Week 3 notes .docx

**Botanical medicine** **Botanical treatment strategies:** Emollients Vulneraries Antimicrobials / Antiseptics Anti-inflammatories Antipruritics Lymphatics Astringents Connective tissue tonics **Calendula / Marigold ** - **Latin: * ****Calendula officinalis* (Asteraceae family) ...

**Botanical medicine** **Botanical treatment strategies:** Emollients Vulneraries Antimicrobials / Antiseptics Anti-inflammatories Antipruritics Lymphatics Astringents Connective tissue tonics **Calendula / Marigold ** - **Latin: * ****Calendula officinalis* (Asteraceae family)  - Plant part**:** Flowerheads and petals (Infusion and tincture for internal, ointments and poultices for external)  - **Indications:** One of best remedies for local skin problems - rash, eczema, psoriasis, abrasions, etc.  - **Actions:** Antimicrobial, lymphatic, antiseptic, anti-inflammatory, vulnerary, demulcent, emollient (Flavonoids, carotenoids, xanthophylls, mucilage)  - Stimulates drainage of enlarged and inflamed lymph nodes - Stimulated granulation tissue  - **Contraindications:** Generally safe, great in first aid kits for skin-healing needs  - **Side Effects:** caution in asteraceae family allergy  - **Research: /** (materia medica)  **Gotu Kola ** - **Latin:** *Centella asiatica* (Apiaceae family)  - Plant part**:** Aerial parts (Infusion, tincture and standardized extracts for internal use, Topical: creams, ointments and poultices applied BID or PRN) - **Indications:** speeds up skin collagen formation and angiogenesis, increases antioxidant levels within wound in early stages of tissue repair,  - **Actions:** Anti-inflammatory (Inhibition of iNOS and COX-2, NF-κB activity, and the release of TNF-α, IL-1β, IL-6, and IgE), CT builder, vulnerary, adaptogen, nervine tonic, anti-allergy (dude to decreased mast cell infiltration and reduced expression of TNF-α, IL-4, IL-5, IL-6, IL-10, and IL-17)  - ​​Asiaticosides increase vascularization of connective tissue and the formation of structural glycosaminoglycans (chondroitin sulfate, hyaluronic acid) - (Saponins, Flavonoids, Alkaloids) - **Contraindications:** don\'t use in pregnancy and lactation, liver disease  - **Side Effects**: Internal use - GI upset, contact dermatitis, sedation, headaches, interacts with anti-diabetics, antihyperlipidemics, CNS depressants and vasodilators  - **Research: ** **Plantain** - **Latin:** *Plantago lanceolata & major* (Plantaginaceae family)  - Plant part**:** Leaves  - **Indications:** wound healing  - **Actions:** antimicrobial, lymphatic, anti-inflammatory, astringent, anti-hemorrhagic, emollient, vulnerary, CT tonic, antipruritic (Mucilage, tannins, flavonoids, resins, alkaloids, saponins, minerals Zn, K, Mg, P)  - Allantoin promotes cell proliferation and induces transition of fibroblasts -\> myofibroblasts to increase tensile strength of CT  - Phenolic acids and flavonoids inhibit COX and LOX  - **Contraindications:** generally safe  - **Side Effects:** high doses internally -\> laxative  - **Research: ** **German Chamomile ** - **Latin :** *Matricaria recutita* (Asteraceae family)  - Plant part**:** Flower heads (infusion and tincture for internal, ointments, baths, poultices external)  - **Indications:** dermatological conditions  - **Actions:** Anti-inflammatory (inhibition of COX and LOX), vulnerary, nervine sedative, emollient, antimicrobial (Volatile oils, flavonoids - inhibition of histamine release, sesquiterpene lactones, salicylic acid, mucilage)  - **Contraindications:** generally safe, caution in asteraceae allergy  - **Side Effects:** may cause contact dermatitis in cases of allergy or sensitivity  - **Research:** Topical chamomile is comparable with 0.25% hydrocortisone for dermatological conditions (Brown and Dattner 1998) **Burdock** - **Latin:** *Arctium lappa * - **Primary Actions:** Alterative, hepatic, mild laxative, mild adaptogen.  - **Constituents:** Lignans, carbohydrates, inulin.  - **Indications**: Hepatic congestion, sluggish bowels, acne, eczema and other skin conditions, IBS, type II diabetes, nausea. -  **Cautions/Contraindications:** Considered safe, even nutritious.  - **Part Used:** Root  Daily Therapeutic Dose Tincture: 9-18 mL (1:5 in 30%)  Daily Therapeutic Dose Infusion or Decoction: 2-12 g root Pairs Well With: Zingiber officinalis for nausea of deficient stomach.  **Barberry ** - **Latin:** *Berberis vulgaris * - Plant part**:** Root - **Indications:** general infections, GI infections, hepatic/gallbladder conditions, constipation, type 2 diabetes, PCOS, any inflammatory skin condition  - **Actions:** Hepatic, cholagogue, antimicrobial, bitter, antiinflammatory, alterative, endocrine modulator (insulin) (Isoquinoline alkaloids)  - **Contraindications:** avoid during preg and lact  - **Side Effects: / ** - **Research:** regulation of blood sugar  **Coptis / Goldenthread** - **Latin:** *Coptis sinensis * - Plant part**:** root  - **Indications:** chronic or acute skin characterized by inflammation, acute GI infections, chronic sinusitis, hepatitis  - **Actions:** antimicrobial, anti inflammatory, hepatic, bitter (Isoquinoline alkaloids)  - **Contraindications:** avoid during preg and lact**,** non-toxic but very strongly bitter, not used for more than 3 weeks  - **Side Effects: / ** - **Research: / ** **Yellow Dock ** - **Latin:** *Rumex crispus * - Plant part**:** Root  - **Indications :** Chronic skin conditions, constipation, convalescence  - **Actions:** Alterative, laxative, hepatic, astringent, mild adaptogen, blood purifier and builder   - **Contraindications:** Not to be eaten fresh, not in preg and lact - **Side Effects: / ** - **Research: / ** **Red Clover ** - **Latin:** *Trifolium pratense * - Plant part**:** Flowers, aerial parts  - **Indications:** skin conditions, PCOS, irregular menses, menopausal hot flashes  - **Actions:** Alterative, lymphatic, mild female endocrine modulator - **Contraindications:** may interact with anticoagulants  - **Side Effects: / ** - **Research: / ** - **Topical herbal pharmacy for skin rash ** - Ointments (salves) -- semi-solid base of oil and beeswax, fats soften at skin temperature making material available to the skin. Creates a protective barrier for the skin. - Creams/lotions -- suspensions of oil in water blended together. Often absorbed faster and more moistening for the skin. - *Example: 2/3 cup rosewater, 1/3 cup aloe vera gel, ¾ calendula oil, 1/3 cocoa butter, 1 tsp lanolin, 2 tbsp. liquid lecithin, ½ ounce beeswax, 6 drops tea tree EO, 6 drops lavender EO, Vitamin A/E* - Poultices -- solid herb in some form (mashed/blended/cut), placed directly on skin, held in place with cloth - Example: blending or mashing fresh *Plantago major* and apply to affected area (may add a little water for consistency) - Pastes -- mixture of powder in a liquid base, keep herbs on the surface for a longer period of time, but contents are not well absorbed - Example: 1 tsp *Althea officinalis* powder with *Centella asiatica* tincture. Mix until desired consistency - Also: compress, bath, steam **Nutrition** **Zinc** - May help reduce eczema severity esp. If deficiency  - Ex. beef, shellfish, nuts & legumes  **Vitamin D** - Deficiency risk of psoriasis & atopic dermatitis - Reduce inflammation & symptoms of eczema - Vitamin D3 (cholecalciferol)  - Synthesis happens in epidermis of skin from UVB  - Animal sources: fish, liver, meat, egg yolks  - Vitamin D2 (ergocalciferol)  - Plant sources: mushrooms, alfalfa sprouts **Fish Oil ** - More studies are needed but shows promising findings on eczema Fatty Acids  - Chains of hydrocarbons of diff. Lengths  - Long-chain FAs: 14-24Cs - Medium-chain FAs: 8-12Cs - Short-Chain FAs:\ - Flax & Canola oils - Omega 6  - Most vegetable oils  - Omega 9  - Olive oil **Vitamin A** - Sources: liver, eggs, dairy, Oily fish (sardines, anchovies, tuna) - Deficiency  - Delayed growth  - Infertility  - Increased infections  - Night blindness & eye dryness **Increased Risk Deficiency In:** - Hypothyroidism  - Liver or gallbladder disease  - Renal disease  - Alcoholics  **Therapeutic Dosage ** - 5k-10k IU present in more multivitamins - Treatment of acne have 100k-500k IU/d **Toxicity** - \4,500 RAE (15k IU) per day of performed vitamin A in pregnant women assoc. w/ birth defects  **Contraindications & Cautions** - High doses of vitamin A contraindicated in pregnancy & sexually active women w/o effective birth control  - Patients w/ end stage renal disease should not be given vitamin A  - People w/ liver disease, malnutrition & alcoholism higher risk of vitamin A toxicity  **Homeopathy** **Urtica Urens - Dwarf nettle ** - Itching, burning, stinging skin  - burns/scalds  - Insect bites/stings - Allergic rxn after shellfish  - Disturbances in lactation (swelling, burning)  - Rheumatism (RA) and Uric acid diathesis (gout, kidney stones)  - Worse: cold bathing, cold/damp air,  snow, touch  - Better: / - Mind: / **Apis mellifica - mellifera ** - Swelling / edema  - Stinging, burning pains, hives w puffy swelling  - Insect bites, puncture wounds, splinters  - Anaphylaxis - no/low thirst  - Worse: night, heat touch, right side  - Better: cold applications, cold water  - Mind: rapidly developing complaints, passionate, busy (like a bee), restless, awkward/clumsy, irritable, jealous/grief, fear of birds, indifference/apathy, weepy  **Rhus toxicodendron ** - Affinities - skin, mucous membranes, fibroid tissue (joints, tendons), aponeurosis  - Stiffness and pain  - RA - Itchy, red skin (chicken pox, herpes, psoriasis, urticaria, cellulitis)  - Worse: at rest (stiff, restless), initial movement, cold damp  - Better: heat, hot bath, stretching, continuous motion  - Mind: busy, restless, dreams of travel, work, superstitious or ritualistic behavior  **Sulfur ** - Itchy, red orifices - Dry skin, warts, blisters, dry nails  - Slouches, hot in bed (uncovers feet)  - Unkempt appearance  - Cat-nap sleepy - Eating at night  - More thirsty than hungry (not hungry in morning) - Worse: pain from standing, heat, weather changes, baths, morning (diarrhea), night, left side  - Better: dry weather, motion, lying on right side  - Mind:  opinionated, critical, independent, nervous, quick-tempered, argues ideas, speculates, high confidence / full of themselves, hard to get up in morning, fear of heights, anxiety/guilt  **Graphites ** - Thick, Rough skin, scars, eruptions (at bends of skin), cracks/fissures, infections (fungal), keloids  - Oozing sticky honey-like discharge  - Eczema, psoriasis, herpes  - Affinity for skin (folds), digestive organs, eyes - Tendency toward obesity, chilliness, constipation  - Stomach disorders, pain worse with milk/eating - Constipation, chronic during/before menses   - Anemia (pale mucosa, red face)  - Menstrual issues, menopause  - Photophobia, blepharitis - Alopecia at vertex or sides of head - Better: in dark, wrapped up - Worse: warmth, night, after menstruation  - Mind: dull, slow, timid, reserved, changeable, easily startled, indecisive insecure, easily offended, fidgety, fear of something bad happening  **Health psychology** **Authenticity** Being genuine and honest to yourself. It's a practice. It's a choice to show up and be real. **The common denominator** The common denominator in insecure styles of attachment is an insecure sense of self, rooted in shame. Authenticity-being me Attachment-being us Awareness-knowing me Attunement-knowing you **TCM** **Wind cold V.S. Wind heat** **Wind cold** **Wind heat** ----------------------------------- ---------------------------------------------- Aversion to cold and/or wind Aversion to cold Sneezing, cough Sneezing, cough Running nose with white discharge Runny nose with slight yellow discharge Slight or no fever Slight sweating Occipital stiffness and aches Itchy and sore throat, swollen tonsils No sweating or thirst Thirst Tongue: thin white coat Tongue: red on tip or sides, thin white coat Pulse: floating, tight pulse Pulse: floating and rapid **Lung function** Extract "clean" qi for the body. - Air Qi + Food Qi = gathering Qi (Zong Qi) lung spread gathering Qi (Zong Qi) all over the body gathering Qi resides in the chest and aids in the lung and heart functions to promote good circulation to the limbs and controlling the strength of the voice. - Qi diffusion to ensure distribution of defensive Qi. - Qi descension to communicate with the kidneys. - Control the skin and the space between skin and muscles. Receive fluids from the spleen. - Manifests body hair (diffuses defensive Qi and fluid) Nose: the opening of the lungs - Invaded by pathogens runny nose - Invaded by dampness clogged and blocked - Heat bleeding nose, thick and yellow nasal mucous - Dryness nasal mucous too dry - Impaired diffusing Qi and fluid nasal discharge or stuffed nose. **Lung deficiencies** +-----------------------+-----------------------+-----------------------+ | Problem | Causes | Symptoms | +=======================+=======================+=======================+ | Lung Qi deficiency | - Chronic cough or | - Feeble cough or | | | asthma. | asthma | | | | | | | - Insufficiency of | - SOB, worse on | | | Qi production. | exertion | | | | | | | | - Low and/or hoarse | | | | voice | | | | | | | | - Fatigue | | | | | | | | - Spontaneous | | | | sweating | | | | | | | | - Dizziness | | | | | | | | - Aversion to cold | | | | | | | | - Pale face | | | | | | | | - Watery or | | | | thin/clear sputum | | | | | | | | - Catches colds | | | | easily | | | | | | | | - Tongue: pale, | | | | thin white | | | | coating | | | | | | | | - Pulse: weak or | | | | empty pulses | | | | especially right | | | | cun position | +-----------------------+-----------------------+-----------------------+ | Lung Yin deficiency | - Prolonged cough | - Dry cough with | | | | small amounts of | | | - Heat disorders | sticky sputum or | | | which injure the | blood-tinged | | | lung | sputum | | | | | | | - Prolonged dryness | - Dry mouth and | | | | throat | | | | | | | | - Afternoon fever | | | | | | | | - Malar flush | | | | | | | | - Night sweats | | | | | | | | - Heat sensation in | | | | 5 centers | | | | | | | | - Tongue: red body | | | | with a dry coat | | | | or little coating | | | | and maybe cracks | | | | or peeling | | | | | | | | - Pulse: rapid and | | | | thready | +-----------------------+-----------------------+-----------------------+ | Lung dryness | - Pathogenic | - Dry cough with | | | dryness (stomach | little sputum | | | yin deficiency) | | | | | - Sputum too sticky | | | - Wind heat | to cough up | | | | | | | | - Dry nose and | | | | throat | | | - Wind dryness | | | | | - Chest pain | | | | | | | | - Dry skin | | | | | | | | - Thirst | | | | | | | | - Hoarse voice | | | | | | | | - Tongue: dry with | | | | thin coating | | | | | | | | | | | | | | | | - Pulse: rapid and | | | | thready | +-----------------------+-----------------------+-----------------------+ | Lung cold | - Pathogenic cold | - Cough, asthma | | | in the lung | | | | | - Thin, white | | | - Wind cold | sputum | | | | | | | | - Absence of thirst | | | | | | | | - Runny nose with | | | | clear mucus or | | | | complicated with | | | | aversion to cold | | | | | | | | - Fever | | | | | | | | - Headache and body | | | | aches | | | | | | | | - Itchy throat | | | | | | | | - Sneezing | | | | | | | | - Tongue: white | | | | coat, pale body | | | | (thin in wind | | | | cold, thicker in | | | | pathogenic cold) | | | | | | | | - Pulse: slow, | | | | strong and tight | +-----------------------+-----------------------+-----------------------+ | Lung heat | - Pathogenic heat | - Cough asthma | | | | | | | - Pathogenic cold | - Yellow sticky | | | turning to | sputum | | | pathogenic heat | | | | | - Thirst | | | - Wind heat | | | | | - Sore throat | | | | | | | | - Aversion to heat | | | | | | | | - Chest pain | | | | | | | | - Yellow purulent | | | | sputum with blood | | | | | | | | - Constipation | | | | | | | | - Scanty, | | | | concentrated | | | | urine | | | | | | | | - Tongue: red body | | | | and thing, yellow | | | | coat | | | | | | | | - Pulse: rapid and | | | | strong | +-----------------------+-----------------------+-----------------------+ | Phlegm damp retention | - Pathogenic wind, | - Cough with frothy | | | cold and damp | or white, sticky | | | | sputum | | | - Prolonged cough | | | | or asthma | - Sputum is easy to | | | | expectorate | | | - Spleen | | | | dysfunction of | - Stuffiness and | | | transportation | fullness in the | | | | chest -- "clogged | | | | up" | | | | | | | | - Gurgling sound | | | | with sputum in | | | | the chest | | | | | | | | - SOB | | | | | | | | - Dislikes lying | | | | down | | | | | | | | - Tongue: pale with | | | | white sticky coat | | | | | | | | - Pulse: wiry, | | | | slippery and | | | | strong | +-----------------------+-----------------------+-----------------------+ | Phlegm heat | - Wind heat | - Barking cough | | obstruction | invasion | | | | | - Profuse yellow or | | | - Smoking | green sputum that | | | | is foul smelling | | | - Excess eating of | | | | hot and greasy | - Asthma | | | foods | | | | | - Heavy feeling in | | | | the chest | | | | | | | | - SOB | | | | | | | | - Tongue: red body | | | | with thick, | | | | sticky yellow | | | | coating | | | | | | | | - Pulse: rapid, | | | | slippery and | | | | strong | +-----------------------+-----------------------+-----------------------+ | Invasion by | - Wind cold + | - Sudden swelling | | wind-water | dampness | of eyes, | | | | gradually | | | | spreading to face | | | | | | | | - Bright-shiny | | | | complexion | | | | | | | | - Scanty and pale | | | | urine | | | | | | | | - Aversion to wind | | | | | | | | - Fever | | | | | | | | - Cough | | | | | | | | - Breathlessness | | | | | | | | - Tongue: sticky | | | | white coating | | | | | | | | - Pulse: floating | | | | and slippery | +-----------------------+-----------------------+-----------------------+ | Cold phlegm in lungs | - Repeated | - Cough with white, | | | wind-cold | watery sputum | | | invasions | | | | | - Worse cold | | | - Excessive | exposure | | | consumption of | | | | raw, cold or | - Feeling of cold | | | diary | | | | | - Cold hands | | | | | | | | - Phlegm in throat | | | | | | | | - Dizziness | | | | | | | | - Heaviness in the | | | | chest | | | | | | | | - Feeling of cold | | | | in the chest | | | | | | | | - Tongue: swollen | | | | and wet with | | | | sticky white | | | | coating | | | | | | | | - Pulse: slow, | | | | slippery and | | | | strong | +-----------------------+-----------------------+-----------------------+ | Dry phlegm in lungs | - Excessive | - Dry cough | | | consumption of | | | | greasy and/or | - Difficult to | | | dairy | expectorate | | | | | | | - Elderly mainly | - SOB | | | | | | | | - Heavy feeling in | | | | the chest and | | | | head | | | | | | | | - Scanty phlegm in | | | | throat | | | | | | | | - Dry throat | | | | | | | | - Wheezing | | | | | | | | - Pasty-dry | | | | complexion | | | | | | | | - Tongue: swollen | | | | with dry, stick | | | | coating | | | | | | | | - Pulse: fine and | | | | slippery | +-----------------------+-----------------------+-----------------------+ **Large intestine function** - Controls passage and conduction - Stool formation - Qi goes downward, stagnation of Qi causes distention and constipation - Mental aspect of letting go, not dwelling on the past, LI points can calm the mind **Large intestine deficiencies** +-----------------------+-----------------------+-----------------------+ | Problem | Causes | Symptoms | +=======================+=======================+=======================+ | LI damp heat | - Excessive | - Abdominal pain | | | consumption of | | | | hot and greasy | - Tenesmus | | | food | | | | | - Blood and mucus | | | - Pathogenic summer | in the stools | | | heat, damp and | | | | heat | - Burning sensation | | | | in the anus | | | | | | | | - Diarrhea with | | | | yellow watery | | | | stools | | | | | | | | - Offensive stool | | | | odor | | | | | | | | - Thirst with no | | | | desire to drink | | | | | | | | - Scanty deep | | | | yellow urine | | | | | | | | - Fever | | | | | | | | - Sweating | | | | | | | | - Tongue: red body | | | | with yellow, | | | | sticky coating | | | | | | | | - Pulse: rapid, | | | | slippery and | | | | strong | +-----------------------+-----------------------+-----------------------+ | LI heat consumption | - Excessive | - Constipation with | | of fluid | consumption of | dry stools | | | hot foods (lamb, | | | | beef and alcohol) | - Burning sensation | | | | in the mouth | | | | | | | | - Burning and | | | | swelling in the | | | | anus | | | | | | | | - Dark, scanty | | | | urine | | | | | | | | - Tongue: red body | | | | with thick yellow | | | | or brown dry coat | | | | | | | | - Pulse: full and | | | | rapid | +-----------------------+-----------------------+-----------------------+ | Cold invading LI | - Chronic exposure | - Sudden abdominal | | | to cold weather | pain | | | with abdomen | | | | exposed | - Diarrhea with | | | | pain | | | - Sitting on cold, | | | | wet surfaces for | - Feeling of cold | | | long periods | | | | | - Cold sensation in | | | | the abdomen | | | | | | | | - Tongue: thick | | | | white coating | | | | | | | | - Pulse: deep, | | | | wiry, slow and | | | | strong | +-----------------------+-----------------------+-----------------------+ | LI dryness | - Blood or yin | - Dry stools | | | deficiency | | | | | - Constipation | | | - Elderly, women | | | | after a delivery, | - Dry mouth and | | | late stages of | throat | | | febrile disease | | | | | - Yellow, scanty | | | - Dry and warm | urine | | | climates | | | | | - Tongue: dry, red | | | | or pale body | | | | without coating | | | | | | | | - Pulse: thready | +-----------------------+-----------------------+-----------------------+ | LI Qi stagnation | - Irregular eating | - Abdominal | | | habits | distention and | | | | pain | | | - Frustration, | | | | anger | - Constipation with | | | | bitty stools | | | | | | | | - Irritability | | | | | | | | - Aggravated by | | | | mood | | | | | | | | - Tongue: normal to | | | | slight red sides | | | | | | | | - Pulse: wiry on | | | | both chi | | | | positions | +-----------------------+-----------------------+-----------------------+ | LI collapse | - Spleen and | - Chronic diarrhea | | | stomach | | | | deficiency | - Anal prolapse | | | | | | | - Excessive | - Hemorrhoids | | | physical work | | | | | - Fatigue after | | | | bowel movements | | | | | | | | - Cold limbs | | | | | | | | - Decreased or | | | | absence of | | | | appetite | | | | | | | | - Mental exhaustion | | | | | | | | - Better with | | | | abdominal massage | | | | | | | | - Tongue: pale | | | | | | | | - Pulse: deep, | | | | fine, weak | +-----------------------+-----------------------+-----------------------+ **Pharmacology** **Corticosteroids --expressed in the skin** Glucocorticoids - Affect carbohydrate, fat, and protein metabolism - Anti-inflammatory, immunosuppressive, anti-proliferative, vasoconstrictive Mineralocorticoids - Primarily involved in electrolyte regulation by modifying renal excretion mechanisms **Topical corticosteroids** Basic structurehydrocortisone backbone Increase potency of the TCS by fluorinating or esterifying certain carbons in the four-ring backbone **Mechanism of action** - Once absorbed, TCS interacts with an intracellular glucocorticoid receptor the complex then translocates to the nucleus where a large number of gene transcription changes take place upregulation of anti-inflammatory mediators, down regulation of inflammatory mediators. - Vasoconstrictive effect reduces delivery of inflammatory mediators and improves erythema - Anti-mitotic effect which inhibits cell proliferation and collagen synthesis - Immunosuppressant effect - Stinging or burning sensation - Dermal atrophy - Striae - Rosacea - Perioral dermatitis - Acne - Purpura - Increased hair growth - Skin pigment changes - Delayed wound healing **Fingertip units** Developed to help patients apply appropriate amounts of TCSs. One FTU is about 0.5g The amount squeezed from a standard tube from the fingertip to the first crease of an adult finger One FTU should cover and area equal to 2 adult handprints with fingers together A table with numbers and text Description automatically generated **Topical drug vehicles** +-----------------------+-----------------------+-----------------------+ | Category | Pros | Cons | +=======================+=======================+=======================+ | Creams | - Fairly standard | - Tend to cause | | | and commonly | irritation due to | | | used. | additives | | | | | | | - Generally | - The least | | | preferred by | effective to | | | patients bcuz | allow the drug to | | | their quick | penetrate the | | | absorbency and | skin. | | | leave minimal | | | | residue. | | +-----------------------+-----------------------+-----------------------+ | Gels | - Useful for hairy | - Alcohol based, | | | areas and oily | can cause | | | skin | stinging and | | | | irritation is | | | | used on open | | | | lesions | +-----------------------+-----------------------+-----------------------+ | Lotion | - Minimal residue | - Alcohol based, | | | (evaporates), | can cause | | | useful for larger | stinging and | | | areas or hairy | irritation is | | | skin areas | used on open | | | | lesions | +-----------------------+-----------------------+-----------------------+ | Ointment | - Has emollient | - Least preferred | | | effect | by patients | | | | | | | - Best vehicle to | - Thick greasy base | | | allow the drug to | like petroleum | | | permeate the skin | jelly | | | | | | | - Cause little to | | | | no irritation | | +-----------------------+-----------------------+-----------------------+ | Foam | - Allows for | - Aerosolized | | | application to | oil-based | | | hard-to-reach | formulation | | | areas | | | | | - Tends to leave a | | | | greasy residue | +-----------------------+-----------------------+-----------------------+ **Potency** Classes - Class 1 -- highest potency. Also called superpotent or ultra-high class. - Class 2 -- high, class 3 -- medium high, class 4/5 -- medium - Class 6/7 -- low potency Potency can change depending on vehicle used (same concentration, higher potency in ointment than cream) Areas - Low potency used on face or thin skins - Medium potency used on body and scalp - High potency used on palms and soles **Prescriptions** Drug name, concentration, base/vehicle Most are standard concentrations, and many are available prepackaged in commonly used vehicles.