Topical treatment
       Topical Treatment(Treatment with drugs which        are used as application)

There are a number of drugs used on the surface of skin. All these drugs are useful in a given situation. The following drugs are used routinely such as 1. Liquid paraffin 2. Coal tar 3. Corticosteroids 4. Vit. D analogue 5. Topical retinoid.6. Topical Calcinurin inhibitor These drugs will give useful effects provided they are used judiciously . However, there are some side effects due to these drugs. Patients who are using these drugs should be aware of such problems and report them immediately .

       Liquid paraffin

         Liquid paraffin is a distillation product of petroleum. It is used mainly as an
emollient. In addition it has got an anti mitotic effect . It increases the cohesiveness of stratum corneum and help to hold the water in stratum corneum thereby helping to improve psoriasis.

       Coal tar

         Coal tar was the main agent of yester years for the treatment of psoriasis.
It is a destructive distillation product of petroleum. There are more than 10, 000 active agents in coal tar. It may be a total effect of coal tar on skin, rather than a single agent causing the beneficial effect on psoriasis . This is used in various regimens such as In grams ‘ regime for the treatment of psoriasis. It improves the disease well. But there is a fear of malignancy developing following the long term use of it. Hence at present it is not a preferred drug for the treatment of psoriasis. Moreover it has some immediate untoward effects such as irritant dermatitis, tar folliculitis, etc. However , it is still used in the treatment of special sites such as scalp when psoriasis is difficult to respond Tar is available as alcohol extract, shampoo, soap and ointment

       Topical corticosteroid

         Topical corticosteroid is a group of drugs useful in the treatment of many inflammatory type of dermatoses. The drugs belonging to this group have different potencies . Based on the potencies they are grouped differently in different countries. For convenience sake the British system of classification depending on potency of steroid is followed here. According to this classification the drugs are grouped into four (4) groups; these include mildly potent, moderately potent, potent and highly potent . the name suggests the drugs belonging to each group will have appropriate efficacy . As there is increase in potency , the side effect profile will also increase. Hence a proper selection of the drug is highly essential for desired effect with minimal side effects.
Corticosteroids as a class will have rapid onset of action. This helps to active the remission fast. But maintenance of remission requires prolonged treatment. If the drug is continued for a longer time, the untoward effects will set in. Moreover if the drug is withdrawn prematurely , there will be an exacerbation of the disease.
Hence routine use of corticosteroids continuously should be discouraged. If there are only very few lesions and the patient wants an immediate response, corticosteroid may be considered. Care should be taken not to use highly potent steroid once a long period of time as well as large areas of body. It should also be kept in mind not to withdraw the drug suddenly, for fear of exacerbation.

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Kerala, India
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