Systemic lupus erythematosus is a disease that is very rare in childhood, progressing with the production of widespread antibodies that the body should not normally produce. In lupus disease, the body develops antibodies against its own cells and damages its own organs. It is a chronic, incurable disease that can involve all organs of the body from head to toe, can have very serious effects, and can lead to severe disease-related complications.
The exact cause of lupus is unknown. There are two main types of the disease. Discoid lupus erythematosus, or DLE, does not affect vital internal organs but affects skin exposed to sunlight. Discoid (round) skin lesions usually leave scars on the skin after treatment. SLE, the much more severe form of the disease, can cause raised, butterfly-shaped rashes on the nose and cheeks that lead to skin scarring if left untreated. Along with the skin, SLE can affect the joints, muscles, lungs, heart, kidneys, brain, intestines—in short, all organs. The disease, which can cause infection or damage to these organs, is also known to cause depression and paralysis. The symptoms of the disease vary depending on the organs involved and the severity of the disease. It begins with redness on the skin, followed by joint involvement. Fever, fatigue, general malaise, a butterfly-shaped rash on the face, sensitivity to sunlight, joint pain and swelling, swollen lymph nodes, muscle aches, nausea, chest pain, and seizures are the most prominent symptoms of the disease. In lupus patients who may develop sores on their skin, especially on their fingers, susceptibility to Raynaud’s phenomenon—which prevents blood from reaching the hands and feet—also increases.
The diagnosis and treatment of systemic lupus erythematosus are carried out by rheumatologists, pediatric rheumatologists, internal medicine specialists, and dermatologists. In lupus disease, which flares up periodically and has no definitive cure, methods aimed at relieving symptoms and preventing flares are predominantly used. The foundation of treatment is to maintain the patient’s quality of life and minimize organ damage.
Dear Colleagues, in this article, I will share with you a formula prescribed in Spain for the treatment of skin lesions occurring in Lupus erythematosus. This formula also normalizes defective keratinization with its antiseptic, keratoplastic effect that supports the renewal of the stratum corneum of the epidermis and its mild irritant effect on the skin; it is used as a disinfectant in eczema, inflammatory dermatoses, burns, fungal infections, and nipple fissures.
The formula is also used in the treatment of erysipelas and psoriasis.
Formula:
Rp.
Ichthammol 5 g
Zinc oxide 10 g
Triamcinolone acetonide 50 mg
Oleo calcarea liniment ad 100 g
Substances in the formula:
Ichthammol- Ammonium sulfoichthyolate- Ichthammol (BAN; Ph. Eur. 4; JP XIII; USP 24; P.Cx.79; BP; INCI; FP):
Ichthammol is a liquid ranging in color from reddish-brown to black, with a strong and characteristic odor. Ichthammol exhibits a weak antiseptic effect due to the sulfur it contains in sulfone form. Its 10% ointments are used as a topical antiseptic in certain skin diseases such as eczema, furunculosis, psoriasis, and acne. It mainly consists of ammonium salts of sulfonic acids. According to the British Pharmacopoeia (BP), calculated on the dry basis, it should contain not less than 10.5% organically combined sulfur and not more than 25% total sulfur as sulfate. According to the United States Pharmacopeia (USP), it should contain not less than 10% total sulfur and not less than 2.5% ammonia. Solubility according to BP: Soluble in water; partially soluble in alcohol and ether. Solubility according to USP: Soluble in water 1:10; miscible with glycerin, fixed oils, and fats; partially soluble in alcohol and ether.
Zinc sulfate- Sulfate de zinc T.K.- Zinksulfat:
It forms colorless, prismatic crystals. Soluble in 0.66 parts water, 0.15 parts boiling water, and 23 parts glycerin. Insoluble in alcohol. Topically applied zinc exhibits astringent, weak antiseptic, and disinfectant effects. This effect is due to zinc ions precipitating proteins. It is bactericidal and fungicidal. Its 0.1%-1% solutions are used as ophthalmic antiseptics, and 4-5% solutions are used as skin antiseptics. It has a mild vasodilator effect. It does not exhibit decongestant activity. Zinc oxide is applied topically. Because it is insoluble in water, it is used as a skin antiseptic in the form of powder, ointment, or paste. Zinc oxide ointment contains 20% and zinc oxide paste contains 25% zinc oxide. Zinc oxide is not absorbed through the skin.
Triamcinolone acetonide- Triamcinoloni acetonidum [PhBs IV; Ph. Eur. 3]:
Triamcinolone acetonide is a white or cream-white, practically odorless, crystalline powder. 11 mg of triamcinolone acetonide is equivalent to approximately 10 mg of triamcinolone. Practically insoluble in water; slightly soluble in alcohol, chloroform, or methyl alcohol; very slightly soluble in ether. According to the British Pharmacopoeia (BP) and the United States Pharmacopeia (USP), the pH of the sterile suspension is between 5.0 and 7.5. Triamcinolone acetonide is a more potent derivative of triamcinolone. Triamcinolone and its derivatives are synthetic glucocorticoids used as anti-inflammatory and immunosuppressive agents. Although the exact antiallergic mechanism of corticosteroids is not fully known, they are known to be very effective against allergies. While triamcinolone itself has been determined to be approximately 2-3 times more potent than prednisone in animal models of inflammation, triamcinolone acetonide is 8 times more potent than prednisone. Triamcinolone exhibits very little mineralocorticoid activity and is therefore not used in the treatment of adrenal insufficiency unless administered with a more potent mineralocorticoid. Triamcinolone is available in oral, nasal, parenteral, topical, and aerosol forms.
Lime liniment- Linimentum calcicum- Liniment oleo calcaire T.K. (1954):
The preparation topically exhibits an emollient and soothing effect on inflamed surfaces. It is used to soften crusts and the skin in eczema and psoriasis. It is particularly used in burns and in the treatment of acute and subacute eczema.
Rp.
Olive oil 1 part
Lime water 1 part
Preparation of the formula:
Ichthammol is dissolved in lime water. Zinc oxide is added gradually to this liniment while shaking. Finally, the formula is completed with the addition of Triamcinolone acetonide. The preparation should be stored in an amber-colored glass bottle, and a “Shake well” label must be affixed to the bottle.
Wishing you a good week…
References:
1-La Formulación Magistral en la Oficina de Farmacia
2-RxMediaPharma®2019 Interactive Drug Information Resource
Specialist Pharmacist Ahmet Nezihi Pekcan
Pekcan Pharmacy – Konya
[email protected]
Tel: (332) 3520657
