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Snippets

Snippets. The following items will be discussed: @ Skin markers @ Rosacea: flaring factors @ Cosmoticals: Peeling @ Phtotherapy @ Biological therapies @ Transdermal drug delivery. S 1OO.

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  1. Snippets The following items will be discussed: @ Skin markers @ Rosacea: flaring factors @ Cosmoticals: Peeling @ Phtotherapy @ Biological therapies @ Transdermal drug delivery

  2. S 1OO • S 1OO stains a calcium binding protein that is expressed in melanocytes & melanocytic tumors. However, it is not specific for melanocytes. It also stains glial & Schwann cell tumors, granular cell tumors, eccrine coil neoplasm, Langerhans cells, chondrocytes, smooth & skeletal muscle & their tumors, sarcomas & occasionally breast adenocarcinoma. • Stains for malignant melanoma: • @ S 1OO : sensitive but not specific. • @ HMB 45:highly specific but poorly sensitive • @ Melan –A/ MART -1: specific but poorly sensitive • **************************** • CD 31 • A sensitive marker for vascular tumors such as angiosarcoma • CD 34 • A less sensitive marker for vascular tumors, also positive in dermatofibrosarcoma protuberance, leukemia, lymphoma • CD 45 • Positive in most leukemias & lymphomas.

  3. Immunofluorecense • Immunoglobulin deposits in the skin are a valuable source of diagnostic information. Best results are usually obtained from peri-lesional skin . The biopsy tissue has to be frozen & stained with fluorecein isothiocynate labeled antibodies to IgG, IgM, IgA, C3 & fibrin. • Direct immune-fluorescernceis useful in: • @ Immunobullous disorders • @ Lupus @ Vasculitis. • ****************************************** • Amyloid stain • Amyloid is an amorphous material that can deposit in the skin leading to a variety of clinical appearances. Congo red stains amyloid an orange – red color & under polarised light green birefringence is seen, There are a number of other stains used for amyloid including crystal violet, methyl violet, PAS & Sirins red.

  4. RosaceaFlaring factors • @ Heat: • Hot bath, saunas, excessively worm environments, overdressing • @ Exertion: @ Alcohol • Exercise, lifting Red wine, liquor, beer • @ Emotions: Anxiety , stress, embarrassment • @ Drugs: vasodilators, anxiety , topical steroid • @ Medical conditions: Chronic cough, menopause • @ Weather: • Sun, hot, cold, strong winds, humidity • @Food: • Spicy & thermally hot foods , foods high in histamine • @ Topical products: • Some cosmetics & hair sprays especially those containing alcohol, witchhazel or fragrances, hydro alcohol or acetone

  5. cosmecuetals BotanicalsA. Lighteners/ brighteners • @ Aloesin ,@ Bearberry .@ Black mulberry ,@ Blueberry ,@ Carrot ,@ Citrus fruit ,@ Cranberry .@ Cucumber .@ Echinacea ,@ Ginseng ,@ Gingko ,@ Grape seed ,@ Indian gooseberry ,@ Licorice ,@ Pear ,@ Soy , @ White mulberry ,@ White willow • B. Tighteners • @ Birch ,@ Gingko ,@ Horse chestnut ,@ Peppermint , @ Red sandalwood ,@ Spearmint ,@ Witchhazel • C. Photoprotective • @ Black tea , @ Cocoa ,@ Golden fern , @ Grape seed ,@ Green tea ,.@ Oat , @ Olive ,@ Pomegranate , @ White sandalwood • D. Emollients: • are substances that makes the skin feels smooth & soft, which is important to consumer acceptability • @ Almond ,@ Aloe ,@Avocado ,@ Borage ,@ Coconut , @ Cucumber ,@Grape , @Jojoba ,@Licorice , @Peanut ,@ Pomegranate ,@ Sattflower , @Sesame ,@Slippery elm.

  6. MoisturizersCommonly used moisturizingingredients • A. Occlusion: • @ Petrolatum, @ Waxes , @Lanolin ,@ Mineral oil ,@ Ceramides @ Sunflower oil ,@ Soybean oil ,@ Jojoba oil @ Olive oil ,@ Evening primrose oil • B. Humectants :Draws water from the formulation base, atmosphere, & from underlying epidermis to increase skin hydration: • @ Glycerol ,/Glycerin , @ Sorbitol ,@ Propylene glycol , @ Amino acids ,@ Lactate ,@ Urea ,@ Salts. • ************************************************************************************ • Symptoms of hair damage by perm products • @ Hair loss : (Rare) ,@ Hair breakage (may be at hair root, in hair length, near the ends) ,@ Hair modifications ( unwanted kinky curls, Curls without springiness) ,@ Wet hair: feels plastified, spongy, extensible ,@ Dry hair: , dry hair feels rough, brittle, uncombable, “matting” ,dull, ready to break) • @ Skin damage : @ redness, ,@ pustules & @ irritant skin

  7. Superficial chemical peelsPeeling agents • @ Alfa hydroxy acid , @ TCA (Trichloroacetic acid) (1O-2O%) ,@ Salicylic acid ,@ Tretinoin ,@ Resorcinol ,@ Solid carbon dioxide ,@ Pyruvic acid (alfa-keto acid) ,@ Jessner’s solution ( resorcinol 14%, lactic acid 14%, & salicylic acid 14% in alcohol) • Photobiologyof topical retinoids: • Owing to their side chain containing multiple double bonds, retinoids strongly absorb UV light. Therefore, it is recommended to avoid UV exposure when using topical retinoids. • Complications associated with superficial peels: • @ Pigmentary changes ,@ Infection ,@ Reactivation of herpes simplex ,@ Contact dermatitis ,@ Prolonged erythema /pruritus ,@ Lines of demarcation ,@ Milia ,@ Enlarged pores

  8. Medium depth chemical peels • A. Agents used: • @ 4O- 5O% TCA • @ Combination 35% TCA + Solid CO2 (Brody : Chemical peeling & resurfacing , Mosby(1997) p. 11O • @ Combination 35% TCA + Jessner’s solution (Monheit:J. Dermatol. Surg. Oncol 15,945 , 1989). • @ Combination of 35% TCA + 7O% glycolic acid ( Coleman & Futrell: J. Dermatol. Surg Oncol 2O, 76,1994) • B. Indications: • @ Treatment of actinic keratose\s ,@ Resurfacing moderate to advanced photoaged skin ,@Improving pigmentary dyschromias , @ Improving mild acne scars ,

  9. MicrodermasbrasionA. Indications • @ Acne , @Hyperpigmentaion ( Melasma ; Pos inflammatory) , @ Oily skin (enlarged pores) , @ Photodamage ,@ Wrinkles • B. Complications: • @ Milia & acne flare , @ Herpes simplex “breakthrough” infection • @ Bacterial infection , @ Fungal infection ,@ Hyperpigmentation ,@ Hypopigmentation , @ Scarring. • *********************************************************************** • Hydroxy acids • I. Alfa-hydroxy acids : Glycolic acid (sugar cane); Lactic acid (sour milk): Water soluble, Action: exfoliative (Penetrate at high concentration) • II. Beta-hydroxy acid: Salicylic acid . Lipid soluble .Source: Willow bark, wintergreen, sweet birch. Action: It is exfoliative comedolytic, anti-inflammatory

  10. Types of phototherapy • Phototherapy is the use of UV radiation to treat skin disorders, four main types of phototherapy are used in dermatology practice as shown in the following table. • UVB phototherapy is most commonly used for psoriasis & purities. Recently, there has been a trend towards using narrow band UVB rather than broad band as it clears psoriasis more efficiently with reduced erythema & reduced carcinogenicity. The commonest short term side effect is a sunburn-like response, long term there is a risk of photo aging & skin cancer • RePUVA is the combination of a systemic retinoid & PUVA, it is more effective than PUVA with psoriasis clearing quicker with lower dose of UVA radiation. • Advantage of PUVA phototherapy over UVB: @ Less frequent treatment @ More effective @ Often works in UVB resistant dermatoses. • :

  11. Types of phototherapy (continue) • Advantages of UVB phototherapy over PUVA: • @ No photosensitizing agent is needed • @ Eye protection is more needed after treatment (systemic psoralen) • @ Less side effects • @ Safe in pregnancy & safer in young patients • @Shorter irradiation time.

  12. Types of phototherapy

  13. Biological agents • The introduction of biological agents has transformed the treatment of severe psoriasis. The use of these agents has been limited by their high cost. • U.K criteria for a patient to be eligible for treatment with biological agents: • @severe psoriasis for over 6 months with a Psoriasis Area& Severity Index (PASI) greater than 1O& Life Quality Index (DLQI) greater than 1O & one of: • @ have developed or at risk of developing drug related toxicity from a systemic therapy for psoriasis • @ Intolerance of or contraindicated for standard systemic therapies • @ Poor clinical response for standard systemic therapies • @ Repeated inpatient admissions due to psoriasis. • @ Severe ,unstable or life threatening psoriasis. • A patient may also meet the criteria for a biological agent due to associated psoriatic arthropathy.

  14. Biological agents used in psoriasis

  15. Side effects of biological therapies • @Injection site reactions occur with all biologic agents but are most commonly seen with etanercept, they are rarely serious. • @ There is an increased risk of infection& serious infection with with all biological agents, reactivation of latent tuberculosis is well recognised. • @ All biological agents carry small risk of malignancy, especially lymphoma. • @ Anti-TNF biological agents are associated with new onset demyelinasting disorders & excerbation of pre- existing multiple sclerosis. • @ Some patients develop ANA antibodies whilst on biol;ogical therapies, only rarely does this lead to a drug induced lupuswhich tends to resolve on stopping the medication. • @ Patients may develop antibodies to the biological agents but this is only clinically relevant for infliximab where antibodies are associatedf with an increased risk of infusion reactions & reduced efficacy. • @ 2O% of patients on infliximab develop non serious infusion reactions such as headache, flushing & nausea, 1% develop serious reactions as anaphylaxis, hypotension & chest pain

  16. Side effects of biological therapies • @ adalinumab can be associated with leucopenia & thrombocytopenia; alefacept with lymphopenia & efalizumab with thrombocytopenia • Absolutecontraindications of biological agents: • @ sensitivity to the drug @ pregnancy @ Active or chronic infection • Relativecontraindications for biological agents: • @ A family or personal history of demyelinating diseases @ history of malignancy @ concomitant immunosuppressive treatment • Congestive heart failure is a contraindication for inflixmab & etancept. Thrombocytopenea is a contraindication for treatment with efalizumamb & lymphopenia is a contraindication for using alefacept. Patients treated with biologic agents should not receive liver vaccine.

  17. Liposomes size: 25 nm – 1OO umDendrimers size: 3 – 1O nm • Dendrimers: are highly branched polymer with a controlled 3 dimensional structure & a central core .They can accommodate more than 1Oo terminal group.

  18. Control of transdermal drug delivery • Can we control the transdermal drug delivery? • Yes, by use of polymers whether natural or synthetic, is sensibly combined with a drug or other active agent in such a way that active agent is released from the material in presdesigned manner. The release of the active agent may be constant over a long period. It may be cyclic over a long period or it may be activated by the environment or other external events. • The purpose of controlling the drug daily : is to eliminate the potential for both under or overdosing

  19. Control of transdermal drug delivery • Examples of polymers used for controllingtransdermaldrug delivery: • @ Poly (3 hydroxy ethyl methacrylate) • @ Poly ( N- vinyl pyrrolidone) @ Poly Methyl methacrylate • @ Poly vinyl alcohol @ Poly acrylic acid • @ Polyacrylamide @ Poly ethyline -co - vinyl acetate • @ Poly ethylene glycol @ Poly methacrylic acid. • @ Polylactides (PLA) @ Polyglyclides (PGA) • @ Polyanhydrides @ Poly orthoesters. • The control release of the active agent of the drug can occur in the form: • @ Diffusion @ Degradiation @ Swelling followed by diffusion. The swelling ability can be triggered by environmental surrounding e.g. PH, temperature & ionic strength.

  20. Control of transdermal drug delivery Swelling release Diffusion system A. Bulk eroding B. Surface eroding

  21. Natural polymers • Natural polymers: starch, lecithen, chitosan , gelatin in nano. In drug industry , they have been used as binders, diluents, disintegrate & matrixing agents. Nano technology helps make significant advances in their biomedical applications, including drug delivery techniques

  22. Lecithen is yellow brownish fatty substance occurring in animal & plant tissues.. Lecithen can be isolated from egg yolk Sun flowers oil, brain tissue, fish. It can act as LiPOSOMES, MICELLS for transdermal drug delivery. It can also as a type of surfactant , emulsifiers, lubricant. It is also taken as medicine in treating Alzheimer disease . It is also used for treating eye , gall bladder , liver diseases & skin eczema

  23. Transdermal drug delivery

  24. Transdermal drug delivery

  25. Temperature sensitive drug delivery for treatment of tumors

  26. Part Ii Part INeedles for mesotherapy 3O g X 4 mm needle for mesotherapy No needle mesotherapy (needle free procedure or electroporation)

  27. needle free procedure (electrophoresis) • Electric current is used for introducing the ions of the drug mixture into the tissues through water channels of the skin

  28. Needles free procedure for Botox : mesotherapy • Totally non invasive

  29. Isophoresis (mesotherapy): Dermal roller needle freeIt creates a pinpoint punctures into the dermis , It sends a special electrical wavesA pulsed or modulated current to achieve molecules so as to allow them to permeate the skin & penetrate into the tissue

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