Documentos de Académico
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Nomenclature
Β-carotene is basically two vitamin A molecules (all-trans retinol)
hooked together; processed to yield all-trans retinol in vivo
Oxidative changes:
all-trans retinol (vitamin A) all-trans retinaldehyde all-trans
retinoic acid via oxidation
Inactivated by CYP450 hydroxylation (adds an –OH on the 4’carbon of all-trans retinoic acid)
Many retinoids now look nothing like RAs but just bind the receptors
(STILL HAVE THE SAME EFFECT ALTHOUGH STRUCTURE DIFFERENT – if you bind the receptor, effect is same!)
Reduce wrinkling, etc.
It’s hard to get drugs through the skin in a reliable manner: Lots of variables
status of skin (damaged?) partition coefficient (if molecule likes to stay in its
location (groin≫eyelids≫chest for absorption) vehicle, it won’t leave)
concentration diffusion coefficient (how fast?)
liphophilicity (more is better) metabolism
MW (smaller better) dermal vascular/lymph flow?
Topical steroids (mild to strong): Hydrocortisone < triamcinalone < fluocinonide < clobetasol
Balance efficacy with side effects; don’t put on groin or eyelids! Can be expensive!
Occlusion: get better penetration by “hydrating the bricks” & loosening up that “mortar”
Principle: ↑ hydration + ↑ temp = ↑ absorption
Can use saran wrap, baggies, cordran tape, vinyl suits, shower caps, whatever
Can cause problems in topical steroid occlusion so be careful (infections, hot, itchy, etc)
Systemic steroids
If you’re going to use them, use an adequate dose;
Give at 7AM & 4PM if itchy, NOT before sleep (interferes with circadian rhythms)
Taper BID to QD in AM 1st, then to alternate day slowly
Can consider alternate drugs too
Key Points
1. Everything you put on
Treating an itch
the skin gets absorbed to
COLD (ice cube, not hot shower – feels good but then bad afterwards)
some degree
Lotions (evaporate; feels good)
2. Absorption ↑ in
Dry? Lube it up with Vaseline diseases skin (↓ barrier
Atarax / sedating antihistamines but don’t use with driving or drinking function)
other therapies too (UV light – but avoid systemic corticosteroids) 3. As skin gets better from
drug, absorption
Wet dressings: for wet, weeping lesions, cooling/antipruritic/debridement decreases
Keep moist for 30 min QID, don’t allow to dry
Continuous wet soaks: good for debridement/cleansing, macerates necrotic tissue
Can use Kerlex/saran wrap, re-wet q4h with asepto syringe