SOME NOTES ON TOPICAL TREATMENT

Vaseline and mineral oil are widely used as a moisturiser in Africa.
They are an important cause of skin problems. They cover the pores of
sweat ducts so that sweat and other fluids are unable to get out. This
causes irritation, which will worsen any inflammatory skin condition.
Also, bacteria and fungi trapped in this warm and humid environment will
thrive and overgrow resulting in clinical infection.
Aqueous cream or emulsifying ointment are good alternatives to
vaseline for use as a moisturiser. They are generally available in supermarkets
and chemists. Vegetable oils, e.g. coconut oil, can be used as
well, provided they are applied on wet skin.
Ointments or creams: as a rule a cream base is preferred for wet and
acutely inflamed lesions, an ointment for chronic, dry or lichenified
lesions.
Topical steroids: the mildest topical steroid is hydrocortison acetate
8
1% cream or ointment. In cases where a steroid is indicated, for example
eczema, start with hydrocortisone 1% before prescribing a stronger
steroid such as betamethasone valerate 0.1%. Use a cream for wet and
acute lesions, an ointment for chronic and dry lesions. Always use strong
topical steroids intermittently (e.g. use 3 days, stop 4 days in a week). Do
not use strong topical steroids for the face or the genital area, or on
babies. When only strong topical steroids are available they may be
diluted on the palm of the hand with an equal amount of cooking oil.
Imidazole preparations: there are many antifungal imidazole creams
i.e. miconazole, clotrimazole, econazole, and ketaconazole. Use
whichever is available.
Potassium permanganate solution 1:4000 to 1:10.000 should always
be prepared freshly as it is inactivated rapidly after being diluted. It is an
adstringent (decreases oozing), antiseptic and mild antifungal. A pinch of
the crystals in a bucket of water should give a solution with a pink colour
(the colour of a fingernail). A purple solution is too strong, it will leave
brown stains. A degraded solution is brown in colour. Soak dressings in
the bucket or bathe affected body parts.
Coal tar paste or ointment: this has anti-inflammatory and anti-itch
properties. It is used e.g. in chronic eczema and psoriasis, as an
alternative to topical corticosteroids. It has photosensitising properties
and should therefore be applied at night and washed off in the morning
on sun-exposed areas. In chronic plaque psoriasis this quality of coal tar
may be used specifically: apply coal tar to psoriatic lesions, expose to
sun for a short time, e.g. 30 minutes, then wash off. The exposure time
may be increased slowly if the treatment is tolerated.
Salicylic acid ointment: removes scales and softens thickened, horny
skin and crusts.
Urea ointment or cream: urea is a strong moisturiser. It helps soften
and smooth the horny layer and aids the penetration of other drugs. It is
used in dry skin conditions, e.g. atopic eczema. It can cause a burning
feeling when used on damaged skin.
GV paint: GV or Gentian Violet solution (0,5–1%) has antifungal and
antiseptic properties. It is used for superficial infections of the skin and
mucous membranes. It stains skin and clothing. When kept for too long,
fluid may evaporate and the solution becomes too strong (>1%), this will
damage the tissues.
Sulphur: Sulphur has antiseptic properties and promotes desquamation.
It dries the skin and is antiseborrhoic.