This document discusses topical keratolytics and topical steroids. It defines keratolytics as drugs that cause mild peeling of the skin or mucous membrane when applied locally by removing the pathologic desquamated keratin layer. Common keratolytics include salicylic acid, urea, benzoyl peroxide, and tretinoin. Topical steroids are defined as medicines used to treat skin conditions like eczema and psoriasis. They are anti-inflammatory and immunosuppressive. Common indications for topical steroids include recurrent aphthous ulcers, Behcet's syndrome, and pemphigus vulgaris. Potent topical steroids like bet

1. Topical Keratolytics &Topical Keratolytics &
Topical SteroidsTopical Steroids
Jignesh Patel,Jignesh Patel,
IV BDSIV BDS
Dept. of Oral Medicine Diagnosis & RadiologyDept. of Oral Medicine Diagnosis & Radiology
K.M.Shah Dental College & HospitalK.M.Shah Dental College & Hospital
Pipariya, VadodaraPipariya, Vadodara

2. Routes of drug administration?Routes of drug administration?
• There are ThreeThere are Three RoutesRoutes of administrationof administration::
–Local Or TopicalLocal Or Topical
–Oral or enteralOral or enteral
–parenteralparenteral

3. Topical Applications:Topical Applications:
• Types ofTypes of topical applicationstopical applications include:include:
–PowderPowder
–PastePaste
–lotionslotions
–DropsDrops
–Ointments etc…Ointments etc…

5. DefinitionDefinition
• KeratolyticsKeratolytics are the drugs which,are the drugs which, whenwhen
applied locally,applied locally, cause acause a
mildmild peeling (Removal ofpeeling (Removal of epidermis orepidermis or
superficial layer of thesuperficial layer of the epithelium)epithelium) of theof the
skin or mucous membraneskin or mucous membrane

6. Pharmacological action:Pharmacological action:
• Keratolytics removes theKeratolytics removes the pathologicpathologic
desquamated keratin layerdesquamated keratin layer from thefrom the
superficial layer of the skin and mucoussuperficial layer of the skin and mucous
membrane bymembrane by its chemical mode of actionits chemical mode of action
• Keratolytics removes excessive keratinKeratolytics removes excessive keratin
layer formed bylayer formed by defective desquamationdefective desquamation ofof
keratocyteskeratocytes

7. Keratolytic agents:Keratolytic agents:
• Salicylic acidSalicylic acid
• Propylene glycolPropylene glycol
• UreaUrea
• Benzoyl peroxideBenzoyl peroxide
• TretinoinTretinoin
• Podophyllin resinPodophyllin resin

8. Salicylic acidSalicylic acid
• Uses:Uses:
– In concentration ofIn concentration of 0.5-2 %0.5-2 % to treatto treat acneacne
vulgarisvulgaris
– In concentration ofIn concentration of 6%6% as anas an ointmentointment
used in the tretment ofused in the tretment of psoriasispsoriasis andand
seborrheic dermatitisseborrheic dermatitis
– AA 15-25% soln. in lactic acid15-25% soln. in lactic acid is used tois used to
treattreat wartswarts

9. Salicylic acid
ointment

10. UreaUrea
• Urea is used in the form ofUrea is used in the form of cream &cream &
ointmentointment to treatto treat psoriasispsoriasis && atopicatopic
dermatitisdermatitis
• Urea hasUrea has hydrating, keratolytichydrating, keratolytic &&
antipruritic actionsantipruritic actions
• ItIt increases absorption of hydrocortisonincreases absorption of hydrocortison
when used in combinationwhen used in combination

11. Urea Cream

12. Benzoyl peroxideBenzoyl peroxide
• Used asUsed as 5-10% cream5-10% cream oror lotionlotion for mild tofor mild to
moderate acnemoderate acne
• It is effective mainly due to itsIt is effective mainly due to its keratolytickeratolytic &&
bacteriostaticbacteriostatic activity against acne bacilliactivity against acne bacilli
• Drug mayDrug may cause irritationcause irritation

13. Benzoyl peroxide cream

14. Podophyllin resinPodophyllin resin
• Hairy tongue-Hairy tongue- results from theresults from the defectivedefective
desqumationdesqumation of cells that make up secondaryof cells that make up secondary
filliform papillae, this build up of keratin resultsfilliform papillae, this build up of keratin results inin
the formation ofthe formation of elongated hairselongated hairs that isthat is hallmarkhallmark
of this activityof this activity
• Podophyllin resin-Podophyllin resin- 1%soln.1%soln. andand
topical tretinointopical tretinoin is used in the treatment ofis used in the treatment of
Hairy tongueHairy tongue

16. DefinitionDefinition
• Topical steroidsTopical steroids are medicines in the form ofare medicines in the form of
cream, ointment or lotion that are used to treatcream, ointment or lotion that are used to treat
certain skin problems such ascertain skin problems such as eczema, psoriasiseczema, psoriasis
and otherand other dermatological conditionsdermatological conditions
butbut in Dentistryin Dentistry topical steroidstopical steroids are used toare used to
treattreat severe erosive-bullous diseasessevere erosive-bullous diseases,,
aphathousaphathous ulcers and herpatiform diseasesulcers and herpatiform diseases

17. Classification of topical steroidClassification of topical steroid
preparationpreparation
• MildMild
– Hydrocortison 1%Hydrocortison 1%
• Moderately PotentModerately Potent
– Clobetasone butyrate 0.05%Clobetasone butyrate 0.05%

18. • PotentPotent
– Betamethasone valerate 0.1%Betamethasone valerate 0.1%
– Hydrocortisone butyrate 0.1%Hydrocortisone butyrate 0.1%
– Fluocinolone acetonide 0.025%Fluocinolone acetonide 0.025%
– Trimecenolone acetonide 0.2%Trimecenolone acetonide 0.2%
• Very potentVery potent
– Clobetasol propionate 0.05%Clobetasol propionate 0.05%

19. Pharmacological action ofPharmacological action of
topical steroidstopical steroids
• Anti-inflammatoryAnti-inflammatory
• Immunosuppresive and anti-allergicImmunosuppresive and anti-allergic
• Inhibit the function of macrophagesInhibit the function of macrophages
• InhibitInhibit the activaton ofthe activaton of cytotoxiccytotoxic
T lymphocyteT lymphocyte
• Complement system is inhibitedComplement system is inhibited
• SuppressesSuppresses cell mediated hypersensitivitycell mediated hypersensitivity

20. Common indication of topicalCommon indication of topical
steroidssteroids
• Severe recurrent aphthous ulcerSevere recurrent aphthous ulcer
• Behcet’s syndromeBehcet’s syndrome
• Pemphigus vulgarisPemphigus vulgaris
• Mucous membrane PamphigoidMucous membrane Pamphigoid
• Erythema multiformeErythema multiforme
• Erosive Lichen planusErosive Lichen planus

21. Erosive Lichen planusErosive Lichen planus
Pemphigus vulgaris
Erythema multiforme

22. Topical corticosteroids used to treatTopical corticosteroids used to treat
ulcerative and vesiculobullous oralulcerative and vesiculobullous oral
mucosal lesionsmucosal lesions
• BetamethasoneBetamethasone-- 0.1% cream0.1% cream oror 0.05%0.05% gelgel
applied thinly b.i.d.applied thinly b.i.d.
• ClobetasolClobetasol-- 0.05% cream0.05% cream or gel appliedor gel applied
thinly b.i.d.thinly b.i.d.
• HalobetasolHalobetasol-- 0.05% cream0.05% cream or gel appliedor gel applied
thinly b.i.d.thinly b.i.d.
• FluocinoloneFluocinolone-- 0.05% cream0.05% cream or gel appliedor gel applied
thinly b.i.d.thinly b.i.d.

23. Hydrocortisone 0.1% (mild) Betamethasone 0.1%
(potent)

24. Intralesional steroidal inj. Of
dexametahsone
Trimecenolone 0.1%
(potent)
Clobetasol 0.05%
(very potent)

25. How they are applied?How they are applied?
• Topical steroids should beTopical steroids should be spread thinlyspread thinly
on the affected area of skin.on the affected area of skin.
• One way ofOne way of measuring amountsmeasuring amounts of topical steroids is inof topical steroids is in
‘fingertip units’,‘fingertip units’, which is the distance from the tip of thewhich is the distance from the tip of the
index finger to the first crease.index finger to the first crease.
• the topical steroid After you have appliedthe topical steroid After you have applied washwash youryour
hands thoroughly.hands thoroughly.
• With some of the more potent topical steroids, you mayWith some of the more potent topical steroids, you may
be advised tobe advised to apply the medicine using a cotton budapply the medicine using a cotton bud
rather than your fingers.rather than your fingers.

26. Local side effects of topical steroidsLocal side effects of topical steroids
include:include:
• Skin thinningSkin thinning (atrophy) and(atrophy) and stretch marksstretch marks
(striae).(striae).
• Easy bruisingEasy bruising and tearing of the skin.and tearing of the skin.
• Perioral dermatitisPerioral dermatitis (rash around the(rash around the
mouth).mouth).
• Enlarged blood vesselsEnlarged blood vessels (telangiectasia).(telangiectasia).
• Susceptibility toSusceptibility to skin infections.skin infections.
• AllergyAllergy to the steroid cream.to the steroid cream.

27. Commonest side effect of topicalCommonest side effect of topical
steroid in oral cavity is:steroid in oral cavity is:
• Oral candidiasisOral candidiasis due to decrease indue to decrease in
immune cells including neutrophills,immune cells including neutrophills,
monocytes, macrophages & plasma cellsmonocytes, macrophages & plasma cells
• Use ofUse of chlorhexidinechlorhexidine before steroidbefore steroid
application helps prevent fungal infectionapplication helps prevent fungal infection

28. Systemic adverse effects:Systemic adverse effects:
• Systemic adverse effects are rare with topicalSystemic adverse effects are rare with topical
steroidssteroids
• Some of them are:Some of them are:
– Cushing's syndromeCushing's syndrome
– Adrenal Gland SuppressionAdrenal Gland Suppression
– Gastric irritationGastric irritation
– Mood swing & insomniaMood swing & insomnia
– Hyperglycemia & weight gainHyperglycemia & weight gain
– Water retaintion and arterial hypertentionWater retaintion and arterial hypertention
– osteoporosisosteoporosis

29. Therapeutic uses:Therapeutic uses:
• Oral lichen planusOral lichen planus:: 0.05%fluocinomide0.05%fluocinomide andand
0.05% clobetasol0.05% clobetasol is frequently used as a creamis frequently used as a cream
or gelor gel
• Recurrent aphthous ulcerRecurrent aphthous ulcer: topical steroid: topical steroid
• Mucous membrane pemnphigoidMucous membrane pemnphigoid:: 0.1%0.1%
betamethasone or 0.05%clobetasolebetamethasone or 0.05%clobetasole
– Intralesional inj. May be usedIntralesional inj. May be used
• erythema multiforme

30. References:References:
• Burcket’s oral medicine, 10Burcket’s oral medicine, 10thth
edition,pharmacology.edition,pharmacology.
• Gandolfo Sergio, oral medicine; ChurchillGandolfo Sergio, oral medicine; Churchill
livingstone elsevier.livingstone elsevier.
• Satoskar R.S. ; pharmacology &Satoskar R.S. ; pharmacology &
pharmacotherapeautics; twentieth edition.pharmacotherapeautics; twentieth edition.
• National institute of health & nationalNational institute of health & national
library of Medicine, pubmed, USAlibrary of Medicine, pubmed, USA