aesthetician will help you make the best choices for your skin.

Hair serves as an important component of insulation, protection, sensation and social communication. Daily care of one’s hair is an essential part of maintenance of appearance and symbolizes health and well-being. Shampoos are important for removal of excess oil and dirt while leaving the hair undamaged and ideally with enhanced body and luster. Changing the hair’s form (from straight to curly hair, and vice versa) and color (either lightening or darkening), are processes currently available to modify one’s appearance. There are several products available to perform these different processes, which your Advanced Dermatology provider can provide informed recommendations on.

Nails serve several biologic functions including aesthetic appearance, grooming, motor function, protection and social communication. With regards to appearance, nail polish is the primary cosmetic beautification product available today. There are several ingredients in most polishes, and newer technologies continue to appear on the market (shellac, gel-nails, etc). Some polishes have added ingredients to help with the strength and act as a protectant from environmental products.

Wound care: wounds are noticeable breaks in the skin barrier classified as acute (<6 weeks) or chronic (>6 weeks or frequently recurring) and have multiple etiologies. Wound care involves knowledge of the wound healing process, other factors contributing to the ability to heal, and treatment options available to augment healing. A full evaluation by your Advanced Dermatology medical provider is crucial to ensure the best treatment for your wound. Many times a comprehensive treatment plan is recommended involving several modalities, along with life-long maintenance.

Dry, scaly skin: accumulation of dead, flaky skin tends to occur under certain conditions, most commonly as we age, in colder and drier climates, and with less skin care maintenance. Four commonly available products for treatment include Salicylic acid, Sulfur, Tar and Urea. Along with helping for dry and scaly skin, these products have also been effective for aesthetics (Salicylic Acid only), acne and acne-like rashes, inflammatory skin disorders, skin infections, nail disorders and even skin cancer therapy.

Insect Repellents: bug bites are a constant source of frustration for many patients who enjoy the outdoors. Whether its biting flies, fleas, mosquitos, or ticks, insect repellents are an excellent option for avoiding this nuisance. Products with DEET, Picaridin, IR3535 or oil of lemon eucalyptus can help protect you and loved ones while enjoying outdoor activities.

Hair Growth: hair thinning or loss is a problem to many people, especially on the scalp and eyelashes. There are a few topical options available that your Advanced Dermatology provider can use to help treat this problem. On the scalp, minoxidil is effective for slowing the loss of hair associated with patterned alopecia in both males and females. On the eyelashes, a newer medication bimatoprost (Latisse) has received FDA approval for thinning.

Hair Removal: unwanted hair growth occurs on both males and females, causing significant social embarrassment. For women, there are popular treatments including waxing, plucking, threading, and depilatory creams available in local spas. There is a topical medical option available to treat this problem. Eflornithine (Vaniqa) is indicated for unwanted facial hair in females that slows growth and makes hair finer and lighter. Make an appointment today to discuss this option.

Pain control: several topical ingredients are employed in dermatology for cutaneous pain control including aloe vera, anesthetics (benzocaine, lidocaine and pramoxine), capsaicin, counterirritants (menthol and camphor), non-steroidal anti-inflammatory drugs, and salicylates (including methyl salicylate or oil of wintergreen). The medications are generally safe and tolerated quite well.

Anti-itch: itch has been deemed a symptom worse than pain, and is quite debilitating to patients suffering from it. Many different topical treatment options are available, including emollients, low pH cleansers, moisturizers, cooling agents (camphor, menthol or phenol), topical anesthetics, topical anti-histamines (over-the-counter and prescription-strength), capsaicin, topical steroids and topical immunomodulators. Make an appointment today with your Advanced Dermatology provider for all of your skin needs.